African Journal of Rheumatology

Relationship between the level of daily alcohol intake and serum uric acid concentrations in a sample of young men from Cameroon, sub-Saharan Africa

JR Nkeck — 2025-01-21

Background: Despite the fact that alcohol is predominantly consumed by young men, there are few studies among this population in Sub-Saharan Africa (SSA) about the relationship of the level of alcohol consumed and Serum Uric Acid values (SUA).

Objective: The study aimed at investigating the relationship between regular alcohol consumption and uricemia in Cameroonian men aged under 45 years.

Methods: This was a cross-sectional study done in Yaoundé (Cameroon), on healthy males aged 18 to 45 years with regular alcohol consumption within the last three months. We assessed their Ethylic Index (EI), purine-rich diet, SUA and hepatic and haematological biomarkers of chronic alcohol consumption. We compared their SUA according to the level of alcohol consumption (low <20, moderate 20-39.9 and elevated ≥40g/L) using the ANOVA test, and search for other associated factors through multivariate linear regression. The threshold of significance was 0.05.

Results: One hundred and fifty seven participants were included: mean age 30.6 (5.8) years, median duration of alcohol consumption 10 [7; 15] years and median EI 24.1 [14.4; 37.1] g/day. Beer consumption was predominant (94.9%); moderate and elevated consumption found in 36.3 and 23.3% of participants respectively. Hyperuricemia was found in 38 (24.2%) participants, associated with diet (p=0.04) and diastolic blood pressure (p=0.04). No difference in SUA between alcohol consumption groups (p=0.26). However, SAU were higher in participants with elevated Gamma Glutamyl-Transferase (GGT) (0.018), and GGT were found to be biomarkers of alcohol consumption (p<0.001).

Conclusions: EI does not seem to reflect the link between alcohol and SUA in young men. However, the association of SUA with GGT represents a relevant biological finding, linking chronic alcohol consumption to uricemia in this population.

Pott’s disease: Knowledge, attitudes and practices of general physicians in referral hospitals of Brazzaville

NE Lamini N’Soundhat — 2025-01-21

Background: Pott’s disease is the leading cause of infectious spondylodiscitis in Republic of Congo. It is usually diagnosed late, at the stage of neuro-orthopaedic complications.

Objective: To determine the level of knowledge, attitudes and practices about Pott’s disease of general physicians working in referral hospitals in Brazzaville.

Methods: This was a knowledge, attitudes and practice study carried out over a period of 6 months in the referral hospitals of Brazzaville. It focused on general practitioners who agreed to participate in the study. The study variables were: The epidemiological, diagnostic and therapeutic aspects of Pott’s disease.

Results: Out of a sample of 70 general physicians, the overall level of knowledge was good (71.6%). The areas of inadequacy concerned the disease itself, in terms of clinical, labs, imaging presentation and anti-tuberculosis drugs, which appeared to be unsatisfactory. The attitude of general physicians is to consider Pott’s disease as a serious condition requiring urgent treatment. The level of practice of general physicians is average, and concerns essentially the search for comorbidities. The socioepidemiological approach of contagious disease, with mandatory reporting, was not taken into consideration.

Conclusion: The knowledge, attitudes and practices of general physicians appear satisfactory overall, but need to be improved, especially about the clinical, labs, imaging and therapeutic aspects of Pott’s disease.

Prevalence of depression and its associated factors among patients with Systemic Lupus Erythematosus at the Kenyatta National Hospital, Nairobi, Kenya

U Bagha — 2025-01-21

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by inflammation of various organs. Neuropsychiatric manifestations such as symptoms of depression may precede SLE, occur concomitantly, or follow its diagnosis. Depression often exacerbates the morbidity of SLE in these patients and lowers their quality of life. Depression is not routinely evaluated in patients with SLE in Kenya, which can lead to a reduction in its treatment and potentially worsen the morbidity of the disease.

Objective: This study aimed to determine the burden and determinants of depression in patients with SLE in Kenya.

Methods: A descriptive cross-sectional study was conducted at the rheumatology clinic in the Kenyatta National Hospital from November 2022 to January 2023. Depression was evaluated using the Patient Health Questionnaire 9. Data analysis was performed using IBM SPSS Version 25. The prevalence of depression was determined by calculating the proportion of participants who reported depression, and the association between depression and sociodemographic variables was assessed using the Chi-square test at a 95% confidence level. A probability value of <0.05 was considered significant.

Results: Fifty-five SLE patients were recruited in the study. Depression symptoms were reported among 24/55 (43.6%) of patients.

Conclusion: A high prevalence of depression was noted in patients with SLE. The afflicted had significant role limitations due to emotional problems, poor physical functioning, and poor health change. This study highlights the importance of evaluating and addressing depression in patients with SLE.

Influencers of deterioration in patients with Rheumatoid Arthritis on DMARD therapy

GO Oyoo — 2025-01-21

Objective: To identify the sociodemographic, clinical and health care factors that influence deterioration to Disease Modifying Antirheumatic Drugs (DMARDS) in patients with Rheumatoid Arthritis (RA).

Methods: We conducted a prospective cohort study on RA patients diagnosed according to the ACR (1987) or ACR/ EULAR criteria (2010). These patients were followed up in four rheumatology clinics in three counties in Kenya. A pre-coded questionnaire was used to capture socio-demographic and clinical characteristics of the patients. Baseline data was collected at the time of recruitment into the study. Patients were then followed up while on treatment with DMARDS and only those who had complete data at 3 months were included in the study analysis. The study outcome was defined using Disease Activity Score 28 (DAS-28) as either remission or Low Disease Activity (LDA) at 3 months follow-up. The Adherence in Chronic Disease Scale (ACDS) was used to assess the implementation of the treatment plan. Data analysis was carried out using Prism7 and SPSS version 25, p value of < 0.05 was considered statistically significant.

Results: Of the 206 patients included, the mean age was 51.2 ± 15.1 years with female predominance (91.3%). Majority (83.5%) had post primary education, only 35.9% had formal professional employment and 3% had medical insurance. At recruitment, nearly half of the included patients (47.6%) had an overall health assessment questionnaire disability index (HAQ-DI) score of > 2.5, indicating moderate to severe disability. The majority of patients had elevated baseline Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP). Most (90.3%) of the patients had a positive Rheumatoid Factor (RF) test at recruitment, and 58.5% of patient had a positive anti-Cyclic Citrullinated Peptide (Anti-CCP) test. Twelve percent, 62%, 10% and 16% of the patients had High Disease Activity (HDA), Moderate Disease Activity (MDA), Low Disease Activity (LDA) and remission respectively. Majority (94.2%) of patients were on Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), 80.6% were on Conventional Disease Modifying AntiRheumatic Drugs (CsDMARDs) and 55% on systemic corticosteroids. The mean duration of follow-up was 4.6 months. During the follow-up, 37.9% found the system to be acceptable and 63.6% found the system to be problematic. Majority of the patients reported to have been adherent to therapy (7.8% were high adherence: 87% were moderate adherence). A total of 52 (27.7%) patients deteriorated (had severe disease activity at follow up). A high baseline of DAS-28 score (OR = 4.4, 95% CI 2.67-7.57, P<0.001) and nonadherence (OR=30.4, 95% CI 4.82-191.66, p<0.001) were identified as independent predictors of deterioration.

Conclusion: High baseline of DAS-28 and non-adherence are independent predictors of disease deterioration in patients with RA.

Knowledge, attitudes and practices of doctors at the Ignace Deen University Hospital Center in Conakry (Guinea) on Nonsteroidal Anti-Inflammatory Drugs

K Condé — 2025-01-21

Objective: To assess the knowledge, attitudes and practices of doctors at the Ignace Deen University Hospital of Conakry (Guinea) on Nonsteroidal Anti-Inflammatory Drugs (NSAIDs).

Methods: This was a descriptive crosssectional study carried out in the various departments of the CHU Ignace Deen between September 2021 and September 2022. We used simple or multiple-choice questionnaires concerning knowledge, attitudes, and practices.

Results: During the period of our study, the number of participants were 180 doctors from different departments. The mean age was 33.5 ± 5.1 years with the extremes of 25 and 57 years. There was a male predominance in 88% of cases with a M/F sex ratio of 7.4 GPs which the most represented status in 53% of cases. The most prescribed NSAIDs were propionics (82.8%) and phenylacetic acids (76.7%) with an average treatment duration of seven days. UGD was the most common adverse effect in 82.8% of the cases. In our study we observed the association of two NSAIDs in 66.1% of the cases.

Conclusion: Among the doctors, 70.6% had good knowledge, 53.8% good attitudes and 57.7% bad practices. Doctors had good knowledge and good attitudes about NSAIDs, but practices still need to be improved, especially among general practitioners.

Juvenile Systemic Lupus Erythematosus co-existing with Hashimoto’s thyroiditis in a 16-year-old Nigerian girl: Case report

EE Aigbokhan — 2025-01-21

This case report presents the rare occurrence of juvenile Systemic Lupus Erythematosus (jSLE) co-existing with Hashimoto thyroiditis in a 16-year-old secondary school female. The patient’s initial complaints included a rash of three months’ duration, joint pain and anterior neck swelling of one month. The clinical examination revealed presence of discoid lesions, and an enlarged thyroid gland. Laboratory investigations confirmed positive autoimmune markers for both SLE and thyroiditis. The treatment plan involved prednisolone, azathioprine, hydroxychloroquine, calcium/vitamin D3 and levothyroxine. This case highlights the diagnostic and management challenges posed by the co-existence of these autoimmune conditions in a juvenile patient.

Difficult to treat relapsing polychondritis responded to tocilizumab in a teaching hospital in Western Kenya: Case report

R Aksam — 2025-01-21

Relapsing polychondritis is a rare autoimmune condition affecting the cartilaginous areas. Some cases respond poorly to conventional Disease Modifying Antirheumatic Agents (DMARDs) and may need biological agents. Here we present such as a case from a teaching hospital in Kisumu, Kenya. A 35 year old lady presented with a one year history of recurrent ear and nasal inflammation, eye pain and reddening, joint pains and swelling, and skin rash affecting the limbs and the trunk. She had been on treatment over the last one year with steroids, leflunomide, methotrexate and cyclophosphamide without significant improvement. Clinical exam showed: episcleritis, erythema nodusum-like skin rash, inflammation of the pinnae, bilateral ankle arthritis and saddleback deformity of the nose. Her inflammatory markers were elevated. She was started on monthly intravenous tocilizumab at 6mg/ kg and made remarkable improvement. Tocilizumab is an effective therapy for difficult to treat relapsing polychondritis.

Massive serositis in a patient with Rheumatoid Arthritis : Case report

M Kuria — 2025-01-21

Pleural and pericardial disease are established systemic manifestations of rheumatoid arthritis. In the following case report, we describe a patient who presented to us with large bilateral pleural effusions, massive ascites and severe pericardial effusion with impending cardiac tamponade. After extensive investigations, the serositis was suggested to be rheumatic in origin, and improved on steroids and biologic agent (rituximab).

Fracture liaison service in Africa: An integral strategy to improve post osteoporotic fracture care

F Paruk — 2025-01-21

No abstract