Author(s): Mohammed Tikly (corresponding author) ; Paul McGill 
[illus. 1] Refers to Elshafie, A. I. et al . Active rheumatoid arthritis in Central Africa: a comparative study between Sudan and Sweden. J. Rheumatol. http://dx.doi.org/10.3899/jrheum.160303 (2016)
Africa, particularly sub-Saharan Africa, is one of the poorest regions in the world. Of the 30 countries in the world with the lowest overall life expectancy rates, 29 are in sub-Saharan Africa . Infections remain the leading cause of morbidity and mortality in the region . Accordingly, despite the increasing burden of non-communicable diseases such as type 2 diabetes mellitus and cardiovascular disease , most health budgets in sub-Saharan African countries prioritize the prevention and treatment of infectious diseases. Musculoskeletal diseases are rarely a direct cause of death, so are not considered a priority by health-care funding bodies in African nations -- an attitude that is in stark contrast to that of other nations, as illustrated by a comparison of patients with rheumatoid arthritis (RA) in Khartoum, Sudan and Gävle, Sweden .
The cross-sectional study by Elshafie et al .  highlights several interesting differences in demographic, clinical and serological features between the two ethnically and geographically distinct groups of patients. Sudanese patients with RA had higher levels of disease activity overall, but a lower rate of seropositivity than their counterparts from Sweden. More importantly in the broader context of clinical rheumatology, this study draws attention to some of the many challenges facing rheumatologists in Africa.
First, the revelation that only four rheumatologists, all based in the capital city of Khartoum , serve a population of over 40 million individuals in Sudan is a stark reminder of the acute shortage and poor distribution of rheumatologists in African countries. This situation reflects the generally rudimentary state of rheumatology services in sub-Saharan Africa, where at most 120 rheumatologists (the majority of whom are based in South Africa) presently serve 1 billion people -- well below the ideal ratio of one rheumatologist per 150,000 people . The reasons for this shortage of rheumatologists are manifold, including the general shortage of doctors on the continent, lack of government funding for specialist rheumatology posts, the limited number of local training programmes and the personal choice of junior doctors. A scarcity of modern diagnostic tools, unavailability of effective therapies (such as biologic agents) and poor remuneration are just some of the factors that discourage young physicians from pursuing a career in...
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