The Fifth Congress of the African League Against Rheumatism (AFLAR) was held in Nairobi, Kenya, from 18th to 22nd February 2007. Shortly after their arrival in Nairobi, delegates required little reminder of their presence in Africa. Many of the magnificent tall imposing giraffes from the Nairobi National Park were on hand to welcome delegates as they made their way from the airport to the city. The conference venue, the Hotel Intercontinental, is situated directly opposite the headquarters of the Kenyan government, the Parliament Buildings complex. The warmth and friendliness of the Kenyan people and the hospitality and efficiency of the organizing committee set the scene for a memorable congress.

The organizing committee for the conference, led by Dr J. Amolo Alouch, provided a forum for scientific deliberations by delegates from all over the world and succeeded in placing the care of patients with musculoskeletal disorders on the agenda of the Health Ministry and the Government of Kenya. The distinguished local dignitaries who participated in the various congress events included the Vice President of Kenya, Honorable A. Moody Awori, and the Director of Medical Services of the Ministry of Health, Dr James W. Nyikal, and the Head of International Relations for Kenya, Dr Ahmed Ogwell. Their presence and contributions provided testimony to the gratitude and support from the Kenyan government for the staging of this event in Nairobi. They acknowledged the importance of addressing the needs of patients with rheumatic disorders while focusing on the life threatening challenges posed by communicable diseases such as HIV infection, tuberculosis and malaria.

The Fifth AFLAR Congress was a historic event as there were participants from 15 countries in Africa, many of whom have only a few or no rheumatologists. The countries represented were Egypt, Ghana, Nigeria, Democratic Republic of Congo, Congo Brazzaville, Cameroon, Sudan, Uganda, Tanzania, Namibia, Botswana, Zimbabwe, South Africa, Zambia and Mauritius.

The conference proceedings included presentations by delegates from all parts of Africa and nearly 20 international delegates from North America, South America, Europe and Asia. International dignitaries and contributors included Professor Abraham Kutzbach, President of International League of Associations for Rheumatology (ILAR), Professor Tore Kvien, President of the European League Against Rheumatism (EULAR) and Professor Ho-Youn Kim, President-Elect of Asia Pacific League of Associations for Rheumatology (APLAR).

Professor Anthony Woolf delivered a keynote address on “The Global Burden of Musculoskeletal Conditions and the Need for Public Health Strategies” during the opening ceremony for the congress. He reported that the burden of musculoskeletal conditions has been recognized by the United Nations and World Bank by the endorsement of the Bone and Joint Decade 2000–2010. He provided statistics on the burden of the various forms of arthritis, low back pain, osteoporosis and musculoskeletal trauma. He noted that many of these conditions can be prevented or effectively treated and evidence-based strategies for their control have been developed.

The theme for the congress, “Rheumatology in Africa—Challenges and Opportunities,” was addressed by Professor Girish Mody, past president of AFLAR. He noted an opportunity to provide support to the small but gradually increasing number of dedicated rheumatologists, especially in Sub-Saharan Africa. The experience, skills and infrastructure associated with the programs for HIV and infectious diseases could be extended to rheumatic disorders and other non-communicable diseases.

Dr A Adebajo reviewed the spectrum of rheumatic disorders in Africans outside Africa. He drew attention to the effects of globalization and the recognition of various differences in ethnic minorities living in many of the developed nations of the world. Dr Paul McGill discussed tropical rheumatic diseases and focused attention on diseases such as leprosy, pyomyositis, fungal and parasitic infections and conditions such as fluorosis, which provided a challenge to clinicians involved in the evaluation and management of patients with rheumatic complaints. Professor Paul Davis, from Canada, reviewed the impact of technological development on education. He concluded that the sharing of educational resources across continents was not only desirable but also feasible and essential to meet the needs of under-resourced countries and educational institutions. Professor Anthony Woolf presented the recommendations of the Bone and Joint Decade Education Task Force on the minimum educational standards for musculoskeletal conditions and the need for their incorporation into the undergraduate medical curriculum.

EULAR sponsored a symposium on rheumatoid arthritis (RA) and arthritis in children. Professor Alan Silman reviewed the possible causes of RA based on an analysis of epidemiological data. He noted the variable contribution of environmental and genetic factors in individual patients and the possible role of the oral contraceptive pill, diet and lifestyle factors such as smoking. Professor Maxime Dougados discussed the parameters used for the assessment of disease activity in RA at various stages of the disease and current approaches to the assessment of outcome measures using various domains/instruments or composite indices. Professor Paul Emery noted that inflammation is bad, inflammation is treatable and that prolonged inflammation resulted in destruction. He presented data to show a better outcome in patients who were diagnosed and treated earlier and the identification of markers, which suggest the likelihood of persistent arthritis. Professor Tore Kvein presented an overview on the use of conventional disease-modifying anti-rheumatic drugs, including corticosteroids, in the management of RA. He acknowledged the need for modified strategies in resource-poor settings with a high prevalence of infection. The spectrum of arthritis in children and the importance of aggressive therapy were presented by Professor Roger Sturrock.

The conference also featured a symposium supported by a delegation from Glasgow. Professor Roger Sturrock discussed the role of ultrasonography in the evaluation of musculoskeletal disorders and suggested that it serves as an extension of the clinical examination. He illustrated a variety of rheumatic disorders in which ultrasonography contributed to diagnosis or assessment of the severity. In a separate presentation, he reviewed the assessment of disease activity and the current therapeutic approaches in the management of spondyloarthropathy. Dr Paul McGill reported their experience on the spectrum of spondyloarthropathy in association with HIV infection. Dr Hillary Wilson discussed the immunopathogenesis of psoriatic arthritis with a focus on the contributions of IL-17 and IL-18. Dr Ann McEntegart and Ms Elizabeth McIvor presented their follow up data on the Tight Control of Rheumatoid Arthritis (TIGORA) and Treatment of Early Active Rheumatoid Arthritis (TEAR) studies.

A workshop on Epidemiology was conducted by Professor Alan Silman. Dr Terry Gibson, from London, provided an update on the pathogenesis and management of gout. Professor Hans Rasker, from The Netherlands, reviewed the use of biologicals in conditions other than RA. In a separate presentation, he challenged the concept of fibromyalgia as a distinct entity. Professor Abraham Kutzbach presented reviews of idiopathic inflammatory myopathies and septic arthritis. Rajiv Dixit, from the USA, presented a practical approach to clinical evaluation and management of low back pain.

Papers relating to infections featured prominently during the congress. Presentations relating to HIV infection included the large studies undertaken by Panganani Njobvu in Zambia on the prevalence and characteristics of reactive arthritis, psoriatic arthritis and soft tissue lesions in association with HIV infection. Other presentations on HIV included a review from South Africa, which included HIV-associated arthritis in children (GM Mody), HIV-associated vasculitis in Kenya (A Otedo and GO Oyoo) and the musculoskeletal manifestations of HIV infection in Congo Brazzaville (H. Ntshiba). Observations related to tuberculosis included the findings of an increased prevalence of tuberculosis, especially osteoarticular tuberculosis, in patients with systemic lupus erythematosus (SLE; MTikly) and the occurrence of extra-pulmonary tuberculosis in patients with rheumatic diseases (GM Mody) in the absence of HIV infection and use of biological agents from South Africa. The spectrum of manifestations and management of a series of 140 patients with Pott’s diseases was reported from Congo Brazzaville (H.Ntshiba). The findings of a series of 176 patients with septic arthritis in Congo Brazzaville (H. Ntshiba) showed that Staphylococcus aureus and tuberculosis were among the organisms that were more commonly identified on culture.

Studies on psoriatic arthritis were reported from Congo Brazzaville (H. Ntshiba), South Africa (AA.Kalla) and Egypt (AM Abdel-Nasser). The only African Community Oriented Program for Control of Rheumatic Diseases (COPCORD) RA study to date was reported from Egypt. (AM Abdel-Nasser). Other studies on RA included the auto-antibodies in early RA (M.Tikly), role of anti-cyclic citrullinated peptide antibodies in RA (AM Abdel-Nasser) and review of RA in Nigeria (F Adelowo). Genetic studies in RA included the finding of a lower gene frequency of HLA DR4 in the Congolese (JM Mbuyi-Muamba) and that polymorphisms of the IL-1 gene cluster served as markers for disease severity in Black South Africans with RA (M Tikly). Studies on SLE included a survey of the association of anti-ribosomal P protein antibodies with neuropsychiatric and other manifestations (AM Abdel-Nasser), neurolupus in Kenya (JO Jowi), the clinical and serological correlations of anti-nucleosome antibody (AA Kalla), the profile of lupus pericarditis in Cameroon (M. Singwe-Ngandeu) and ophthalmologic considerations in SLE (M Mazur). Presentations on osteoporosis included a review of osteoporosis in Africa (AA Kalla), biochemical markers of bone turnover in Congolese post-menopausal women (JM Mbuyi-Muamba), a review of the risk factors for fracture (P McGill) and evaluation of the impact of the location of an osteoporosis awareness poster (A Juby).

A multi-disciplinary session presentations on depression in RA (AM Abdel-Nasser), role of the rheumatology nurse specialist (EM McIvor), effect of an occupational therapy intervention programme in RA (CA du Plessis), a clinical audit of podiatric interventions (EAM Clarke), and a quality of life evaluation in Nairobi (BA Owino).

Prof A D Woolf and Dr Terry Gibson conducted a clinical skills workshop for 60 post-graduate students in internal medicine at the School of Medicine, University of Nairobi. The students greatly appreciated the opportunity to have practical demonstrations from renowned rheumatologists. The president of the International League of Associations for Rheumatology, Prof Abraham Kutzbach, addressed a well-attended public lecture in Nairobi. The theme of the lecture was “Living with Arthritis,” and the presentation stimulated active participation by the audience.

A poster session was introduced for the first time at an AFLAR congress and generated considerable interest on the various topics, which were reported.

The quality of the scientific programme, the collegiality among the delegates, an entertaining social programme featuring African song and dance and the hospitality of the Kenyan people made this conference a memorable one for all the participants. The Fifth AFLAR Congress will hopefully stimulate further growth and development of rheumatology in Africa.