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 ≅ 203
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Abdurhman Saud Al Arfaj, Najma Khalil
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 9-18; doi:10.4236/ojra.2021.111002

Eye and/or orbit involvement occurs in Granulomatosis with polyangiitis (GPA) patients frequently. The aim of our study was to describe the clinical manifestations, therapy and outcome of ocular involvement in our GPA patients. A retrospective study was conducted including patients with GPA who followed up in Rheumatology clinics during 1990-2016 at King Khalid University Hospital, Riyadh. Information relating to demographics, ocular manifestations, laboratory findings, therapy and outcome of GPA patients were noted. Ocular involvement was detected in 9 (39.1%) of the 23 GPA cases identified. The mean age of ocular GPA patients was 51.8 (range 27 - 62) years, the mean age at onset of disease was 39.6 (range 11 - 57) years and the mean duration of disease was 9.0 (range 2 - 19) years. Concomitant ear, nose, throat and sino-nasal manifestations occurred with ocular symptoms in 77.8% GPA patients. The most frequent manifestations were, eye pain (66.7%), scleritis/episcleritis (55.6%), eye redness and itching (55.6% each). Antineutrophil cytoplasmic antibodies (ANCA) were positive in 88.9% patients, 55.6% had c-ANCA and 33.3% had p-ANCA. Infections were observed in 22.2% of patients, which included pneumonia in one patient and esophageal candidiasis and bacterial meningitis in another. All patients received oral prednisolone, 44.4% received intravenous cyclophosphamide, 22.2% refractory cases received rituximab doses and the disease outcome was good. Comparison of ocular GPA with non-ocular GPA patients showed that 77.8% of ocular GPA patients had concomitant sino-nasal symptoms compared to 42.9% in non-ocular GPA patients and 22.2% of the ocular GPA patients had renal involvement compared to 64.3% in non-ocular GPA patients (p = 0.049). We found that the frequency of ocular manifestations in our GPA patients was similar to reports elsewhere, and the most frequent symptom was eye pain and scleritis/episcleritis.
Kaba Condé, Carlos Othon Guelngar, Igué Kadidjatou, D. D. Granga, Mamadou Ciré Barry, Mamadou Hady, Karinka Diawara, Konaté Mamady, Touré Moriba, AwadA Mohamed, et al.
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 48-52; doi:10.4236/ojra.2021.112006

Tuberculous sacroiliitis secondary to a psoas abscess is rare, only a few sporadic cases were reported in the literature. Tuberculous sacroiliitis is rare, usually unilateral, its symptomatology is misleading, its diagnosis is often delayed or even confused with damage to the hip or lumbosacral hinge, most often related to difficulties exploration of the sacroiliac joint. We report the case of a 66-year-old diabetic patient with low back pain, unilateral right with inflammatory appearance, insidious installation, evolving for about 8 months. The diagnosis of tuberculous sacroiliitis was made after biopsy of the sacroiliac joint. CT and MRI are necessary for lesion diagnosis. Tuberculosis treatment was started and the abscess was surgically drained. The aim of this work was to describe the diagnostic pathway of a patient with tuberculous sacroiliitis in a tropical environment. Conclusion: Tuberculous sacroiliitis, secondary to an abscess of the psoas muscle is an unusual cause of hip pain and is likely to be overlooked due to its atypical presentation.
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; doi:10.4236/ojra.2021.112005

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; doi:10.4236/ojra.2021.111001

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.
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; doi:10.4236/ojra.2021.112007

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.
Mohammad Al Mousa, Fahad Al Muhanna, Ahmad Al Shami, Yaser M. Ali
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 19-27; doi:10.4236/ojra.2021.111003

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.
Soukaina Zaher, Kawtar Nassar, Ibtissam Razzouki, Meriem Regragui, Mehdi Karkouri, Saadia Janani
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 29-35; doi:10.4236/ojra.2021.112004

Background: The association of primary Sjögren syndrome (PSS) and AA amyloidosis is a rare occurrence. Objective: To describe the phenotype of patients with this association through our two cases and a literature review. Materials and methods: A report of two cases of AA amyloidosis complicating primary Sjögren syndrome with a literature review. Results: Eight patients of Primary Sjögren’s Syndrome complicated by AA amyloidosis were studies. Six cases were reported in the literature by consulting several databases. 50% of patients had a positive immunological assessment, three cases with kidney damage, and three cases lung damage. Conclusion: The immunological activity in the Primary Sjogren’s Syndrome requires the search not only a lymphoma but also AA amyloidosis apart from any clinical or biological chronic inflammation.
Adel Elbeialy, Abdlnby Bauomi, Basma Elnaggar, Hala Elzomor
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 79-88; doi:10.4236/ojra.2021.112010

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.
Adel A. Elbeialy, Hesham M. Eldesouky, Noha E. Mosellhy
Open Journal of Rheumatology and Autoimmune Diseases, Volume 11, pp 64-72; doi:10.4236/ojra.2021.112008

Subject: SLE is an autoimmune disease with skin, joint, renal, cardiovascular, and nervous manifestations. The disease is classified as an immune complex-mediated disease and is characterized by the production of various autoantibodies. Until now, more than 100 autoantibodies have been identified. Patients and methods: This study was performed on 200 SLE patients. All of them were females and their ages ranged from 20 to 49 years. All participants in this study were subjected to physical examination, thorough history taking including age, sex, age of onset, duration of SLE disease, family history, and SLEDAI. Laboratory investigations included: CBC, ESR, liver function tests, renal function tests, ANA, Anti-dsDNA, CRP, Complements C3, C4, and Anti-NCS. Results: There was a highly significant inverse correlation between anti-NCS antibodies and Hb level, a significant direct correlation between anti-NCS antibodies and 24hr proteinuria, a significant inverse correlation between anti-NCS antibodies and complements (C3 and C4), a significant correlation between anti-NCS antibodies and anti dsDNA antibodies, a significant correlation between anti-NCS and disease activity, SLEDAI, and renal affection. Conclusion: Anti-NCS antibody can be a useful tool in the diagnosis of SLE especially in patients who are negative for anti-ds DNA antibodies.
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; doi:10.4236/ojra.2021.112011

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.
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