African Journal of Rheumatology The journal aims to publish papers on basic and clinical research in rheumatology and be a vessel of sharing knowledge across the globe. Original research work, reviews, case reports and other relevant scientific work will be published in the journal. The readers of the journal are mainly practicing rheumatologists, researchers, physicians, surgeons and other practitioners (nurses, clinical officers etc) involved in rheumatology and arthritis management. African League of Associations for Rheumatology (AFLAR) en-US African Journal of Rheumatology 2307-2482 Copyright belongs to the journal. Fibromyalgia: Reviewing the epidemiology and gender-based differences in Africa <p><strong>Objectives:</strong> Fibromyalgia is a complex disorder which presents with chronic widespread musculoskeletal pain, together with other symptoms like fatigue, sleep disturbances and cognitive disturbance. The cause remains unclear but it is postulated that there are abnormalities in neurohormonal profile and central sensitization to pain as the main mechanism. It is known to occur more commonly in females than males. This study set out to look at these differences in terms of epidemiology and gender differences.</p> <p><strong>Data source:</strong> We conducted online and public library searches using the English language.</p> <p><strong>Data extraction:</strong> We reviewed several papers and research work focusing on epidemiology and differences in gender presentation. The period of the search was between the years 1990 up to 2020.</p> <p><strong>Conclusion:</strong> Fibromyalgia is a commonly occurring rheumatologic condition. Gender differences exist with regard to epidemiology, clinical presentation and health seeking behaviors. Population based studies would be of use to establish the prevalence in Africa. More studies would be necessary to explain the gender differences noted in the many aspects of the disease including response to treatment.</p> N.M. Mumo G.O. Oyoo Copyright (c) 2021-04-05 2021-04-05 9 1 3 7 Prevalence and spectrum of rheumatic and musculoskeletal diseases in a Lagos hospital community: An under-reported non-communicable disease in Africa <p><strong>Background:</strong> Rheumatic and Musculo-skeletal Diseases (RMDs) previously known as the musculoskeletal (MSK) diseases are a major cause of chronic pain and functional disability. While there are few hospital based reports of RMDs and its individual conditions in Nigeria, community data of these conditions are even rarer.</p> <p><strong>Objectives:</strong> To determine the prevalence and spectrum of RMDs as well as the factors associated with MSK pain in Nigeria.</p> <p><strong>Design:</strong> This was a cross-sectional survey of staff and patients’ relatives at a Lagos tertiary hospital.</p> <p><strong>Methods:</strong> We prospectively collected data on 350 respondents using a pre-tested interviewer-based study questionnaire and the Health Assessment Questionnaire-Disability Index (HAQ-D1) questionnaire. Clinical information was recorded and laboratory tests done for all participants. Data was analysed with descriptive statistics using Statistical Package for Social Sciences (SPSS) version 21. Ethical approval was obtained for the study.</p> <p><strong>Results:</strong> A total of 268 (76.6%) respondents completed the study comprising 176 (65.7%) females and 92 (34.3%) males with a mean age of 57.3±12.4 years (range 20-70 years). RMDs and MSK pain (current/past) were diagnosed in 59 (22%) and 162 (60.4%) respondents respectively most of whom were female (n=38, 64%) and middle aged (n=31, 52.5%). Osteoarthritis (25.5%), limited joint mobility (18.6%), lumbosacral spondylosis (10.1%) and DeQuervain’s tenosynovitis (10.1%) were the most frequent RMDs. The median HAQ-DI was 0.8 (IQR 0.1-1.8) with significant disability (HAQ-DI≥1) in 57.5% of the subjects with RMDs. Respondents with MSK pain had higher proportions of truncal obesity (BMI&gt;30) (n=89, 54.9%, p=0.016), family history of arthritis (n=93, 57.4%, p=0.001), abdominal obesity (n=97, 60%, p=0.002), hypertension (n=102, 63%, p=0.001), elevated acute phase reactants (n=57, 35.2%, p=0.003) and hyperuricemia (n=61, 37.6%, p=0.001) than respondents without MSK pain with no significant predictors of MSK pain documented after multivariate regression analysis.</p> <p><strong>Conclusions:</strong> RMDs and MSK pain are common among Nigerians occurring in 22% and 60.4% respectively resulting in significant functional disability. Osteoarthritis was the most frequent presentation of MSK pain while obesity, hypertension, hyperuricaemia, positive family history of arthritis and elevated acute phase reactants were all associated with MSK pain.</p> H. Olaosebikan A.A. Akpabio A. Awesu O. Adelowo Copyright (c) 2021-04-05 2021-04-05 9 1 8 14 Factors associated with extra-articular manifestations of rheumatoid arthritis in Abidjan, Côte d’Ivoire <p><strong>Objective:</strong> The aim of this study was to identify factors associated with extra-articular manifestations of rheumatoid polyarthritis in Abidjan, Côte d'Ivoire.</p> <p><strong>Design:</strong> A descriptive and analytical retrospective study.</p> <p><strong>Methods:</strong> The study was conducted at the Rheumatology Department of Cocody’s University Teaching Hospital in Abidjan from January 2009 to December 2018. The study participants were 106 patients with rheumatoid arthritis diagnosed on the basis of ACR 1987 and ACR/EULAR 2010 criteria, with extra articular manifestations.</p> <p><strong>Results:</strong> The study included 129 cases of rheumatoid polyarthritis and 106 of them had extra-articular manifestations. The hospital frequency of extra-articular manifestations in rheumatoid arthritis was 82.17%. Our sample population were 92 females (86.79%) and 14 males (13.21%) with an average age of 44.69 years. The average duration of disease progression was 62.36 months. Extra-articular manifestations observed were largely dominated by general signs (83.86%) and haematological manifestations (78%). Other cases included rheumatoid nodules (10%), abarticular manifestations (7.62%) and dry syndrome in 8.70% of cases. Visceral manifestations were cardiovascular (3.77%), neurological (1.89%) and pulmonary in 1% of cases. Only articular deformities (OR=2.4; IC 95% = [1.4-6.3]; P=0.03) were significantly associated to the presence of extra-articular manifestations.</p> <p><strong>Conclusions:</strong> Extra-articular manifestations are very common during the rheumatoid arthritis in Abidjan. Joint deformities are the major factors significantly associated to the presence of extra-articular manifestations.</p> M. Diomandé Y.N.C Kpami A. Bamba A. Traoré G.L. Kengni S.M. Taganga Y. Coulibaly A.K. Coulibaly K.J.M. Djaha M. Gbané B. Ouattara J.C. Daboiko E. Eti Copyright (c) 2021-04-05 2021-04-05 9 1 15 18 Ocular manifestations in chronic inflammatory rheumatism <p><strong>Objective:</strong> To contribute to the study of the characteristics of Chronic Inflammatory Rheumatism (RIC) in Guinea.</p> <p><strong>Design:</strong> Cross-sectional study.</p> <p><strong>Methods:</strong> The study was carried out over a period of nine months on patients with chronic inflammatory rheumatism and the ocular manifestations.</p> <p><strong>Results:</strong> The study population consisted of 28 patients including 10 men and 18 women, the mean age was 39.07 ± 16.04 years. The different types of rheumatism encountered were: rheumatoid arthritis (n=18), ankylosing spondylitis (n=8) systemic lupus erythematosus (n=1), juvenile idiopathic arthritis (n=1). All patients presented with ocular manifestations (100%): sicca syndrome (n=24), allergic conjunctivitis (n=5), ametropia (n=5), cataract (n=3), anterior uveitis (n=3), episcleritis (n=1), keratitis (n=1) and glaucoma (n=1).</p> <p><strong>Conclusion:</strong> Ocular manifestations during inflammatory rheumatism are frequent, the sicca syndrome was dominant.</p> A.I. Balde A.B. Kamissoko E. Yombouno M. Awada Copyright (c) 2021-04-05 2021-04-05 9 1 19 22 Profiles of vitamin D among patients with rheumatoid arthritis at the Kenyatta National Hospital <p><strong>Background:</strong> Rheumatoid Arthritis (RA) is an autoimmune, chronic debilitating condition of undetermined cause. It affects numerous extra-articular organ systems. Vitamin D is a steroid hormone synthesized in the skin by the action of ultraviolet B (UVB) irradiation. Active vitamin D is important in the inhibition of T cell proliferation and down-regulation of key inflammatory cytokines responsible for the pathogenesis of RA. There is growing evidence demonstrating the association between vitamin D insufficiency and higher incidence of RA as well as increased severity of disease and increased functional disability in RA patients.</p> <p><strong>Objective:</strong> The purpose of this study was to determine serum vitamin D levels among patients with rheumatoid arthritis at the Kenyatta National Hospital (KNH) and its association with disease activity and functional disability.</p> <p><strong>Design:</strong> This was a descriptive cross-sectional survey.</p> <p><strong>Methods:</strong> The study involved subjects with RA at the Kenyatta National Hospital. Consecutive sampling technique to recruit patients with rheumatoid arthritis, having met the 2010 American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) classification criteria was selected. Ten mls of peripheral blood was collected from the recruited subjects to determine serum vitamin D levels. Every participant had their demographics, clinical history and disease duration documented. Clinical Disease Activity Index (CDAI) was used to assess disease activity and severity. It comprised of number of tender joint out of 28 joints (T-28), number of swollen joints out of 28 (S-28) global health assessment score by both the physician and the patient. Level of disability was determined by the standard Modified Health Assessment Questionnaire (MHAQ). Data analyzed was correlated to determine their association with serum vitamin D levels. SPSS version 21 was used to analyze the data collected and this entailed descriptive statistics, chi-square, ANOVA and students’-test to compare and correlate vitamin D levels with age, duration of disease, CDAI score and modified HAQ score in RA.</p> <p><strong>Results:</strong> Eighty one patients with a mean age of 48.7 (SD 13.9), median of 48.0 (IQR 40.0-59.0) were evaluated. The female to male ratio was 4:1. The mean serum 25-VD concentration was 34.9ng/ml (SD11.6). Thirty five participants (43.2%) had insufficient vitamin D levels (&lt;30ng/ml), whereas 46 study participants (56.8%) had sufficiency of vitamin D. Majority of the patients 54 (67.5%) had low disease activity. Fourteen subjects 17.5% had high disease activity and while 2.5% were on remission. Functional disability was assessed using the modified health assessment questionnaire. Thirty eight participants (46.5%) demonstrated no disability, 33.8% had mild disability while 9% had severe disability. Correlation between vitamin levels with age, duration of disease, CDAI and HAQ did not attain statistical significance.</p> <p><strong>Conclusion:</strong> Vitamin D insufficiency is high among patients with rheumatoid arthritis with no correlation with age, duration of disease, functional disability and disease activity.</p> S. Aradi G.O. Oyoo E. Amayo J. Kayima Copyright (c) 2021-04-05 2021-04-05 9 1 23 27 A prospective cohort of gouty arthritis patients presenting with hyperuricemia and chronic kidney disease stage 3 and 4 for the safety, efficacy and renal effect of febuxostat at Changhai Hospital, Shanghai, China <p><strong>Background:</strong> Hyperuricemia (HU) is a risk factor for the onset of Chronic Kidney Disease (CKD) and accumulating evidence significantly associates it with disease progression. A major challenge in treating hyperuricemia with traditional Urate-Lowering Drugs (ULDs) are the adverse effects associated with the accumulation of these drugs or their metabolites in CKD patients. Due to these unwanted effects, doses of ULDs are down-regulated to levels commensurate with the kidneys’ ability to excrete their metabolites. This leads to suboptimal efficacy. Febuxostat, a selective Xanthine Oxidase (XO) inhibitor has demonstrated high efficacy in reducing Serum Uric Acid (SUA) levels and is well tolerated in mild kidney disease. However, its efficacy, safety and renal effects have not been studied in patients with advanced kidney disease, hyperuricemia and gout.</p> <p><strong>Objective:</strong> To evaluate the safety, efficacy and renal effects of febuxostat in patients with HU, gout and CKD stage 3 and 4.</p> <p><strong>Design:</strong> This was a 16-week prospective study, single-center, open-label, self-controlled trial.</p> <p><strong>Methods:</strong> Thirty five patients included received febuxostat 40mg/day. Changes in kidney function tests; SUA levels; liver function tests and full blood count were evaluated. Gout was diagnosed based on 2015 ACR/EULAR criteria, and GFR was estimated using the MDRD formula.</p> <p><strong>Results:</strong> Febuxostat decreased SUA levels to a target &lt;360micromol/L for uncomplicated gout in 5 (36%), n=14, and SUA decreased to a target &lt;300micromol/L for complicated gout in 5 (24%), n=21. Changes in eGFR and SUA were statistically significant, with p=0.001 for both at 95% confidence interval. Mean absolute eGFR from baseline to week 16 represented 9.04 ml/min (19.05%), and was attributed to febuxostat (R2 = 0.9556, 96%). Changes in LFTs and full blood count were insignificant. No drug-related AE were reported.</p> <p><strong>Conclusion:</strong> Febuxostat, as a ULD was safe and effective in controlling SUA levels in patients with gout, hyperuricemia and CKD stage 3 and 4. The drug also exerted renoprotective effects in this patient group. The reduction in SUA by febuxostat was associated with improvement in eGFR and overall kidney function, although a causal relationship wasn’t evaluated in this study.</p> A. Lwando D. Zhao B.C. Chiluba Copyright (c) 2021-04-05 2021-04-05 9 1 28 36 Treatment of chronic inflammatory joint disease in Zanzibar: Impact of the Covid-19 pandemic <p><strong>Background:</strong> The Covid-19 pandemic has had a major impact on economies and health globally. It has also affected the availability of drugs such as hydroxychloroquine, commonly used in rheumatic disorders.</p> <p><strong>Objective:</strong> The aim of this study was to describe the impact of the Covid-19 pandemic among patients with chronic inflammatory joint disease.</p> <p><strong>Methods:</strong> A study on chronic inflammatory joint disease in Zanzibar was undertaken in July 2019 and is ongoing. So far, 38 participants have been recruited and were included in the present study. These participants were contacted for phone interview regarding information on self-reported disease activity, joint pain and swelling. Patients were also asked about adherence to medication, Covid-19 symptoms, household expenditure and quality of life during the pandemic.</p> <p><strong>Results:</strong> At baseline, 38 patients, mostly females (92%), had been enrolled. The mean age was 45 years and mean disease duration was 3.5 years. Majority had moderate and severe disease activity (58%). For this study, 33 patients were reached for interview. The majority reported joint pain (91%) and swelling (52%). Twenty four (73%) noted their disease activity to be better than before joining the ongoing study. Only 13 (39%) reported symptoms of Covid-19. Adherence was generally lower during the pandemic (52%) compared to baseline (58%) although this was not statistically significant. About a third of participants were unable to quantify their expenditure. Of the remainder, 13 (39%) participants reported a decrease.</p> <p><strong>Conclusion:</strong> The pandemic had a negative impact on patients due to lack of funds to purchase drugs and unavailability of drugs such as hydroxychloroquine which is cheaper compared to alternatives. We believe that the overall improvement in disease activity may be attributed to management that had been commenced prior to the pandemic.</p> S.S. Said T.W. Nystad C.F. Aas K. Johansson B.T. Fevang Copyright (c) 2021-04-05 2021-04-05 9 1 37 42 Editorial: Emerging value of stem cell therapy in rheumatic diseases <p>No Abstract.</p> T.A. Gheita S.A. Kenawy Copyright (c) 2021-04-05 2021-04-05 9 1 1 2 Clinical and radiological features of neuropsychiatric systemic lupus erythematosus: Case series from East Africa <p>Neurological and psychiatric manifestations of Systemic Lupus Erythematosus (NPSLE) are clinically diverse, may occur early in the disease, and can be the first manifesting symptom. A high index of suspicion is thus required in such cases to allow timely diagnosis and appropriate treatment in order to avoid irreversible damage of the brain. Magnetic Resonance Imaging (MRI) may offer a diagnostic clue, and several patterns have been described in the literature. We present here a series of cases of NPSLE with index neurological symptoms and uncommon MRI brain findings: diffuse white matter changes, optic tract signal change, slow dural venous sinus flow, and large non-dominant hemisphere stroke. The diagnosis of NPSLE was missed in the initial presentations, but was only made when the clinical picture, these MRI features and laboratory findings were put together for each case. Our case series highlight the broad spectrum of neurological manifestations and MRI brain scan findings in NPSLE.</p> J. Rakiro F. Otieno D. Sokhi Copyright (c) 2021-04-05 2021-04-05 9 1 43 50 A dual diagnosis of skeletal tuberculosis and sarcoidosis: Case report <p>Tuberculosis (TB) is a common granulomatous infection in South Africa. The prevalence of TB and the extent of multi-system involvement have escalated since the advent of the HIV pandemic in the 1980’s. The combination of TB and sarcoidosis is an uncommon concomitant diagnosis but has been described in the literature in multiple different contexts. We report the first known case of multisystem tuberculosis and sarcoidosis with multifocal skeletal lesions in a patient with complicated diabetes mellitus. We anticipate increasing the index of suspicion among clinicians of such a potential combination, especially in a population with impaired immunity such as in individuals with poorly controlled diabetes mellitus.</p> S. Ntshalintshali A. Coetzee F. Moosajee R. Abousriwiel M. Conradie R. du Toit Copyright (c) 2021-04-05 2021-04-05 9 1 51 55