African Journal of Rheumatology

Rheumatology in Mauritius: challenges and opportunities

2024-01-15T11:50:05+00:00

No abstract.

Possible juvenile dermatomyositis in a 7-year-old Nigerian girl: a case report

2024-01-15T12:19:06+00:00

Juvenile Dermatomyositis (JDM) is a systemic autoimmune disease that presents in children before their 16th birthday. Although the skin is the most obvious organ affected, it also affects the skeletal muscles, the lungs, the gastrointestinal system and the heart. The paucity of rheumatologists, especially paediatric rheumatologists, and dermatologists in Nigeria results in delayed identification and management. This is a case report of a 7-year-old Nigerian girl who presented with clinical and laboratory features of possible juvenile dermatomyositis. Limitations encountered during management of this patient were the absence of electromyogram and muscle biopsy for histology. It is the hope of the authors that this case will heighten the index of suspicion and add to the growing literature of JDM in Nigeria and Africa at large.

Anti-SRP myopathy, a rare form of necrotizing myopathy in an adult Nigerian female: a case report and literature review

2024-01-15T12:22:14+00:00

Anti-Signal Recognition Particle (SRP) myopathy is a rare form of Immune-Mediated Necrotizing Myopathy (IMNM). The IMNM is characterized by acute to sub-acute progressive severe symmetrical proximal myopathy with markedly elevated muscle enzymes. They have a variable response to steroids and immunosuppressive drugs. There are no sufficient data in African literature regarding this form of myopathy but rituximab has been used in refractory cases.We report a rare case of anti-SRP immune-mediated necrotizing myopathy in a 29-year-old Nigerian female with typical clinical, biochemical, and serologic features. A 29-year-old black African female presented with features of bilateral symmetrical severe progressive proximal muscle weakness of upper and lower limbs. She had no features of organspecific manifestations. Drug causes of myopathy and other connective tissue diseases were excluded. Creatine kinase was markedly elevated (18824 u/L) with positive anti-SRP antibody. She received IV methylprednisolone pulses over three days, oral prednisolone at 30mg daily, and IV rituximab weekly for initial 4 weeks and 6 monthly after unresponsiveness to azathioprine. Although initially bedridden, her symptoms improved over a few weeks of treatment as she can ambulate with support. She returned to working as a chef after 2nd course of rituximab at 6 months. Anti-SRP myopathy is a rare form of necrotizing myopathy with a variable response to steroids and immunosuppressive medications.

Primary antiphospholipid syndrome with multiple organ involvement: case report

2024-01-15T12:26:17+00:00

Antiphospholipid syndrome is a systemic autoimmune disease, characterized by the occurrence of venous and arterial thrombosis, and the detection of circulating antiphospholipid antibodies. Thrombosis mainly affect the deep veins and cerebral circulation, but can also occur in other sites such as visceral arteries, cerebral venous sinuses, and micro vessels in the lungs, heart and eyes. This is a case of a 32 year old African male with AntiPhospholipid Syndrome (APS) presenting with multiple organ involvement-left central retinal artery occlusion, right MCA infarct, superior mesenteric artery thrombosis with multiple splenic infarcts, and severe aortic regurgitation with heart failure.

Prevalence, burden and determinants of low back pain: a survey of medical specialization trainees in Cameroon, sub- Saharan Africa

2024-01-15T11:53:21+00:00

Background: Trainees in medical specialization are a vulnerable group for Low Back Pain (LBP). However, studies on this subject in sub-Saharan Africa are scarce.
Objective: The aim of this study was to investigate the epidemiological burden of low back pain in Cameroonian trainees in medical specialization.
Methods: From August 1st to 24th, 2023, we conducted a cross-sectional study in medical specializing trainees in Cameroon, using a self-administered online questionnaire. Factors associated with LBP are presented with the odds ratio (OR) and its 95% confidence interval.
Results: Three hundred and six participants (55.6% females, aged 31.14 (2.96) years) filled the questionnaire. LBP affected 110 (35.9%) and 218 (71.2%) respectively before and after the beginning of the specialization. Six (2.7%) were severe cases, and 53 (24.3%) reported adverse outcome on their training. The main determinants of LBP directly related the specialization as reported by trainees were insufficient ergonomic measures (103; 47.2%), prolonged standing (137; 62.8%) and heavy workload (69; 31.6%). In statistical analysis, we found a significant association with female gender (OR: 1.89 [1.14; 3.12]), history of low back pain prior to specialization (OR: 15.42 [6.02; 39.52]), and BMI ≥30kg/m² (OR: 3.48 [1.19; 10.17]).
Conclusion: The trend in prevalence of low back pain is considerable with specialization in Cameroon. The authorities responsible for medical specialization schools are urged to implement preventive measures to tackle this potentially detrimental burden for their trainees.

Prevalence and associated risk factors of metabolic syndrome among rheumatoid arthritis patients attending a tertiary teaching hospital in Nairobi, Kenya

2024-01-15T12:00:58+00:00

Background: Rheumatoid Arthritis (RA) predisposes afflicted patients to an increased risk of metabolic syndrome and cardiovascular disease. The prevalence of metabolic syndrome in RA has variably been reported in different populations.
Objective: To determine the prevalence, and associated risk factors, of Metabolic Syndrome (METS) among RA patients.
Methods: Following ethical approval, 127 patients with established RA were recruited. The following parameters were obtained/calculated for further analysis: patients’ demographics, biochemical parameters, waist circumference, BMI and ten-year ASCVD risk. Presence of metabolic syndrome was ascertained as per guidelines. Appraisal of patient and disease features between patients with and those without metabolic syndrome was carried out using the Independent Student’s t and Chi-square tests. Logistic regression was performed to estimate the impact of moderator variables, adjusting for age, sex and baseline characteristics. Throughout the analysis, a p<0.05 was considered statistically significant at a 95% CI.
Results: The mean age of the participants was 51.48±15.7 years while age at diagnosis was 43.29±13.81 years. Median duration of treatment was 6.65 years. Eighty-three patients (65.4%) had a waist circumference above the set cut off, 74 (58.26%) were overweight, 68 (53.5%) were hypertensive, 18 (14.2%) were diabetic while 38 (29.9%) patients had dyslipidaemia. Twenty-seven (21.26%) patients met the criteria for METS. A majority (55.12%) had advanced disease activity. Of the 97 patients aged above 40 years, 52.58% had advanced Cardiovascular Disease (CVD) scores. Univariate analysis, age at diagnosis (OR= 1.07, p<0.001), disease duration (OR= 1.08, p=0.004), disease activity (OR= 1.76, p=0.004), elevated CRP (OR= 1.01, p=0.021) and steroid use (OR= 2.90, p=0.018) were associated with METS.
Conclusion: Metabolic syndrome and its components are highly prevalent and there was sub-optimisation of many of the modifiable risk factors.

Clinical profile of lupus erythematosus in Nigerian males

2024-01-15T12:06:15+00:00

Background: Systemic Lupus Erythematosus (SLE) is a sexually dimorphic chronic autoimmune inflammatory disease affecting multiple organs, characterized by production of autoantibodies against nuclear and cytoplasmic antigens. Like other autoimmune conditions, SLE is more prevalent in females of childbearing age, and very rare in males. Recent evidence implicated the presence of higher genetic risk loads in men. There is strong evidence supporting the contribution of X-linked Toll-like receptor 7 (TLR7) gene polymorphism to the development of SLE with a stronger effect in males than females.
Objective: This study describes the demographic traits, potential risk factors, clinical and laboratory profiles of male lupus patients. The second part is a review of the literature to document the demographic characteristics, possible protective and predisposing
factors, pathophysiology and peculiar characteristics.
Methods: We document findings in the five males who presented with SLE (from a cohort of 108 SLE patients) who presented between May 2015 and June 2017.The second part involved a review of the literature on SLE in males to document the demographic characteristics, possible protective and predisposing factors, pathophysiology and peculiar characteristics. The review involved a literature search using PubMed, Medline, Google Scholar, Africa-wide NiPAD and African Journal online.
Results: Most males with SLE present in the third and fourth decades of life. The most common clinical findings are on the skin, joints, renal and haematology systems. Cutaneous lesions include acute utaneous lupus like malar rash; and chronic cutaneous lupus, ssociated with hair affectation (non-scarring alopecia). Others include serositis (pericardial effusion); renal impairment leading to chronic kidney disease; neuropsychiatric and haematologic (lymphopaenia) features; and positive serology: elevated antinuclear antibody (values from 1/320 to 1/640), raised anti double-stranded DNA, anti SmAb and low complement level.
Conclusions: Males and females both have the classic lupus symptoms, but other clinical characteristics such as a later onset, a more severe form of the disease, and prognosis appear in males.

Clinical spectrum of Behcet's disease among patients seen at the tertiary rheumatology clinic

2024-01-15T12:15:22+00:00

Background: Behcet’s Disease (BD) is a variable vessel vasculitis with heterogeneous clinical features. Although BD occurs worldwide, it is more common in populations along the Old Silk Road, stretching between the Mediterranean basin, the Middle East and Far East. The prevalence of BD is usually higher in populations with the highest frequency of HLA-B51. Although classical manifestations are mucocutaneous lesions, arthritis and uveitis, it can also affect vessels, nervous system and the gastrointestinal tract.
Objectives: The aim of the research was to study the presentations of Behcet's Disease (BD) in the Saudi population and to determine any differences in clinical manifestations between men and women.
Methods: This was a prospective study involving 16 BD patients seen at the outpatient rheumatology clinic of King Abdul-Azeez Specialist Hospital, Sakaka, Saudi Arabia. They were reviewed to analyze the frequency of different disease manifestations.
Results: Sixteen patients with diagnosis of BD were identified among 840 patients seen in the out-patient clinic. They were mainly Saudi indigenes. All the 16 Saudi indigenes with Behcet’s disease satisfied the International Study Group (ISG) criteria and allowed us to obtain a prevalence rate of 1.9%. Twelve men and four women were diagnosed as Behcet’s patients, with a mean age of 29 ± 3 years. The median duration of disease at presentation was 4 years (range 1–7 ears). Mucocutaneous manifestations were present in all the 16 (100%) patients, ocular manifestations in 7 (43.75%) patients, vascular manifestations in 5 (31.25%) patients, and neurological manifestations in 3 (18.75%) patients.
Conclusion: Behcet’s disease among the Saudi population was found not to be an aggressive disease. Ocular complications are mild and responded well to treatment.

Surveillance and management strategies for lupus nephritis: A practical summary guide for clinical settings lacking specialist care and expert histopathology

2024-01-15T12:29:07+00:00

Lupus nephritis may be the presenting feature of Systemic Lupus Erythematosus (SLE) and is often an early complication of the disease affecting up to half of patients with SLE. It is a major cause of morbidity and mortality. It is typically heralded by the silent onset of proteinuria, then may progress to a clinically evident edematous state with hypertension and renal impairment. The overarching goals of treatment of lupus nephritis include patient survival, preservation of kidney function, prevention of disease flares and organ damage, management of comorbidities, and improvements in disease-related quality of life. Management of active lupus nephritis should include an initial period of intense immunosuppressive therapy (induction) followed by a longer period of maintenance therapy. In the English-speaking Caribbean, as in many developing states, the lack of specialists results in non-specialists having to manage cases of lupus nephritis often with limited resources and guidance. We proffer a 14-step approach which highlights key issues and allows the novice doctor to gain some level of comfort and confidence when faced with the daunting task of having to function as a combined nephrologist/rheumatologist and assume responsibility for care of patients with this most challenging condition. It begins with case ascertainment by formal screening and home testing for proteinuria and continues with guides to the more widely available immunosuppressive therapy and addresses supportive care including a guide to effective blood pressure control.