Open Journal of Rheumatology and Autoimmune Diseases

Journal Information
ISSN / EISSN : 2163-9914 / 2164-005X
Published by: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 206
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SHERPA/ROMEO
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Aly Badra Kamissoko, Tayo Nadège Raissa Edikou, Abdoulaye Barry, Marina Sanda, Kadé Fofana, Lou Nahan Eunice Irie, Mamadou Lamine Diallo, Owonayo Oniankitan
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 152-159; https://doi.org/10.4236/ojra.2021.114016

Abstract:
Background: Rheumatoid arthritis is a chronic autoimmune disease that causes socio-economic, psychological and sexual problems. It imposes limitations on sexual relationships and these issues are still taboo in African society. Objective: The objective is to assess the impact of rheumatoid arthritis (RA) on women’s sexuality at the Ignace Deen National Hospital. Patients and Methods: This was an analytic case-control study of 8 months (from April 6, 2020 to December 11, 2020). All patients followed for rheumatoid arthritis diagnosed according to 2010 ACR/EULAR criteria for RA had been included. Results: One hundred and five women (52 RA patients and 53 controls) were collected. The two groups were comparable in terms of demographic characteristics. Sexual dysfunction was found in 69.2% of cases versus 35.8% of controls. Women with RA had poorer sexual functioning in the categories of desire, arousal, lubrication, orgasm, satisfaction, and pain of the FSFI score compared to healthy women (p = 0.01; p = 0.7; p = 0.3; p = 0.8; p = 0.1; and p = 0.3 respectively). Patients were 4 times more likely to have sexual dysfunction than healthy individuals and this result was statistically significant with a p-value less than 0.05. Conclusion: Sexual dysfunction was noted in a large number of RA patients surveyed at the rheumatology department of the Ignace Deen national hospital. A larger study is needed to better assess this issue and seek management solutions.
Mariana Do Socorro Quaresma Silva, Rita Catarina Medeiros Sousa, Cezar Augusto Muniz Caldas
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 36-47; https://doi.org/10.4236/ojra.2021.112005

Abstract:
Background: Chikungunya fever is an infectious disease that can evolve to a subacute or chronic condition, with changes in the daily activities of patients. Drugs that aim to reduce these symptoms are used, such as corticoids (acute phase) and disease-modifying anti-rheumatic drugs (chronic phase). Objective: To evaluate the clinical response to drug therapy in the subacute and chronic phase of infection by the Chikungunya virus. Methodology: A prospective and a retrospective study with patients with subacute and chronic Chikungunya infection, out at the infection and autoimmunity outpatient clinic at the Nucleus of Tropical Medicine, from January 2016 to December 2019, in the morning of Thursdays. The patient was observed in the Baseline, first and second return, and drugs were introduced according to the stage of the disease with subsequent reassessment. The Visual Analogue Scale (VAS) was applied to all evaluation moments. Results: 101 patients were evaluated, and arthralgia was the predominant symptom in the three evaluated moments. According to the VAS, moderate baseline pain was observed in 58.1% and 58.6% of subacute and chronic cases, respectively. On the first return, moderate pain still predominated in 46.2% in subacute cases and 43% in chronic cases. In the second visit, all patients were in the chronic phase of the disease, 43.8% had VAS with no pain. Regarding the number of compromised joints in the Baseline, polyarticular involvement predominated in both subacute (79%) and chronic (74.1%) cases, in the first return, oligoarticular involvement predominated in 53.8% of subacute cases and 54.7% in chronic cases and, the second return, 40.6% of the patients had oligoarticular involvement and 43.8% had no joint involvement. As for the use of medications in the Baseline, 33.4% of subacute cases used antiinflammatory drugs, and 40% of chronic cases used corticosteroids. At the first visit, 25% of chronic patients were already using combined corticosteroids and methotrexate and 15% were using only methotrexate. In the second return, 35.1% used combined methotrexate and corticosteroids, and 64.9% used only methotrexate. Safety in the use of methotrexate was observed in the context of CHIKV treatment, as the number of adverse reactions was minimal (three patients) and the medication was well tolerated. Conclusion: It was observed that with the adjustment of the medications, there was a reduction in joint impairment, VAS showed mild pain indexes and in some cases with no pain, showing the benefit of using therapy in subacute and chronic cases and improving quality of life of these users.
Kaba Condé, Mamadou Ciré Barry, Carlos Othon Guelngar, Igue Kadidjatou, Mamadou Hady, Karinka Diawara, Konaté Mamady, Touré Moriba, D. Granga D, AwadA Mohamed, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 1-8; https://doi.org/10.4236/ojra.2021.111001

Abstract:
Introduction: Juvenile Idiopathic Arthritis (JIA) is the most common rheumatoid disease in children. In Sub-Saharan Africa, little data is available on the prevalence of JIA. The objective of our study was to determine the frequency and describe the clinical profile of JIA in Guinean children seen at the Department of Neurology, Academic Hospital, University of Conakry (Guinea). Patients and Method: This was a retrospective study carried out at the Ignace Deen Academic Hospital, Conakry between January 2016 and December 2018. Patients were recruited through the Rheumatology and Paediatrics Department. Results: We collected forty (40) observations of JIA in 22 girls (55%) and 18 boys (45%). The median age at diagnosis was 14 years (range 7 - 18 years), compared to 7 years at onset (range 5 and 13 years). There were 3 cases of systemic arthritis (7.5%), 16 (40%) patients with persistent oligoarthritis, 3 patients (7.5%) that had extensive oligoarthritis, polyarthritis with positive RF in 8 cases (20%) and with negative RF in 4 cases (10%), psoriatic arthritis in 3 cases (7.5%), and enthesitis related arthritis in 2 cases (5%). There was one case of undifferentiated arthritis. A total of 23 (57.5%) received methotrexate, 9 (22.5%) were treated with salazopyrin. Conclusion: The profile of JIA in our study is different from that described in African studies with a predominance of oligoarticular JIA.
Prenam Houzou, Sadat Oniankitan, Omboma Bouglouga, Bidamin N’Timon, Erika Djougnwe Mba, Viwale Etonam Koffi-Tessio, Kodjo Kakpovi, Komi Cyrille Tagbor, Eyram Fianyo, Awaki-Esso Atake, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 144-151; https://doi.org/10.4236/ojra.2021.114015

Abstract:
Background: Hepatocarcinoma is the most common primary malignant tumor of the liver with rare bone metastases, electively residing in the vertebrae, ribs and sternum. They remain exceptionally revealing. Cases reports: We report two cases of bone metastases indicative of hepatocellular carcinoma in patients with viral hepatitis C. Through these two observations, we describe the various clinical, paraclinical and therapeutic aspects of this condition whose prognosis is poor. Conclusion: Although unusual, osteolytic bone metastases may be indicative of hepatocellular carcinoma, the diagnosis must be made in the event of any tumor bone involvement in a patient with chronic liver disease, particularly viral.
Mohammad Al Mousa, Fahad Al Muhanna, Ahmad Al Shami, Yaser M. Ali
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 19-27; https://doi.org/10.4236/ojra.2021.111003

Abstract:
IgG4 related disease is a relatively recently recognized systemic entity, that has been observed in nearly every organ system, with similar histopathological features across all identified organs. IgG4 is an antibody molecule accounting for less than 5% of the total IgG count in a healthy person. The molecule is implicated in numerous autoimmune diseases; however its role in IgG4 related disease, whether primary or secondary, remains unknown. The gold standard in the diagnosis of this condition is demonstration of organ involvement from biopsy specimens. In this case report, the patient had exhibited symptoms related mainly to the gastrointestinal tract for 12 years prior to his diagnosis of IgG4 related disease. After this patient’s diagnosis of IgG4 related disease, he was commenced on Rituximab, a monoclonal antibody, which was successful in subsiding his symptoms and he has remained symptom free for the past two years of follow up since commencing treatment and hadn’t developed any complications of the disease nor any complications related to treatment. IgG4 related disease is a systemic autoimmune disease that involves multiple organs 60% - 90% of the time, therefore clinicians should be aware that IgG4 related disease can mimic some autoimmune rheumatic diseases and place it as a differential diagnosis when multi-organ disease with systemic features is involved.
Adel Elbeialy, Abdlnby Bauomi, Basma Elnaggar, Hala Elzomor
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 79-88; https://doi.org/10.4236/ojra.2021.112010

Abstract:
Objectives: Rheumatoid arthritis is sometimes misdiagnosed for other diseases, like psoriatic arthritis, erosive OA, viral arthritis, reactive arthritis, IBD arthritis, Lyme’s disease, and palindromic rheumatism. Secondary hyperparathyroidism was not included in the differential diagnosis of RA, though it sometimes presents with joint pains and tenderness, and even arthritis. Fibromyalgia is a psychosomatic disorder characterized by chronic widespread pain and tender areas. Mimicry of some manifestations of these diseases sometimes results in misdiagnosis as RA. Methods: Two hundred patients previously diagnosed as RA from outpatient clinics in Al-Azhar Faculty of Medicine, attended as not responding to medical treatment of RA. All patients were subjected to a re-evaluation of disease activity including HAQ, and DAS 28, CDAI, and SDAI. Also, we measured serum vitamin D3, PTH, total and ionized Calcium, Phosphorus, Uric acid, ACPA, and other routine lab. All patients were exposed to various radiological imaging modalities. Results: Cases not responding to RA treatment were reevaluated and were found to have a syndrome of fibromyalgia associated with vitamin D3 deficiency and secondary hyperparathyroidism. Conclusions: Fibromyalgia/Hyperparathyroidism syndrome is an underdiagnosed disease, which results from chronic vitamin D3 deficiency. SHPT can cause bone erosions, which are mostly shaggy in appearance and distributed in the radiocarpal, radioulnar, metacarpophalangeal and distal interphalangeal joints, in contrast to that which predominate proximal IP joints of rheumatoid arthritis. Radiology of FM/HPT syndrome patients revealed a sign of spur-like excrescences in terminal finger tufts unilaterally or bilaterally, which we think is pathognomonic.
Kaba Condé, Carlos Othon Guelngar, AwadA Mohamed, Igué Kadidjatou, Douna Granga Daouya, Mamadou Ciré Barry, Mamadou Hady Diallo, Karinka Diawara, Konaté Mamady, Touré Moriba, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 73-78; https://doi.org/10.4236/ojra.2021.112009

Abstract:
Secondary hypertrophic osteoarthropathy, or Pierre-Marie Bamberger syndrome, is characterized by the association of digital clubbing, polyarthritis and periostitis affecting the long bones. Most commonly it is a paraneoplastic syndrome associated with lung cancer in 80% of cases. We report the case of a 49-year-old female patient who is actively smoking, one pack per day for 20 years. Seen in consultation for pain and swelling of the hands, elbows, knees, ankles, and feet evolving for about 5 months, associated with a poorly differentiated pulmonary adenocarcinoma. On history, she told us about a weight loss of about 8 kg, no fever, no cough, no family history of inflammatory rheumatism or cancer. Bilateral digital clubbing was noted. The diagnosis was based on imaging and histology. Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and chemo-radiotherapy was started.
Condé Kaba, AwadA Mohamed, Carlos Othon Guelngar, Adjibaye Emmanuel, Sanni Yaya Aminou, Mamadou Hady Diallo, Touré Moriba, Kamissoko Aly Badra, Konaté Ibrahima Sory, Fodé Abass Cissé
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 89-95; https://doi.org/10.4236/ojra.2021.112011

Abstract:
Objective: Rheumatologic disorders of chronic inflammatory bowel disease (IBD) and reactive arthritis with a digestive origin are part of the spondyloarthritis family. In black Africa, the prevalence of SpA associated with IBD is not clearly established. Thus the objective of our study was to describe the clinical and radiological characteristics of spondyloarthritis associated with IBD. Patients and Method: We carried out a prospective study in the rheumatology department of CHU Ignace Deen between January and December 2019. The diagnosis of SpA was based on clinical and biological arguments in accordance with the criteria of Amor and ASAS. Results: Fifteen observations of spondyloarthritis associated with IBD were collected in patients mean age 52 years with extremes of 32 and 65 years. 9 (53.33%) were female. Ten patients had Crohn’s disease (CD) and 5 had ulcerative colitis (UC). The mean number of pushes was 2.5 ± 1.2. The average diagnostic time was 46 months. Sacroiliitis was present in 73.3% of cases and the mean mSASSS score at diagnosis was 32.11/72. In total, corticosteroids were used in 9 (60%) of patients, NSAIDs in 26.6% while DMARDs salazopyrine and methotrexate in 33.3% and 20% of patients, respectively. Conclusion: The MICI and SpA association is undoubtedly underestimated in our regions. Better collaboration between rheumatologists and gastroenterologists could facilitate diagnosis and improve care.
Komi Cyrille Tagbor, Viwale Etonam Sika Koffi-Tessio, Kodjo Kakpovi, Prenam Houzou, Eyram Fianyo, Sadat Oniankitan, Awaki-Esso Atake, Parou Kamkote, Kokou Hefoume Amegan-Aho, Owonayo Oniankitan, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 97-105; https://doi.org/10.4236/ojra.2021.113012

Abstract:
Objectives: To determine the epidemiological, clinical, and bacteriological characteristics of septic arthritis of the hip (SAH) among patients hospitalized in the departments of Rheumatology in Lomé. Patients and Methods: This was a multicentre, descriptive study, conducted over a 16-year period, from January 2004 to December 2020 on patients’ records at the three departments of Rheumatology in Lomé. We included in this study only patients with complete laboratory and radiological data. Patients who underwent hip replacement surgery and those with arthritis of the hip due to all inflammatory arthropathies were excluded. The diagnosis of SAH was based on clinical, radiological and bacteriological features. In the absence of bacteriological confirmation, the presumptive etiological diagnosis was based on epidemiological data, contacting with a person with tuberculosis, the presence of high-grade fever, the mode of presentation of the symptoms, the patient’s general appearance, and the result of the tuberculin skin test. The data was collected using Epi info 7.0 and statistical analysis was performed using STATA/IC 11.0. Results: Out of 3776 patients hospitalized in the three departments over the study period, 705 (18.67%) were diagnosed with septic arthritis of which 70 (9.92%) patients with SAH. The 70 patients with SAH were 44 (62.86%) females, and 26 (37.14%) males (Table 1), with a sex ratio of 1.7 F/M. The mean age of the patients was 42.43 ± 19.37 years (range: 5 years and 80 years) and the mean duration of symptoms was 6.57 ± 8.85 months (range: 2 days and 48 months). The pain was inflammatory in nature in 46 (65.71%) and mechanical in nature in 24 (34.29%) patients. The onset of the disease was progressive in 50 (71.43%) patients and sudden in 20 (28.57%) patients. The locations of the pain were: groin only 25 (35.71%), greater trochanter only 15 (21.43%), groin and lower back 14 (20%), and groin and greater trochanter 9 (12.86%). Sixty-four patients (91.43%) were limping and only six (08.57%) were crippled. Weight loss was noted in 38 (54.29%) patients. A risk factor was identified in 63 (90.00%) patients; they were chronic alcohol abuse 24 (34.29%), poor hygiene 17 (24.29%), sickle cell disease 13 (18.57%), HIV infection five (7.14%), and diabetes four (05.71%). Radiologic features suggestive of SAH were seen on plain radiograph and computed tomography in 55 (78.57%) and 15 (21.43%) patients, respectively. The SAH was unilateral (48 right hip and 20 left hip) in 68 (97.14%) patients and bilateral in two (02.86%) patients. The diagnosis of SAH was probable tuberculosis in 46 (65.71%) patients and probable pyogenic bacteria in 24 (34.29%) patients. The outcome was favourable in 68 (97.14%) patients and two (02.86%) patients died. Conclusion: The hip remains a relatively rare localization of infectious pathologies. Most cases of SAH are due to tuberculosis.
Heloisa Lima Heller, Ana Paula Gomides Reis, Cleandro Albuquerque, Isadora Jochims, Luciana Muniz, Talita Yokoy, Licia Mota
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 53-63; https://doi.org/10.4236/ojra.2021.112007

Abstract:
Introduction: Rheumatoid arthritis (RA) is a chronic systemic rheumatic disease which is usually treated with corticosteroids and immunobiologicals. The goal of this article is to carry out an assessment of disease activity indices in a cohort of patients with rheumatoid arthritis. Patients and Methods: This is a prospective cohort study. Individuals from the Initial Rheumatoid Arthritis Brasília Cohort, which is an incident cohort of early RA diagnosed patients, were monitored at the Rheumatology Service of the Hospital Universitário de Brasília (HUB), University of Brasília (UnB), Brazil. A cross-sectional analysis was carried out from 2017 to 2018 to evaluate patients with 15 or more years of follow-up, through a direct interview and review of medical records. The main focus of the study is on the assessment of disease activity, based on the indices: 28-joint Disease Activity Score based on Creactive protein (DAS 28 CPR) and based on erythrocyte sedimentation rate (DAS 28 ESR), Clinical Disease Activity Index (CDAI), and Simple Disease Activity Index (SDAI). The reference remission criteria used were the Composite Disease Activity Indices. Results: 107 patients were evaluated, mostly women, mean age of 55.1 years. Concerning the disease characteristics, 75.5% of the patients were positive for rheumatoid factor and 12 (11.3%) had documented erosive disease. The mean Health Assessment Questionnaire (HAQ) at the time of assessment was 0.6 (median 0.35). The indices analyzed showed: DAS28-ESR 48.6% of patients were in remission and 12.1% had low activity levels, DAS28-CRP 55.1% and 11.2%, SDAI 42% and 26.1%, CDAI 41.1% and 27.1%. These remission and low disease activity levels are higher than those generally found in the literature. Conclusion: This study presents a cohort of patients with RA who started treatment at an early stage of the disease and who achieved higher rates of remission and lower disease activity than those reported in the literature.
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