African Journal of Rheumatology

Climate change and the growing epidemic of rheumatic autoimmune diseases in Africa

UE Ima-Edomwonyi — 2024-06-04

No Abstract

Genetic studies on uric acid and gout in Africa: Where do we stand?

J.R. Nkeck — 2024-06-04

No Abstract

Tribute to a great rheumatology teacher: Professor Debashish Danda (1958-2024)

C. Omondi — 2024-06-04

No Abstract

Clinical features of women with gouty arthritis in Cameroon, sub-Saharan Africa

F.K. Lekpa — 2024-06-04

Background: Limited data are available on the characteristics of women with gout in sub-Saharan Africa.

Objectives: To assess differences in clinical features of gouty arthritis between female and male patients in a Cameroonian population.

Methods: A cross- sectional study from January 2004 to December 2013 was conducted in the Rheumatology Unit of the General Hospital, Douala, Cameroon, including patients diagnosed with gout according to 1977 ACR criteria. A comparison between female and male patients with gout was made.

Results: We included 511 patients (96 women and 415 men). Women were older than men at the time of the diagnosis (62.56 ± 11.02 years vs. 54.45 ± 10.22 years; p<0.001). Gouty arthritis in Cameroonian women was characterized (p<0.05) by: (i) a late age at onset, mainly after menopause, with women older than men at the time of diagnosis; (ii) a higher frequency of hyperuricemia, but with uric acid levels lower compared to men; (iii) a lower frequency of structural joint damage; (iv) a greater frequency of comorbidities (particularly the metabolic syndrome components) and drugs intake like diuretics and low-dose aspirin. The distribution of joint damage was not different between the two sexes in our study. Women had globally fewer tophi than men (p<0.05), but they had more tophi at the proximal (p=0.01) and distal (p=0.03) interphalangeal joints than men.

Conclusion: Gout in women seems to present specific characteristics. Further studies with robust design are needed to understand these differences

Comparative study of isthmic spondylolysthesis and nonisthmic spondylolysthesis in Northern Togo

M.L. Diallo — 2024-06-04

Objectives: To describe the epidemiological and clinical characteristics of isthmic and non-isthmic spondylolisthesis in a rheumatological environment in northern Togo

Methods: This was a retrospective study lasting 2 years, from January 1, 2020 to December 31, 2022, of patients with lumbar spondylolisthesis with or without slippage at the CHU and CHR Kara.

Results: One hundred and six (86 women; 20 men) of the 1699 patients who attended our clinic suffered from lumbar spondylolisthesis. The mean age of the patients was 54.15 ± 12.21 years. The average duration of evolution was 46.57 ± 54.09 months. Overweight accounted for 51.6%, followed by moderate obesity at 25.8%. Low back pain radiated in 91.5% and bilateral in 62.3%. The walking distance was limited (62.3%) and the average was 324.92 ± 361.28m. Anterolilisthesis was found in 79.2%, L4-L5 and L5-S1 seats were affected in 62.3% and 28.3% respectively. Meyerding grade I was found in 91.5%. Isthmic spondylolysthesis accounted for 51.9%. Among non-isthmic spondylolysthesis, the degenerative type accounted for 44.3%. A statistically significant correlation was observed between the patient’s age (p=0.004), the type of obesity (p=0.001), anterolysthesis (p=0.001), the site of the L4-L5 slip (p=0.001) and Meyerding grade II (p=0.003).

Conclusion: Spondylolysthesis is a frequent reason for consultation with a female predominance. Isthmic spondylolysthesis is the most frequent followed by degenerative spondylolysthesis. There was a statistically significant correlation with patient age, type of obesity, anterolysthesis, site of slippage, and Meyerding grade II.

Neck pain in Burkinabe students who use smartphones: frequency and associated factors

T.W.J.S. Zabsonre — 2024-06-04

Objective: To determine the prevalence and associated factors with the occurrence of neck pain in smartphone users at Joseph KI-ZERBO University (UJKZ) in Ouagadougou in 2022.

Method: The UJKZ served as the study framework. This was a descriptive crosssectional study with an analytical aim using stratified and proportional random sampling. The study included, any student registered at the UJKZ aged 18 to 30 years, having no previous history of neck pain and having given his free written consent. The evaluation of the associated factors was done by a bivariate and then multivariate logistic regression. The Chi2 test was used to search for an association between neck pain (the variable of interest) and the other variables. A dendrogram allowed us to look for a link between the different variables in order to eliminate possible association bias. The study was approved by the Ethics Committee for Health Research (CERS) of Burkina Faso.

Results: Of the 768 students questioned, 41 were excluded for a history of surgery or cervical trauma, i.e. an inclusion of 96.66%. Among the 727 participants included, 589 (81%) students had neck pain, the mean age being 23 (SD ± 1.8) years; 286 (48.5%) were female with a sex ratio of 1.05. Smartphone was used permanently for 24 hours among 330 (56%) students and for more than 12 hours with 402 (68.3%) students. The head tilt angle was 60° in 415 (70.5%) students. Multivariate logistic regression highlighted the factors associated with the occurrence of neck pain: permanent mobile internet connection (Odds ratio: 2.12 and 95% CI: 1.27 to 3.55 and p-value: 0.004) , the level of smartphone addiction (Odds ratio: 4.65 and 95% CI: 2.66 to 8.27 for moderate addiction; Odds ratio: 9.5 and 95% CI: 5.19 to 17.7 for severe addiction and p-value: <0.001); the number of hours of smartphone use (Odds ratio: 1.73 and 95% CI: 1.05 to 2.86 and p-value: 0.031) and level of education (Odds ratio: 0.31 and 95% CI %: 0.11 to 0.87 and p-value: 0.026).

Conclusions: Neck pain among smartphone users was very common at UJKZ in 2022. The level of addiction was severe among the majority of students according to the SAS-SV. The original UFR, the permanent mobile internet connection, the number of hours of use >12 hours and the level of severe to moderate smartphone addiction among students at UJKZ, the angle of inclination of the head were factors associated with the occurrence of neck pain.

Functional results of physical and rehabilitative management of patients treated for low back pain at the Teaching Hospital of Brazzaville, Congo

N'Soundhat N.E. Lamini — 2024-06-04

Objective: To report the functional results of physical and rehabilitative management of low back pain for low back pain in Brazzaville University Teaching Hospital.

Patients and methods: Descriptive and analytical cross-sectional study conducted in the Department of Physical Medicine and Rehabilitation of Brazzaville University Teaching Hospital. Patients followed between 1st May and 31st October 2022 (7 months) for low back pain were included to the study. Each patient was assessed at baseline and at 10, 20 and 30 days. The care protocol consisted of 15 sessions, 3 sessions per week, combining sedative physiotherapy, muscle strengthening and endurance training. The study variables were epidemiological, clinical and functional.

Results: During the study period, 215 patients were seen, 82 for common low back pain, representing a hospital frequency of 38%. The mean age was 57±14 years (extremes 25 and 93 years). Women predominated, (sex ratio: 0.43). The evolution was chronic in 93.9% of cases, with an average of 5±5.2 years (extremes: 1 month and 24 years). At the 30th day of the protocol, enabled 80.49% of patients to move from a pain intensity of more than 8/10 on the visual analogue scale to a pain intensity of less than 3 in 97.6% of patients. Similarly, functional capacity was restored in 97% of cases, with the Shirado test increasing from 38±13 seconds (range 9 to 90 seconds) at inclusion to 49.5 seconds, the Sorensen test from 31 ±15 (range 1 to 75 seconds) to 41.1 seconds, and the Roland-Morris Disability score going from a severe score in 90.2% to a mild score in 52% of patients and full functional restoration in 45%, with statistically significant.

Conclusion: Physical and rehabilitative management is an essential modality in the treatment of common low back pain, effective on both the functional and pain components.

Multiple myeloma in a 20-year-old patient: case report

V.E.S. Koffi-Tessio — 2024-06-04

The observation we report is that of a particular Kahler’s disease by the young age of the patient (20 years at diagnosis), admitted for a melena induced by a Forrest IIc gastric ulcer caused by taking non-steroidal antiinflammatory drugs for bone pain dating back two years. These pains, indicative of myeloma, were associated with a significant alteration of the general condition (body mass index at 12.5 kg / m²), infectious syndrome, paraparesis, and gibbosity. Treatment was palliative and the course fatal within two weeks.

Peripheral ulcerative keratitis in Behçet’s disease: A rare bilateral presentation with subsequent corneal perforation

N.M. Abdelazim — 2024-06-04

Peripheral Ulcerative Keratitis (PUK) is marked by stromal inflammation and degradation of the cornea and is a rare ocular presentation of Behçet’s Disease (BD). Early diagnosis and treatment are essential to prevent ocular morbidity. A 36-year-old male known to have BD presented with one month duration of bilateral ocular pain, redness, tearing, photophobia and impaired vision. There was previous history of oral and genital ulcers, skin rash, arthritis and subacute deep venous thrombosis of the superior vena cava. Slit lamp revealed a right inferotemporal corneal ulcer (3x1mm) with a vascularized margin and a left inferonasal corneal perforation with lost anterior chamber and iris prolapse; with no evidence of intraocular inflammation. The unaided visual acuity was 0.05 (right) and 0.016 (left). Scleral patch graft was used to repair the left corneal perforation. Autoimmune profile and thrombophilia screen were negative. The patient was treated with pulse methylprednisolone (1g/day) for 3 days followed by cyclophosphamide (1g/month) for 6 months; then he was maintained on oral steroids, azathioprine (150mg/day), oral colchicine (1mg/day) and anticoagulation. After one month, the ocular pain decreased and hyperemia resolved with improved vision. On follow-up, slit-lamp revealed right clear cornea and left healed scleral patch (2x3mm) at 8.30 o’clock. BD may atypically present with bilateral PUK; which might be complicated by corneal perforation. This case contributes to raise the awareness of rheumatologists and ophthalmologists regarding this unusual presentation of BD. Patients with PUK may require evaluation for coexistent rheumatic diseases.

Skeletal lesions in a rare form of multisystemic brucellosis

S.D. Ntshalintshali — 2024-06-04

Brucellosis is a zoonotic infection caused by bacteria belonging to the genus Brucella. Human infection typically occurs through contact with infected animals or consumption of contaminated animal products such as unpasteurized milk. In the context of rheumatic diseases, Brucellosis is known to cause musculoskeletal manifestations, making it relevant to rheumatology. The joints are commonly affected, and patients may experience symptoms such as a migratory arthritis, joint pain and myalgias. The inflammatory arthritis is often referred to as brucellar arthritis. Chronic brucellosis can be challenging in that clinical features and laboratory markers can overlap with other infectious and rheumatic diseases such as Systemic Lupus Erythematosus (SLE). This case report illustrates one of such occasions whereby chronic brucellosis presented with features mimicking a rheumatic disease and/or metastatic bone disease.

Symmetric gangrene of the legs revealing granulomatosis with polyangiitis leading to double transtibial amputation

Y.L.T. Bayala — 2024-06-04

Antineutrophil Cytoplasmic Antibody (ANCA) vasculitis can cause serious complications, leading to bilateral amputations in a young patient. This is a case of a 23-year-old black African patient with a case of previous pathological history. He was admitted to emergency surgery because of necrotic lesions on his feet extending down his legs. The symptoms progressed rapidly and extensively to necrosis within three days. The patient also presented with epistaxis. Initially, local care was attempted, but the necrosis spread, reaching the lower third of the legs. The clinical picture on admission showed almost normal vital signs, with the exception of tachycardia and severe pain. Physical examination revealed limited necrosis from the feet to the middle third of the legs, with grey to black discolouration of the skin. The lesions had a putrid odour, loss of cutaneous and muscular substance, and pedal pulses. Biological tests revealed an inflammatory syndrome. Given this picture, urgent bilateral amputation of the legs was recommended to the patient, who also developed mild reactive depression. Following amputation, the patient experienced worsening skin necrosis in other areas, leading to a diagnosis of Granulomatosis with Polyangiitis (GPA) according to the ACR/EULAR 2022 criteria. Despite treatment, the patient suffered a repetition and died of septic shock following cutaneous sepsis on readmission to emergency, two hours after admission.

Takayasu arteritis: An unusual cause of stroke in a young person

E.K. Genga — 2024-06-04

Takayasu Arteritis (TA) is a rare granulomatous vasculitis that occurs primarily in females. It affects large and medium vessels, primarily the aorta and its large branches, and proximal portions of pulmonary, coronary, and renal arteries. There is a paucity of epidemiological data on the disease. Numerous cases have been reported worldwide, though it is more prevalent in Asian countries such as Japan. It is thought to be rare in the African continent. If diagnosed or treated late, Takayasu’s can have grave complications. Early diagnosis is vital, though it can be challenging to many physicians due to its non-specific presentation, such as fever, fatigue, arthralgia, myalgia, and weight loss, which can often be missed. About 84-96% of these patients present as diminished or absent pulses associated with limb claudication and blood pressure discrepancies between the two arms. Here we report a case of a 26-year-old lady who presented with an ischemic stroke secondary to Takayasu.