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 ≅ 222
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Ahmad Al-Shami, Naser Al Hadhood
Open Journal of Rheumatology and Autoimmune Diseases, Volume 12, pp 46-55; https://doi.org/10.4236/ojra.2022.121006

Abstract:
This report describes clinical findings of a 28-year old female patient presented with non-healing digit ulcer and Raynaud’s phenomenon. Upon investigation was found to have high eosinophil count alongside hypocomplementemia. This patient was diagnosed with diffuse cutaneous systemic sclerosis and was started on therapy; her other laboratory findings were attributed to a coinciding helminthic infection. This case suggests the possibility of having two different diagnoses presenting at once causing a clinical dilemma.
Cyrille Komi Tagbor, Viwale Etonam Sika Koffi-Tessio, Prenam Houzou, Eyram Fianyo, Kodjo Kakpovi, Kokou Hefoume Amegan-Aho, Sadat Oniankitan, Awaki-Esso Atake, Victor Adjenou, Owonayo Oniankitan, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 12, pp 21-28; https://doi.org/10.4236/ojra.2022.121003

Abstract:
Objectives: To determine the frequency, the clinical and radiological features of lumbar spondylolisthesis in a rheumatological practice in Lomé. Patients and methods: This was a cross-sectional study conducted in the rheumatology department of the Sylvanus Olympio Teaching Hospital in Lomé between January 1997 and December 2019. Medical records of patients with symptomatic spondylolisthesis with radiographic confirmation were reviewed. The Meyerding classification system was used for grading. Results: Of the 350 patients contacted, 118 consented to participate in the study, making a response rate of 33.71%. Of the 118, 104 (88.1%) were females. 109 (92.4%) presented with radicular pain and 9 (7.6%) presented low back pain. The mean age of the patients was 54.24 ± 11.19 years. The average duration of the pain was 4.56 ± 1.32 years. The spondylolisthesis level most involved was the L4 - L5 (92/118), followed by L5 - S1 (23/118). 106 (89.8%) patients had anterolisthesis only, seven (5.9%) combination anterolisthesis and retrolisthesis. The spondylolisthesis was associated with spondylosis in 110 (93.2%) patients. Spondylosis was found at level L4 - L5 in 38.98% patients, followed by L5 - S1 (24.58%), L3 - L4 (18.64%). Grade I slip was found in 108 (91.53%) patients and Grade II slips 10 (8.47%). Isthmic lysis was found in 40 (33.9%) patients and it was located at L4 in 30 (75.0%). Conclusion: Lumbar spondylolisthesis appears to be expected in Lomé patients with nonspecific back pain and mainly affects females.
Giovana Gabriela Koptian, Dalianna Luise Andrade Souto Rodrigues, Luiz Felipe Adsuara de Sousa, Dawton Yukito Torigoe
Open Journal of Rheumatology and Autoimmune Diseases, Volume 12, pp 65-70; https://doi.org/10.4236/ojra.2022.122008

Abstract:
Dermatomyositis (DM) is a rare systemic autoimmune disease characterized by symmetrical and predominantly proximal muscle weakness in the limbs, associated with typical skin lesions. Autoimmune diseases have already been described as an adverse effect of vaccines. Case-report: A 65-year-old Caucasian female patient evolved, 5 days after the first dose of the AZD1222 vaccine against the COVID-19 virus, with skin lesions suggesting heliotrope and Gottron’s sign, with partial improvement of the condition with use of topical glucocorticoids in the lesions. After two months, the patient received the second dose of AZD1222 vaccine, and evolved with proximal muscle weakness of upper and lower limbs, dysphagia, increase of muscle enzymes, in addition to skin lesions compatible with heliotrope and Gottron’s sign again. After treatment with pulse therapy with methylprednisolone 1000 mg per day for three days and treatment with immunosuppressants, she evolved with significant clinical improvement. Conclusions: This case-report demonstrating an important chronological relationship between dermatomyositis and the vaccine AZD1222 alerts to the possibility of the disease as an important adverse reaction of vaccine against COVID-19 virus, as has been recently described by other authors.
Aly Badra Kamissoko, Ibrahima Sory Barry, Marina Sanda, Cletus Dieuval Houngbegnon, Mamadou Lamine Diallo, Abdoulaye Barry, Mamadou Dadhi Baldé, Owonayo Oniankitan
Open Journal of Rheumatology and Autoimmune Diseases, Volume 12, pp 57-64; https://doi.org/10.4236/ojra.2022.122007

Abstract:
Introduction: Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease. It is a systemic disease with extra-articular manifestations that can be life-threatening. In sub-Saharan Africa, there is little published information on cardiovascular manifestations in RA. Objective: The objective is to determine the asymptomatic cardiac manifestations during rheumatoid arthritis in Conakry. Patients and Methods: This was a cross-sectional study lasting 6 months from January 1, 2020 to June 30, 2020 in the rheumatology and cardiology departments of the Ignace Deen National Hospital. Patients with RA diagnosed according to the 2010 ACR/EULAR criteria, asymptomatic at the cardiovascular level, which had an ECG and echocardiography, were included in the study. Left ventricular diastolic dysfunction was considered in any patient with an E/A ratio 1, an E/E’ ratio > 10, and an LVEF = 50%, assessed by the Simpson biplane method and classified according to Redfield. Epidemiological, clinical and paraclinical data were analyzed using SPSS statistics 21.0 software. Results: Seventeen cases of rheumatoid arthritis (5.9%) were collected. There was a predominance of women with 14 cases (82.4%). The mean age of patients was 48.2 ± 11.9 years. The average duration of RA was 7.2 ± 4.2 years. Cardiovascular risk factors were dominated by overweight and obesity (58.8%) and sedentary lifestyle (35.3%). RA was predominantly high activity (DAS 28 ≥ 5.1) in 82.4% of patients. Anti-CCP antibodies were positive in 76.9% of cases. Fourteen patients (82.4%) had abnormal cardiac results. The electrocardiogram showed left atrial hypertrophy in 29.4% of cases, left ventricular hypertrophy (11.8%) and ventricular extrasystole (11.8%). The cardiac Doppler scan showed diastolic dysfunction of the left ventricle (47.1%) and moderate pericardial effusion in 11.8% of cases. Conclusion: The study found asymptomatic cardiac manifestations of rheumatoid arthritis. They were dominated by ventricular hypertrophy on electrocardiogram and left ventricular diastolic dysfunction on cardiac Doppler ultrasound. Systematic examination of patients with RA is necessary to detect them early and avoid complications.
Marta B. Bean, Chris T. Derk
Open Journal of Rheumatology and Autoimmune Diseases, Volume 12, pp 35-45; https://doi.org/10.4236/ojra.2022.121005

Abstract:
Introduction: Cutaneous manifestations of systemic sclerosis (SSc) include skin ulceration; 4% - 12% of patients with SSc develop lower extremity ulcers of various etiologies. Limited data, significant morbidity, and substantial cost of wound care led us to undertake this study to describe and identify risk factors. Methods: After Institutional Review Board approval, we identified 30 patients with SSc and lower extremity ulcers over a 10-year period at a single center with an SSc clinic, which were included in a descriptive analysis. Results: Median age of onset of lower extremity ulcers was 59.5 years (range 20 - 84). Ninety percent of patients were female, 60% were Caucasian, 63% had limited SSc, 13% diffuse SSc and 23% an overlap syndrome. Immunomodulators or steroids were prescribed in 53%; hypercoagulable state identified in 16%. Ulcers were attributed to venous stasis (27%), SSc (20%), trauma (20%), arterial disease (17%), and multifactorial/unknown (17%). In patients with ulcers attributed to SSc, age at onset was lower (45.5 vs 59.5 years). Biopsies generally did not contribute to management. Multidisciplinary treatment was routine; 20% required amputation, 10% endovascular intervention, 20% frequent surgical debridement, 10% hyperbaric oxygen, 26% local treatment and antibiotics and 13% received immunosuppression for wound treatment. Conclusion: Lower extremity ulcers are a serious clinical problem in patients with SSc. The clinical exam, venous dopplers, ankle-brachial indices and assessment of vascular risk factors helped define causality. In younger patients, ulcers were more frequently attributed to SSc and these patients were more likely to be on immunosuppressants/DMARDS, possibly indicating severe phenotype of SSc.
Paul Eloundou, Aly Badra Kamissoko, Francine Same Bebey, Marina Sanda, Al Mâmy Aboubakar, William Nguekouo, Abèni Faouziyath Yaya, Mireille Yomba, Severin Noumbissi
Open Journal of Rheumatology and Autoimmune Diseases, Volume 12, pp 29-34; https://doi.org/10.4236/ojra.2022.121004

Abstract:
Background: Cogan’s syndrome is a rare autoimmune vasculitis (less than 300 cases described in the literature) characterized in its typical form by cochleovestibular involvement, interstitial keratitis, and an inflammatory involvement of large vessels. It is frequently accompanied by general signs and cardio-vascular, rheumatologic, and digestive complications. Its management is essentially based on the use of corticosteroids and immunosuppressants. The outcome of the treatment, even if rapid, does not always avoid functional complications. This disease is probably under-diagnosed in Africa. Objective: The objective of this study was to report a case of Cogan syndrome in sub-Saharan Africa. Case report: A 78 year old black African female patient presented with arthritis of the left knee without fever. The examination also revealed a bilateral deafness of rapidly progressive onset. The patient was known to be diabetic and hypertensive, and was regularly monitored. The biology revealed an inflammatory syndrome and an inflammatory joint puncture fluid. Pure tone audiometry confirmed a 77% hearing loss. The ophthalmological examination revealed stromal oedema and hypertensive retinopathy of Kendall stage III. The rheumatological evolution was good under methylprednisolone and methotrexate, but the deafness persisted. The occurrence of a fever on day 12 of treatment required further investigations (blood culture, PCR-Covid 19 test, cytobacteriological examination of sputum, thoracic CT). The evolution was unfavourable with the death of the patient. Conclusion: Cogan’s disease is a rare inflammatory disease. Its diagnosis and management are multidisciplinary. The treatment can be disappointing.
Kodjo Kakpovi, Sadat Oniankitan, Komi C. Tagbor, Koulouktsoa Kondian, Viwalé Es Koffi-Tessio, Awaki-Esso Atake, Lamine Mamadou Diallo, Pahimi Yibe, Erika Djougnwe Mba, Moubarak Tiadjeri, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 12, pp 9-20; https://doi.org/10.4236/ojra.2022.121002

Abstract:
Chronic inflammatory rheumatism is a pathology of variable frequency and severity with a significant impact on the socio-economic, personal and family level. Study Aim: To describe the epidemiological, clinical, laboratory, radiological, therapeutic and evolutive features of chronic inflammatory rheumatic diseases in rheumatological practice in Togo. Patients and Methods: This was a multicenter cross-sectional study conducted from January 2011 to December 2019 on patients examined in the three rheumatology departments in Lomé (Togo). Patients 18 years old and above who have presented joint pain with or without synovitis, and/or rachialgia (back pain) for at least three months were included. The diagnosis of chronic inflammatory rheumatic diseases was made according to international consensus criteria. Results: Out of the 20333 patients whose files were collected during our study period, 290 (1.43%) suffered from chronic inflammatory rheumatic diseases. There were 226 (77.93%) females and 64 (22.07%) males. The mean age of the patients was 42.79 ± 15.18 years. The mean duration of symptoms was 40.80 ± 54.09 months. Arthritis (67.24%) was the main reason for consultation, followed by joint pain (31.38%). rheumatoid arthritis (41.03%), unclassified chronic inflammatory rheumatic diseases (38.62%), spondyloarthropathies (15.17%) and systemic lupus erythematosus (2.41%) were the major clinical forms. The immunological tests performed in 13.79% of cases were positive in 52.94% of cases. Carpitis (57.55%) and diffuse osteoporosis (45.28%) were the commonest radiographic features of the hands. 289 patients (99.66%) received symptomatic treatments such as NSAIDs (73.36%) and corticosteroids (51.90%) and 90 patients (31.03%) were treated with synthetic DMARDs such as methotrexate (88.89%). The outcome was favorable in 27.93% of cases. Conclusion: Chronic inflammatory rheumatic diseases are common diseases in rheumatological practice in Togo that deserve special attention. The establishment of a specialized immunology laboratory could be very useful for the diagnosis and early management of these diseases.
Mohammed Reda Sewilam, Nasser Al Hadhood
Open Journal of Rheumatology and Autoimmune Diseases, Volume 12, pp 71-82; https://doi.org/10.4236/ojra.2022.123009

Abstract:
Rat-bite is uncommon worldwide, excluding developing countries. The history of a bite is usually missed if not meticulously asked for in history, proper exposure and examination. Today we report a case of culture-negative rat-bite fever with poly septic arthritis resembling a rheumatoid arthritis-like picture in a 64-year-old gentleman. The presentation at first imitated an arthritis-like picture which was polyarthritis affecting the right ankle, right knee, right wrist, right proximal interphalangeal, left metacarpophalangeal and proximal interphalangeal joints.
Kodjo Kakpovi, Awaki-Esso Atake, Prenam Houzou, Issa Diallo, Mamadou L. Diallo, Viwale E. Koffi-Tessio, Komi C. Tagbor, Sadat Oniankitan, Pahimi Yibe, Erika Djougnwe Mba, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 12, pp 1-8; https://doi.org/10.4236/ojra.2022.121001

Abstract:
Infectious spondylodiscitis in the elderly is a diagnostic and therapeutic emergency. They are mainly a functional and sometimes vital prognosis issue, with long-term chronic disabling sequelae and significant social costs. Study aim: To describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of infectious spondylodiscitis in the elderly in a rheumatological setting in Togo. Patients and methods: This was a multicenter, cross-sectional study conducted on the records of patients aged at least 65 years, suffering from infectious spondylodiscitis and hospitalized in four rheumatology units from their respective opening dates till December 31, 2020. Data collection lasted three months (December 1, 2020 to February 29, 2021). The diagnosis of infectious spondylodiscitis was radioclinical and laboratory-based. Results: 83 (49 women, 34 men) of the 1281 patients (6.48%) examined had infectious spondylodiscitis. The mean age at consultation was 70.59 ± 5.09 years, and the mean duration of the clinical course was 12 months. Spondylodiscitis was of tuberculous etiology (89.20%). It was most often found in the lumbar (56.62%) and dorsal (21.69%) segments. The location was multifocal in 12.05% of cases. It was associated with pulmonary involvement in 22.64% of cases. A neurological complication was identified in 48.19%. The main risk factors identified were promiscuity (48.82%), chronic alcoholism (18.07%), HIV infection (8.43%), diabetes (6.03%) and sickle cell disease (6.03%). The clinical course under medical treatment was favorable in 57 patients (68.68%). Conclusion: Infectious spondylodiscitis remains a frequent reason for hospitalization, tuberculosis being the most frequent etiology. Multifocal location, deterioration of general condition, gibbosity and neurological complications are exclusive to the elderly subject.
Heloisa Lima Heller, Aline Rizzo Borges, Luís Otávio Amarante Franco, João Pedro De Oliveira Aucelio, Marcos Igor Albanaz Vargas, Rebeca Naoum Lorga, Mirella Bastos Sales, Natália Vargas Do Nascimento, Gabriela Furlan Ribeiro Barbosa Netto, Beatriz Carneiro Passos, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 169-187; https://doi.org/10.4236/ojra.2021.114018

Abstract:
A literature search of articles from 2002-2019 was performed using Medline, Embase, Cochrane, LILACS, IBECS, CRD, and Epistemonikos databases, to analyze the effects of Cognitive-Behavioral Therapy (CBT) in the treatment of fibromyalgia. Twenty-seven articles were selected in which CBT was performed exclusively by specialist physicians, associated or not with conventional pharmacological treatment and/or physical exercise. In most articles, CBT worked with self-knowledge and cognitive restructuring, attempting to reduce pain perception, and it showed a general improvement in daily activities by decreasing patient’s limitations, such as morning stiffness. The literature showed significant correlations of CBT in pain processing over time. When CBT was compared to conventional pharmacological therapy, a certain superiority of CBT could be observed concerning the quality of life, catastrophizing, and acceptance of pain. However, when they were simultaneously applied, this improvement in quality of life was not observed.
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