Open Journal of Rheumatology and Autoimmune Diseases

Journal Information
ISSN / EISSN : 21639914 / 2164005X
Current Publisher: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 190
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Latest articles in this journal

Mariam Gbané, Jean Claude Soglo, Mohamed Diomandé, Guy Léopold Kengni, Baly Ouattara, Jean Mermoz Djaha Kouassi, You Nina Carmelle Kpami, Yaya Coulibaly, Edmond Eti, Gbané Mariam, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 10, pp 1-7; doi:10.4236/ojra.2020.101001

Objectives: The aim of this study was to describe the diagnostic and etiological aspects of bone metastases in the Rheumatology Department of Cocody’s University Teaching Hospital (UTH). Methodology: This was a descriptive, 11-year retrospective study (January 1, 2006 to December 31, 2016) of inpatient records of bone metastases. The diagnosis was made on clinical (bone signs), radiological (osteolysis, bone condensation) and sometimes histological basis. Result: Eighty out of 6, 1111 inpatients suffered from bone metastasis with a hospital frequency of 1.30%. The average age was 60.74 years (range 26 to 81 years). Men were predominant (53 men for 27 women) with a sex ratio of 1.96. The main complaints were pain (97.6%). chronic (90%), severe (73.8%), inflammatory (93.8%). There was sometimes a neurological complication: a motor deficit (21.3%), sensitive (13.8%). These symptoms were associated with fever (56.3%) and altered general state (85%). Bone metastases have been revealing in the vast majority of cases (93.75%); the primary cancer was known only in 5 patients (prostate = 2, breast = 2 and cervix = 1). Bone condensation (61.3%), osteolysis (50%) and mixed lesions (7.5%) where the main radiological lesions observed. The primary tumors were: prostatic (50%), pulmonary (18.8%), mammary (11.3%), uterine (5%), renal (2.5%), hepatic (2.5%), bladder (1.3%) and adrenal (1.3%). Conclusion: Bone metastases affect mostly the elderly; inflammatory spinal pain is the main symptom. Bone condensation is the most common radiologic lesion. The prostate, breast and lungs are the main primary tumors.
Baïdy Sy Kane, Ahmed Ould-Hennia, Nesrine Karaa-Zbidi, Souhaibou Ndongo, Abdoulaye Pouye, Richard Damade, Sy Kane Baïdy, Ould-Hennia Ahmed, Karaa-Zbidi Nesrine, Ndongo Souhaibou, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 10, pp 8-13; doi:10.4236/ojra.2020.101002

Introduction: Immune checkpoint inhibitors targeting programmed death protein-1 and cytotoxic-T-lymphocyte-antigen-4 have revolutionized the treatment of various cancers. Despite their effectiveness, these therapies can lead to immune related adverse events. Observation: We reported a case of a 43- year-old white woman who was referred to our department for a management of acute polyarthritis. She was followed for a relapsing metastatic melanoma (stage IIIb) by surgery and Pembrolizumab, an immune checkpoint inhibitor targeting programmed death protein-1. After receiving her 4th cycle of this therapy she developed arthritis of the knees and the ankles, tenosynovitis and dry eyes with keratitis. After exclusion of other causes of polyarthritis such as connective-tissue disease, the diagnosis of rheumatologic immunerelated adverse events was retained. She was treated by 20 mg of prednisone daily, Pembrolizumab was discontinued. The evolution was favorable. Conclusion: Rheumatologic manifestations secondary to immune checkpoint inhibitors have been less well described in the literature. Their management requires the collaboration of oncologists and rheumatologists to limit the diagnostic delay and for an appropriate therapeutic choice according to their severity.
Moustapha Niasse, Baïdy Sy Kane, Alain Dimitri Walah Mabom, Carole Makougang, Moudine Dézoumbé, Yetna Tcheindah, Diouf Coumba, Saer Diadié, Saïdou Diallo
Open Journal of Rheumatology and Autoimmune Diseases, Volume 10, pp 14-23; doi:10.4236/ojra.2020.101003

Introduction: Multiple autoimmune syndrome is rarely described in the African literature. We report 25 cases. Patients and Method: A Retrospective, descriptive study was carried out in the Rheumatology Department of Aristide Le Dantec University Hospital in Dakar from 2013 to September 2019. Patients with at least 3 distinct autoimmune diseases were included. Results: Twenty-five cases of multiple autoimmune syndrome were collected in 23 women and 2 men, with a mean age of 42.4 years (extremes: 24 and 67 years). The mode of discovery of the disease was a connective tissue disease in 19 cases (76%) and an organ-specific autoimmune disease in 6 cases. According to Humbert and Dupond’s classification, 18 patients (72%) had both type 2 and type 3 criteria. An isolated type 2 was noted in 5 cases (20%) and an isolated type 3 in 1 case (4%). One case (4%) was unclassifiable. The evolution under treatment was marked by remission in 84% of cases. Conclusion: Multiple autoimmune syndromes account for 5.66% of the autoimmune diseases in our study. They predominate in young women with a mean age of 42.4 years. Not all entities were classifiable by the Humbert and Dupond’s classification. The evolution under treatment was marked by remission in 84% of cases.
Isaac Ginsburg
Open Journal of Rheumatology and Autoimmune Diseases, Volume 10, pp 79-87; doi:10.4236/ojra.2020.102010

The present study offers a novel approach that may explain the mechanisms of pathogenicity of the auto immune destructive disorder, Lupus Erythematosus. It is proposed that deposition of immune complexes and complement components in tissue is mediated by highly cationic histones released from neutrophils nets the phenomenon of netosis. Histones act a potent opsonic factor similar to antibodies which interact by strong electrostatic forces with negatively-charged domains in immune complexes and complements facilitating their deposition and also their internalization by hosts’ cells. However, the main cause of cell and tissue damage in Lupus is inflicted by the plethora of toxic pro inflammatory agonists released by neutrophils and by macrophages recruited to inflamed tissues by cytokines. The melioration of tissue damage may be initiated by highly anionic heparins, which neutralizes histones’ action if also combined with steroids, colchicin and methtorxate as well as by other agents which retard leukocytes migration and functions.
Susana Ferreira Krampe, Nicole Pamplona Bueno De Andrade, Letícia Guimarães Da Silveira, Claiton Viegas Brenol
Open Journal of Rheumatology and Autoimmune Diseases, Volume 10, pp 95-108; doi:10.4236/ojra.2020.103012

Rheumatoid Arthritis (RA) is an inflammatory disease associated with high morbidity and increased cardiovascular disease, and Metabolic Syndrome (MS) is understood as a set of metabolic disorders that correlates with obesity and sedentary lifestyle. The aim of this study is to evaluate the prevalence of MS in a cohort of patients with RA and its correlation to specific factors of the disease. A retrospective cohort study was conducted with 283 patients with RA, followed at the Rheumatology Outpatient Clinic of the Hospital de Clínicas de Porto Alegre (HCPA) between 2008 and 2016; 187 continued to be followed and agreed to be reevaluated between January and November 2016. MS was defined according to the National Cholesterol Education Program and disease activity was assessed using the Disease Activity Score (DAS28). Clinical, biochemical, and anthropometric evaluations were conducted. The prevalence of MS in the first evaluation was 43.9% and, after 8 years, 59.4%. Increased waist circumference and blood pressures, elevated triglycerides and low High-Density Lipoprotein were the most frequent features of MS. The DAS28 was significantly lower in the reevaluation (p = 0.006). The prevalence of MS was higher at the end of 8 years; disease activity, as well as blood pressure, decreased during this period. Steroid use had also decreased at the end of follow-up. There was an increase of 15% of cases with MS in an 8-year follow-up cohort of patients, which was in agreement with the current literature and showed how the inflammatory process in RA is correlated to MS. The parameters of MS that varied the most were blood pressure, cholesterol and triglycerides. Ultimately, these parameters and disease activity must be observed closely in order to improve the prognosis of patients with RA.
M. Dieng, B. Djiba, M. Sow, B. S. Kane, J. T. Ahouandogbo, M. Ba, M. A. Ndour, B. C. Fall, M. Niasse, N. Diagne, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 10, pp 70-78; doi:10.4236/ojra.2020.102009

Introduction: The extended administration of corticoids by oral way for a length of more than 3 months defines the long-term-corticosteroid-therapy. This one, used in numerous indications, displays most often at the risk of undesirable effects linked sometimes to the habits of prescription of the doctors. Patients and Methods: In order to study the prescription modalities of this treatment, we conducted a cross-sectional, multicentric and descriptive study from June 1st, 2017 to August 1st, 2017, over a period of 2 months. It involved a questionnaire given to medical specialists of all medical specialties and practicing in the University Hospital of Dakar. Results: 170 doctors were interviewed. Dermatologists and internists were mostly found 19.4% and 18.8% or 33% and 34% doctors. Systemic autoimmune diseases alone accounted for 48% of prescription reasons. Prednisone was prescribed in 88% of cases. The immunosuppressive dose of 1 mg/kg was most often prescribed. Practitioners very heterogeneously prescribe most adjuvant measures to prolonged systemic corticosteroid therapy. Thus, the recommendation of a low-sodium diet (38% of physicians), and the systematic prescriptions of proton pump inhibitors (44.7% of physicians) and vitamin-calcium supplementation were frequently performed by physicians (34% of physicians). While the low carbohydrate diet was advocated by less than a quarter of doctors and the prevention of pneumocystosis and osteoporosis were rare (respectively 61% and 52% of prescribers did not). Conclusion: The global analysis of the habits of our medical specialists concerning the use of long-term glucocorticoids reflected a diversity of indications, heterogeneity of practices, with certain habits not in accordance with the usual recommendations.
Kristina Areskoug-Josefsson, Sara Hjalmarsson, Mathilda Björk, Annette Sverker
Open Journal of Rheumatology and Autoimmune Diseases, Volume 10, pp 109-124; doi:10.4236/ojra.2020.103013

Background: Sexual health needs are insufficiently met for persons living with rheumatological diseases and it is necessary to create better ways to meet these needs. Objective: To co-create a working model to improve sexual health for persons living with rheumatological diseases, that can be used by rheumatological teams in regular rheumatology practice. Design: This study applied a co-creation design with three key features: 1) it took a systems perspective with emergent multiple interactive entities; 2) the research process was viewed as a creative endeavour with strong links to design, while human imagination and the individual experience of patient and staff were at the core of the creative design effort; 3) the process of the co-creative efforts was as important as the generated product. Results: A model defining the role of the patient, the professionals, and the team in optimizing sexual health for persons living with rheumatological diseases was co-created. The model can be seen as a practice guideline, which includes the support needed from and to each participant in the process of promoting sexual health, while being within the professional scope of the professionals’ knowledge and capacity, and in line with the needs of the persons living with rheumatological diseases. Discussion and Conclusions: The co-creative work process identified crucial factors in promoting sexual health, resulting in a useful model for patients, professionals and teams. Co-creation was experienced to be a useful research design to improve rheumatological care, through valuing and using the competence of all research members equally.
Rafael Giovani Missé, Luiz Felipe Adsuara De Sousa, Lucas De Macedo Dos Santos, Abrahão Fontes Baptista, Clarice Tanaka, Julia Maria D’Andréa Greve, Samuel Katsuyuki Shinjo
Open Journal of Rheumatology and Autoimmune Diseases, Volume 10, pp 88-93; doi:10.4236/ojra.2020.102011

Transcranial direct current stimulation (tDCS) has emerged as a nonpharmacological tool in physical rehabilitation. There have currently no studies that evaluated the safety and efficacy of tDCS in patients with dermatomyositis. Case-report: Three adult women with dermatomyositis were allocated randomly to intervention (i-tDCS, one patient) or not (sham-tDCS, two patients) of three consecutive days of tDCS and evaluated in four periods: before-tDCS (PRE), 15 minutes after-tDCS (0th POST), 15 days after-tDCS (15th POST), and 30 days after-tDCS (30th POST). The tDCS was safe throughout the protocol, without disease relapsing or adverse effects related to tDCS. Furthermore, the tDCS increased the muscle torque and total work of dominant and non-dominant elbow flexors in the patient with i-tDCS, when compared to two patients with sham-tDCS. Conclusions: The tDCS was safe and appeared to influence long-term strength in the limb of the patient with stable dermatomyo-sitis.
Murat Baloğlu, Engin Deveci, Şenay Deveci
Open Journal of Rheumatology and Autoimmune Diseases, Volume 10, pp 125-131; doi:10.4236/ojra.2020.103014

M. Dieng, B. Djiba, B. S. Kane, B. C. Fall, M. A. Ndour, M. Sow, N. Diagne, A. C. Ndao, A. Faye, S. Ndongo, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 10, pp 57-63; doi:10.4236/ojra.2020.102007

Introduction: The occurrence of tuberculosis (TB) during the follow-up of Connective tissue diseases (CTD) is a particular situation often posing real diagnostic problems. This is an association described in the literature. Patients and methods: We conducted a retrospective and descriptive study at the internal medicine department of Aristide Le Dantec Hospital. The purpose of this study was to determine the treatment that patients followed for CTD and suffering from TB took before the occurrence of this one. Results: During a study period of 11 years and 6 months, 21 cases of TB were diagnosed in 602 cases of CTD (0.03%). The predominance was female with a sex ratio (H/F) of 0.6. The median age was 42 years old. The majority of cases originated from the Dakar region (13 patients or 61.9%) and 85.7% had previous follow-up exclusively in modern medicine and 21 cases (95%) received the CTD’s treatment. This consisted of prednisone (90.5%) combined with methotrexate (52.4%), azathioprine (23.8%) or cyclophosphamide (19.4%). The respective medians doses of these drugs were 12.5 mg per day for prednisone, 13.5 mg per week for methotrexate and 100 mg per day for azathioprine. The median duration of patient follow-up was 36 months. The cumulative dose of prednisone during this period was 23.6 g and that of methotrexate 2.25 g. CTD were dominated by rheumatoid arthritis (RA) (57.1%), and systemic lupus (19%). Isolated cases of systemic scleroderma, primary Sjôgren, SHARP syndrom, mixed connective tissue disease, and multiple autoimmune syndrom were noted. TB was localized in 95% of cases, readily bilateral and poorly disseminated. The respective medians diagnostic delays for systemic disease and TB were 21 months and 5 months. Tuberculin intradermal reaction was performed in 16 cases and was positive in 9 cases, sputum bacilli was performed in 19 cases and was positive in 15 cases. Conclusion: The association of TB and CTD was characterized by its rarity, its poorly disseminated character and its frequency on RA field.
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