African Journal of Rheumatology

Challenging seronegative arthritis and rheumatic manifestations of syphilis: A case-based review of the great imitator

Thu, 03 Aug 2023 00:00:00 +0000

Syphilis can have varied presentations, including rheumatological and ocular. Early recognition and treatment are necessary to prevent permanent complications. A 34-year-old married male presented with symmetric seronegative arthritis, diagnosed as rheumatoid arthritis, and not responding initially to corticosteroids and Disease-Modifying Anti-Rheumatic Drugs (DMRADs) but eventually resolved. It was followed by amaurosis fugax that lasted for three days. Magnetic Resonance Imaging (MRI) of the brain and spinal cord were normal. Aquaporin-4 antibodies were negative. Anticardiolipin IgM (55 U/ml), IgG (50.8 U/ml) and β-2 glycoprotein-I (68.6 U/ml) were positive, justifying anticoagulation. This was followed by recurrent attacks of diminution of vision and floaters in both eyes; Slit lamp examination and fluorescein angiography revealed posterior uveitis, bilateral vasculitis with leaking discs, cystoid macular edema and peripheral ischemia. He had no orogenital ulcers, lymphadenopathy, skin rashes or sicca manifestations. A serological panel of investigations for infection revealed positive Rapid Plasma Regain (RPR) (1:128), Venereal Disease Research Laboratory (VDRL) and Treponema Pallidum Hemagglutination Assay (TPHA), highly suggestive of syphilis. The patient was treated with ceftriaxone with dramatic improvement. On follow-up, the uveitis resolved with persistent peripheral ischemia, Optic Coherence Tomography (OCT) revealed bilateral dry macula, the serology and antiphospholipids dropped and tended to normalize. Syphilis may atypically present with symmetrical seronegative polyarthritis, posterior uveitis, retinal vasculitis, optic neuritis and associated positive antiphospholipid antibodies. This case contributes to increase the awareness of rheumatologists and ophthalmologists regarding the confusing clinical aspects of this great mimicking disease, syphilis.

From occupational asthma to pulmonary tuberculosis to systemic sclerosis sine scleroderma: A case report

EE Aigbokhan , MI Agun-Ebreme , II Omoaghe, A. Mamudu , L Ojiaku — Thu, 03 Aug 2023 00:00:00 +0000

Systemic sclerosis is a chronic multisystem autoimmune disease of unknown cause that affects the skin and internal organs of the body. It occurs worldwide but has racial and ethnic differences in terms of presentation, blacks tend to have a more diffuse cutaneous presentation. Although genetics plays a significant role in its occurrence, environmental factors including exposure to silica dust, radiation, adulterated rapeseed oil and drugs like bleomycin have also been implicated. It is characterized by progressive fibrosis of the skin and internal organs which is often preceded by inflammation and vasculopathy. We present a case of a 34-year-old poultry farmer who presented with systemic sclerosis sine scleroderma who had initially been misdiagnosed as having occupational asthma and was already on treatment for pulmonary tuberculosis.

The management of psoriatic arthritis in Africa

AB Maharaj , A Ajibade , AO Adebajo — Thu, 03 Aug 2023 00:00:00 +0000

No abstract

Prevalence and impact of fibromyalgia in patients with systemic lupus erythematosus at the Kenyatta National Hospital, Nairobi, Kenya

SS Awadh , GO Oyoo , EK Genga — Thu, 03 Aug 2023 00:00:00 +0000

Background: Fibromyalgia is an increasingly recognized medical disorder that presents with chronic widespread musculoskeletal pain, fatigue, and poor sleep. The aetiology remains unknown, but it has been described in association with other rheumatological diseases. The overlapping symptoms of lupus and fibromyalgia can lead to misinterpretation of lupus activity and risk of overtreatment. No studies of this association have been held in the black African population, bearing in mind the nature of the influence of chronic disorders on quality of life and disease activity. Understanding the nature of this association in our population may contribute to this discussion.
Objectives: To determine the prevalence and impact of fibromyalgia in patients with Systemic Lupus Erythematosus (SLE) attending the rheumatology clinic at the Kenyatta National Hospital (KNH).
Methodology: This was a cross-sectional descriptive study of SLE patients attending a rheumatology clinic at the KNH. All the SLE patients with chronic musculoskeletal pain were screened for fibromyalgia using the revised 2010 ACR criteria. The study tools included the study proforma, the FIQR, SF-36, and SLEDAI-2K; which were used to assess the severity and the impact of fibromyalgia on the quality of life, and disease activity of lupus respectively.
Results: Sixty patients with SLE were recruited into the study, all female with a mean age of 34 years. The prevalence of fibromyalgia among SLE patients was 39 (65%). All domains of HRQoL were impaired. The mean score of the 8 domains were; Physical function 30.6±19.2, physical health 3.2±8.5, emotional problems 15.4±36.6, fatigue 32.1±12.5, social function 39.5±16.3, emotional well-being 39.4±18.0, pain 39.7±12.7 and general health 30.6±19.2. The median SLEDAI score was 7.0 (IQR 4.0-10.0), with half of the patients having moderate–severe disease activity (51.3%). Patients with fibromyalgia were more likely to be on steroids than non-fibromyalgia (p-value < 0.05). Other factors like marital status, nature of employment, and age were not found to be statistically significant.
Conclusion: Fibromyalgia is prevalent in SLE patients presenting with chronic musculoskeletal pain, in their middle age. The majority of the patients have moderate disease activity. The presence of fibromyalgia adversely impairs the quality of life of patients with lupus.

A pilot study of serum calprotectin ability to be a potential biomarker of erosive course juvenile arthritis

AN Kozhevnikov , NA Pozdeeva , EA Derkach, SV Vissarionov — Thu, 03 Aug 2023 00:00:00 +0000

Background: Juvenile Idiopathic Arthritis (JIA) is the most common chronic arthritis in children. There is no reliable laboratory test for JIA. Some researchers have reported that the serum level of calprotectin may be correlated with arthritis activity.
Objective: The aim of this study was to investigate the potential role of serum calprotectin in predicting the erosive course of JIA.
Methods: Level of serum calprotectin (sCal) was evaluated in 70 children with JIA (50 active JIA / 20 inactive JIA) and 20 adolescents with non-rheumatic joint disease. In comparison the serum level of IL6, TNF-alpha, vimentin were assessed.
Results: sCal level was higher in patients with active erosive course JIA (R2 = 0.4159, T = 4.336, OR erosive JIA = 3.3193, 95%CI 1,7006-6.4789, p=0.0079). Serum level of vimentin, IL6 and TNFalpha were not always correlated with active stage JA and erosive joint damage (p>0,05). The ROC analysis of the sCalc showed that a cut-off point more of 2,9 μg/ml may be high prognostic factor for related erosive JIA (AUC 0,837±0,0553, 95%CI 0,711-0.923).
Conclusions: The serum levels of calprotectin are significantly associated with erosive course of JIA. These results suggest that calprotectin might be superior to serum IL6 and TNF-α for aggressive erosive course of JIA.

Tight control of rheumatoid arthritis: Efficacy in a resource constrained setting

Thu, 03 Aug 2023 00:00:00 +0000

Objectives: This study was designed to evaluate the efficacy of a treatment strategy based on the “tight control” principle in patients with Rheumatoid Arthritis (RA) with a one year follow up and in a limited resource setting..
Method: This was a « before-after » observational study, comparing disease activity and handicap in the same patient throughout the year 2018 (before) and 2019 (after). This assessment was based on the « tight control » principle and performed in a rheumatology outpatient setting in patients who met the 2010 ACR/EULAR classification criteria for RA. Disease activity was assessed using DAS28-CRP, SDAI, CDAI disease activity scales and disability using the HAQ. disability index.
Results: Of the fifty patients, 47 (97%) were female and 3(6%) male. The average number of outpatient visits was 2.34 ± 1.21 with extremes of 1 and 5 in 2018 and 3.94 ± 1.6 with extremes of 1 and 8 in 2019 (p < 0.0001). The frequency of patients in remission before and after the tight control strategy was 4% (before) and 48% (after) respectively according to DAS28-CRP (p<0.0001), 2% (before) and 12% (after) according to SDAI (p<0.0001) and 2% (before) and 16% (after) according to CDAI (p<0.0001). The mean HAQ was of 1.18 ± 0.58 (before) and 0.35 ± 0.25 (after) (p<0.0001).
Conclusion: The “tight control” treatment strategy resulted in a significant reduction in disease activity and handicap in the
majority of RA patients in a real life limited resource setting.

Characteristic features of lupus patients with neuropsychiatric manifestations: a study from a single tertiary care center in Saudi Arabia

F Albalwi , S Alenazi , I Al-Homood — Thu, 03 Aug 2023 00:00:00 +0000

Objective: This was a study reporting Neuropsychiatric Systemic Lupus Erythematosus Events (NPSLE) in Saudi lupus patients.
Methods: A retrospective study for adult patients who attended rheumatology clinics at King Fahad Medical City between 2014 and 2020 and fulfilled the Systemic Lupus International Collaborating Clinics classification criteria (SLICC). NPSLE identified based on ACR 1999 nomenclature. The primary outcome is to identify the most common NPSLE while the secondary outcome is to find the association between NPSLE and other major organs and with the radiological features.
Results: One hundred and forty eight Systemic Lupus Erythematosus (SLE) patients participated in the study, One hundred and thirteen (76.4%) females and 35 (23.6%) males. Twenty one (14.2%) of our patients had NPSLE of whom 16 (76.2%) were female patients. The most frequently recorded event is seizure (42.9%) followed by stroke (23.8%). Psychosis was the most dominant psychiatric symptom (9.5%). Depression, headache, acute confusion, transverse myelitis, and peripheral neuropathy each presented by 4.8%. Lupus nephritis was diagnosed in 66.7% of patients with NPSLE while carditis was 28%. No significant association was found between aPL and anti-ds- DNA positivity and NPSLE. The most obvious abnormalities in imaging (MRI/ MRA/ MRV) were abnormal high signal intensity that was identified in 8 (57.1%) patients, infarction in 4 (28.6%) patients while vasculitic changes was in 3 (21.4%) patients.
Conclusions: NPSLE are reported prominently among female patients with seizure being the most common symptom followed by cerebrovascular accidents (CVA). The kidney is the most obvious major organ involved in patients with NPSLE followed by the heart. Abnormal signal intensity, infarction and vasculitis are the most noticeable lesions in imaging respectively.

Does the weight of the schoolbag influence the occurrence of low back pain in schoolchildren?

Thu, 03 Aug 2023 00:00:00 +0000

Background: There is a global controversy on the role of schoolbag weight in the occurrence of Low Back Pain (LBP) in schoolchildren.
Objectives: To determine whether age and gender influence the relationship between LBP and School bag weight among schoolchildren in Douala, Cameroon.
Methods: We conducted a post hoc analysis of a cross-sectional study. Schoolchildren surveyed completed a self-administered questionnaire with the assistance of trained interviewers. We recorded sociodemographics, usual physical activity, and clinical data. Schoolbags were weighted on the day of the survey. Informed consent was obtained from the parents.
Results: Of the 1075 children (532 girls), 132 (12.3%) had LBP monthly. The median age was 11 years [range, 8–14 years]. There was no relationship between LBP and the weight of the schoolbag, regardless of gender, BMI, duration of pain, type of school, distance and way of transportation from home to school, and age. However, there was a trend toward an association between schoolbag weight in schoolchildren aged 8 to 10 years old carrying a schoolbag weighing > 15% of their body weight (p = 0.05). When looking at gender, a significant association was found only in girls aged 8 to 10 with a schoolbag weight > 15% of their body weight (p = 0.036).
Conclusion: Schoolbag weight was associated with the development of low back pain only in girls aged 8 to 10 years old carrying a schoolbag weighing more than 15% of their body weight.