[Factors associated with the quality of life of patients with knee osteoarthritis]. / Facteurs associes a la qualite de vie des patients ayant une gonarthrose.

INTRODUCTION: knee osteoarthritis, a common condition in Sub-Saharan Africa, affects the quality of life of patients. OBJECTIVE: Identify the factors associated with impaired quality of life. PATIENTS AND METHODS: Cross-sectional and analytical study, carried out in the Department of Rheumatology at the University Teaching Hospital of Brazzaville, in two steps. The first made it possible to collect data of patients diagnosed as having knee osteoarthritis according to the the ACR criteria of 1986 and followed up from January 1st, 2013 to December 31st, 2017. The second step consisted in measuring the quality of life of patients using a specific quality-of-life questionnaire for knee and hip osteoarthritis OAKHQOL, then identifying by bivariate analysis after analysis of variance (ANOVA), the factors associated with an impairment of the quality of life (P≤ 5%). It took place from May 02 to November 02, 2018 (6 months). One hundred and nineteen patients were investigated. RESULTS: We included in this study 103 women and 16 men (sex ratio M / F of 1/6). The average age was 56.1 ± 9 years (range 27 to 77 years). The mean evolution time was 5.1 ± 3.6 years. The knee osteoarthritis moderately impaired the overall quality of life of patients. The most affected dimensions were physical activity and pain (51.3% and 42.9% of patients between 25 and 50 respectively). The evolution time and functional impact were potentially associated with all dimensions of quality of life. Age was associated with poorer quality of life in the physical activities (p = 0.012) and social activities (p = 0.001) dimensions, as was obesity, with the social activities dimension (p = 0.004). CONCLUSION: The duration of evolution and the functional impact were associated with deterioration in the quality of life.

INTRODUCTION: La gonarthrose, affection fréquente en Afrique Sub-saharienne, altère la qualité de vie des patients. OBJECTIF: Identifier les facteurs associés à l'altération de la qualité de vie. PATIENTS ET MÉTHODES: Etude transversale, descriptive et analytique, menée dans le Service de Rhumatologie du CHU de Brazzaville, en deux étapes. La première a permis de colliger les dossiers des patients diagnostiqués selon les critères de l'ACR de 1986 et suivis pour une gonarthrose du 1er janvier 2013 au 31 décembre 2017. La seconde consistait, en la mesure de la qualité de vie des patients identifiés à l'aide du questionnaire AMIQUAL, puis à identifier par analyse bivariée après analyse de la variance (ANOVA), les facteurs associés à une altération de la qualité de vie (P≤ 5%). Elle s'est déroulée du 02 mai au 02 novembre 2018 (6 mois). Cent dix-neuf patients ont été enquêtés. RÉSULTATS: 103 femmes et 16 hommes (sexe ratio H/F de 1/6). L'âge moyen était de 56,1 ± 9 ans (extrêmes 27 à 77 ans). La durée moyenne d'évolution était de 5,1 ± 3,6 ans. La gonarthrose altérait de façon modérée la qualité de vie globale des patients. Les dimensions les plus touchées étaient les activités physiques et la douleur (respectivement 51,3% et 42,9% des patients entre 25 et 50). La durée d'évolution et le retentissement fonctionnel étaient potentiellement associés à toutes les dimensions de la qualité de vie. L'âge était associé à une moins bonne qualité de vie dans les dimensions activités physiques (p=0,012) et activités sociales (p=0,001), de même l'obésité avec à la dimension activités sociales (p=0,004). CONCLUSION: la durée d'évolution et le retentissement fonctionnel étaient associés une altération de la qualité de vie.

[Visceral Comorbidities Associated With Gout: About 75 Patients Followed At Brazzaville University Teaching Hospital (Congo)]. / Comorbidites Viscerales Associees A La Goutte : À propos de 75 patients suivis au CHU de Brazzaville (Congo).

OBJECTIVE: To investigate visceral comorbidities observed during gout. PATIENTS AND METHOD: A descriptive and analytical cross-sectional study of gout patients diagnosed according to the ACR 1977 criteria, followed between January 1, 2012 and January 31, 2017 in the Rheumatology Department of the Brazzaville University Teaching Hospital in Congo. Patients were assessed for visceral cardiovascular, renal, and cerebral comorbidities. RESULTS: 105 patients with gout were identified during the study period, 75 (71.43%) of whom met the inclusion criteria, thus constituting the study population. There were 60 men and 15 women (sex ratio 4/1), mean age 60 +/- 11.47 years (range: 30-82 years). Visceral co-morbidities were represented in 50.67% of cases. These included renal failure (21.33%), coronary heart disease (14.67%), stroke (12%) and heart failure (2.67%). The presence of comorbidities was associated with irregular follow-up in 86.56% of cases (P = 0.025) and therapeutic nonobservance in 93.75% of cases (P = 0.006). CONCLUSION: Gout is a serious disease because of the frequency of its visceral comorbidities. Irregular monitoring and therapeutic nonobservance are the main factors associated with this.

OBJECTIF: Rechercher les comorbidités viscérales observées au cours de la goutte. PATIENTS ET MÉTHODE: Etude transversale descriptive et analytique, portant sur les patients goutteux diagnostiqués selon les critères ACR 1977, suivis entre le 1erjanvier 2012 et le 31 janvier 2017 dans le service de Rhumatologie du CHU de Brazzaville au Congo. Les patients ont été évalués à la recherche de comorbidités viscérales cardiovasculaires, rénales et cérébrales. RÉSULTATS: 105 patients goutteux ont été répertoriés durant la période d'étude, dont 75 (71,43%) qui répondaient aux critères d'inclusion, constituant ainsi la population d'étude. Il s'agissait de 60 hommes et de 15 femmes (sex-ratio de 4/1), d'âge moyen de 60 +/- 11,47 ans (extrêmes: 30-82 ans). Les comorbidités viscérales étaient représentées dans 50,67 % des cas. Il s'agissait de l'insuffisance rénale (21,33%), la maladie coronarienne (14,67%), les AVC (12%) et l'insuffisance cardiaque (2,67%). La présence des comorbidités était associée à un suivi irrégulier dans 86,56% des cas (P=0,025) et une mauvaise observance thérapeutique dans 93,75% des cas (P=0,006). CONCLUSION: La goutte est une maladie grave de par la fréquence de ses comorbidités viscérales. Le suivi irrégulier et l'inobservance thérapeutique en sont les principaux facteurs associés.

Rheumatic diseases in patients attending a clinic at a referral hospital in Yaounde, Cameroon.

BACKGROUND: The spectrum of rheumatic diseases in sub-Saharan Africa remains poorly defined. OBJECTIVES: To determine the spectrum of rheumatic diseases in Yaounde. DESIGN: Descriptive cross-sectional study. SETTING: Rheumatology clinic at the Yaounde General Hospital, Cameroon. SUBJECTS: Twelve thousand four hundred and ninety four patients were referred to the outpatient department of the Internal Medicine service of the General Hospital of Yaounde over a 12-month period. Of these cases, 536 (9.4%) were diagnosed as belonging to the general class of rheumatic conditions. There were 334 (62.31%) females and 202 (37.69%) males. The mean age was 52.72 +/- 5.3 years. RESULTS: The 536 cases were further classified as follows: degenerative disease of the spine 196 (36.5%), osteoarthritis of the limbs 110 (20.5%), regional musculo-skeletal disorders 83 (15.5%), arthritis associated with infections 50 (9.3%), chronic inflammatory and connective tissue diseases 44 (8.2%), crystalline arthropathies 32 (5.9%) and miscellaneous (unclassified) rheumatic conditions 21 (4.1%). CONCLUSION: From these results, we concluded that degenerative disease of the spine and limbs are the most common forms of rheumatic disease in this region. Gout is the most commnon acute inflammatory arthropathy and rheumatoid arthritis the most prevalent arthropathy due to chronic inflammation.

[Cutaneous B-cell lymphoma in a 50 year old woman at Brazsaville University Teaching Hospital]. / Localisation cutanee d'un lymphome B chez une femme de 50 ans au CHU de Brazzaville.

The authors report one case of no epidermotropic cutaneous B-cell lymphoma on 50-year-old female patient, with acute evolution, presenting cutaneous, spleen, peritonea and ophthalmologic multiple nodular lesions, diagnosed while a knee staphylococcus aureus septic arthritis.

[Human immunodeficiency virus associated arthritis in Congo Brazzaville]. / Les arthrites liées au virus de l'immunodéficience humaine au Congo Brazzaville.

OBJECTIVE: The authors report epidemiologic, clinical, para clinical, and evolutive aspects of arthritis related to HIV in an AIDS endemic country. MATERIAL AND METHODS: A retrospective study was made in the rheumatology department of the Brazzaville University Teaching Hospital during 15 years and 6 months, on 3.042 in-patients among whom 306 (10%) were positive for HIV, 220 (7.2%) presented with a rheumatologic manifestation, and 158 (71.8%) with HIV related arthritis. RESULTS: The 158 patients included 91 men (57.6%), 67 women (42.4%), average 34.5 years of age, ranging from 15 to 61, all heterosexual. 99 patients (62.7%) were in the B stage, 40 (25.3%) in the C stage, and 19 (12.2%) in the A stage. Arthritis was polyarthritis (83.5%) or oligoarthritis (16.5%), symmetrical (97.5%), prevailing on the lower limbs (99.3%) with involvement of the great toe in 23% of cases. There was an important inflammatory syndrome with an erythrocyte sedimentation rate exceeding 100 mm for the 1st hour in 63.3% of the cases. Rhumatoid factors were negative. Synovial fluid was sterile, without microcrystals, and inflammatory. X-rays were normal. This non-destructive arthritis, evolved by successive bouts, and resolved in 2 to 5 weeks with NSAIDs and did not meet Amor nor European spondyloarthropathy criteria. CONCLUSION: Arthritis related to HIV represents the principal expression of nonseptic rheumatologic HIV manifestations in Congo.

[Pathological fracture revealing an osseous histoplasmosis. A case report on a 60-year patient]. / Fracture pathologique révélant une histoplasmose osseuse. A propos d'une observation chez une patiente de 60 ans.

The authors report a new case of African Histoplasmosis in a 60-year-old patient. It was an humeral localization revealing a pathological fracture which grew into an extension of osteolysis and a cutaneous fistulization likely to be a malignant bone tumor. The case has been diagnosed by surgical biopsy and histological analysis. Its antifungal treatment in progress resulted in the drainage of the out-flow that should permit the bone reconstruction by graft. The authors stress on the need to focus on this affection whenever, in a tropical area, one is faced with any chronic bone fistula that cannot positively be cured in spite of sound medical cares.

[Retrospective study of 53 erysipelas cases in Brazzaville University Hospital, Congo]. / Etude rétrospective de 53 erysipèles hospitalisés au CHU de Brazzaville, Congo.

Hospitalizations for erysipelas became frequent in the Brazzaville (Congo) service of dermatology. A link between the use of topical corticosteroids for bleaching purpose and erysipelas cases of the leg in women users has been evoked. We carried out a retrospective survey over eleven months analysing 53 files of patients hospitalized for erysipelas, among which 48 cases (91%) concerned topical corticosteroids users and 5 cases of (9%) non users. The average age of these patients was 26 years old, with extremes 18 and 55, for an hospitalization varying between 3 weeks and one month.

[Septic arthritis in tropical environment. 176 cases report in Brazzaville]. / Les arthrites septiques en zone tropicale. a propos de 176 cas observes a Brazzaville.

OBJECTIVE: We report epidemiologic, clinic, para clinic, therapeutic and evolution aspects of septic arthritis in African tropical zone. MATERIAL AND METHODS: Retrospective survey in rheumatologic department of Brazzaville University Teaching Hospital over a period of 15 years and 6 months carrying on 176 septic arthritis observed among 3042 hospitalized patients. RESULTS: 70 men (39.77%) and 106 women (60.23%) average 35.25 years old, extremes 6 and 81 years. It was 158 cases of banal germ arthritis (89%) and 18 cases of tuberculosis arthritis (11%). The arthritis localised on knee in 42% of cases, hip 30%, sacroiliac joint 17% and shoulder 7%. Localization was multiple in 12%. A portal of entry was identified in 54% of cases. It was cutaneous in 21.5% and obstetrical in 16.5%. Risk factors were alcohol and tobacco (5.6%), diabetes mellitus (4%), sickle cell anaemia (4%) and HIV (3%). The diagnosis delay beyond of one month has been noted in 2/3 of cases. The causal germ can be isolated only in 30% of cases. It was staphylococcus aureus in 46.4% of cases, streptococcus in 10,7% and enterobacteria in 10.7% of cases. Koch bacillus has been isolated in 32% of cases. Inflammatory syndrome was important with an erythrocyte sedimentation rate upper 50 mm in 71% of cases. On X-ray, we noted in 64% of cases cartilaginous destruction signs and erosions in mirror. Antibiotics treatment associated to plastered immobilization were successful in 78% of cases but with functional prognostic in half of cases. The middle length of hospitalization was 25 days. Four patients died. CONCLUSION: Septic arthritis are very frequent in African tropical environment, localized to knee, hip and sacroiliac joint. Staphylococcus is recovered in the half of cases and Koch bacillus in 1/3 of cases. Late diagnosis explains cartilaginous destructions and ulterior functional prognostic.

[Knee septic arthritis: 100 cases report in intertropical zone]. / Cent cas d'arthrites septiques du genou en zone intertropicale.

The authors report 100 cases of knee septic arthritis seen during ten years among 2298 patients admitted in the rheumatology department of Brazzaville university teaching hospital. Bone and joint infection is the first hospitalisation cause in this service. Knee is the first septic localization with 42% of cases coming before hip 25%, sacro-iliac 18% and shoulder 7%. Patients are 56 males and 44 females aged from 5 to 79 years old, average 35 years. Most frequently germs are Staphylococcus aureus in half cases, Mycobacterium tuberculosis in 30% of cases and gram-negative bacillus. Contributing factors are AIDS: 12 cases, diabetes mellitus: 7 cases, alcohol-tobacco intoxications: 4 cases, ickle-cell disease: 3 cases, gout and renal failure in 2 cases each. Late diagnosis and consultation, inadapted antibiotic drugs are responsible for important articular damages compromising further functional prognosis.

[Four first Congolese cases of pelvic ankylosing spondylitis]. / Quatre premiers cas congolais de pelvispondylite rhumatismale.

The authors report four ankylosing spondylitis cases observed within 11 years (1990-2000) of rheumatologic exercise among 10,000 patients examined in consultation and hospitalization at Brazzaville university teaching hospital. It confirms that ankylosing spondylitis is a rare disease in sub-Saharan black Africa.

[Multiple exostoses. The first 4 Congolese cases]. / La maladie des exostoses multiples. Les 4 premiers cas congolais.

UNLABELLED: Multiple cartilaginous exostoses disease is a deforming chondrodysplasia with a single autosomal dominant transmission and complete penetrance. In this work, we report 4 Congolese cases diagnosed over a period of 10 years in the rheumatology department of the Brazzaville university hospital, with complete picture and familiar form. RESULTS: Number = 3 females and 1 male aged respectively 14, 18, 20 and 21 years, including 1 brother and 1 sister. Low height and weight, concave forearm, short ulneas, limitation in pronation and supination movement, bilateral knee valgus, ankle valgus, cubic feet. Dextroconvex dorsal scoliosis and blue sclera were observed. Multiple exostoses in descending metaphysis in 1/3 superior of the tibias, humerus, ulneas and peroneal bones; ascending of 1/3 lower of both femur, ulneas and tibias; at the level of great and small trochanters with enlargement of the metaphysis; superior radio-ulnar and peroneo-tibial synostosis; spina bifida in D1-D2; tomato shape of the pelvis. Exostosis is an benign ostochondroma of spongious bone. Because of the risk of the disease developing into cancer, regular control of patients is warranted.

[Subacute osteomyelitis in adults. Apropos of 3 cases]. / Ostéomyélites subaiguës de l'adulte. A propos de 3 cas.

We report three cases of subacute osteomyelitis in 25, 31 and 38-year old adults. The clinical presentation was an insidious condition with persistent nondisabling pain. Radiographical signs suggested a bone tumor. Diagnosis was established from the bacteriological and pathology examinations of the surgical biopsy taken when evacuating the abscess. Cure was obtained in all three patients with combination antibiotic regimens. In two cases immobilisation was required because of bone fragility.

[Diagnosis of arthritis in black Africa. Apropos of 473 cases in Congo]. / Le diagnostic des arthrites en Afrique noire. A propos de 473 cas au Congo.

A cross-sectional study of arthritis was conducted in the Rheumatology Department of the Brazzaville Teaching Hospital, Congo. A total of 473 patients with arthritis seen between 1989 and 1991 were subjected to the limited tests available. Gout was the leading diagnosis (n = 83). Septic arthritis (n = 82) and infectious discitis (n = 55) were the most common reasons for admission. Tests often failed to identify the causative organism; Staphylococcus was the most commonly recovered organism. Tuberculous discitis was less common than discitis due to pyogenic bacteria. HIV-related arthritis (n = 57) usually manifested as severe, febrile, asymmetrical, nonerosive, polyarthritis. Cases of rheumatoid arthritis (n = 29) fit the classical description of the disease. In 83 patients with monoarthritis, oligoarthritis, or polyarthritis, no etiology could be identified.

[Epidemiological and clinical aspects of gout in equatorial Africa. Apropos of 60 cases followed in the Department of Rheumatology of the Teaching Hospital Center in Brazzaville]. / Aspects épidémiologiques et cliniques de la goutte en Afrique Equatoriale. A propos de 60 cas suivis dans le Service de Rhumatologie du Centre Hospitalier et Universitaire de Brazzaville.

Between December 15, 1988 and November 30, 1990, the application of Rome and New York criteria enabled the diagnosis of 60 cases of gout among patients with arthritis or hyperuricemia seen as out-patients or hospitalised in the Department of Rheumatology of the Brazzavile T.H.G. There were 57 men and 3 women, with a mean age of 51. Gout is the primary form of inflammatory arthropathy in adults in the Congo. Affecting all socio-professional groups, it is diversely associated with obesity, alcoholism, hypertension and diabetes. Initial involvement affects the big toe. Oligo and polyarticular forms predominate because of the absence or delay in specific treatment. This series included 30 per cent of cases of chronic gout. Evidence of renal impairment was found in one third of patients. However, urate lithiasis was absent. Tophi were found preferentially over the elbows. Sickle cell disease was responsible for one case of tophaceous gout. In contrast with the results of studies undertaken before the 1980s, gout is seen to be a common condition in equatorial Africa.

[Bone density in 20 black African young adults of the Bantu race is identical to that in subjects of white race]. / La densité osseuse à l'âge adulte jeune de 20 sujets noirs Africains d'éthnie bantoue est identique à celle de sujets de race blanche.

Bone mineral content (BMC in g) as well as bone mineral density (BMD in g/cm2) were measured by dual photon absorptiometry in 20 black africans and 20 white individuals of the same age and sex. The BMC of african males, as well as their body mass index (BMI), were significantly less than those of the whites. In contrast, neither BMD nor the ratio of BMC to BMI differed between the two groups. These results suggest that morphotype plays a greater role than the ethnic factor in the determination of bone mass in the young adult.

[Prospective study of rheumatic manifestations in human immunodeficiency virus infection. Apropos of 26 cases in Congo]. / Etude prospective des manifestations rhumatologiques au cours de l'infection par le virus de l'immunodéficience humaine. A propos de 26 cas au Congo.

A 12-month prospective study of the osteo-articular complaints in HIV infected patients was carried out in the Department of Rheumatology, Brazzaville, Congo. Positivity of the HIV serology was systematically researched. And so the authors have observed rheumatic disorders in 26 patients, 12 males, 14 females, with a mean age of 36 years (ranged from 13 to 78). These disorders are as follow: linked to HIV oligo or polyarthritis, 18 cases; septic arthritis 3 cases; destructive spondylodiscitis 2 cases; bilateral sciatica with paralysis 3 cases; tropical myositis 2 cases. Contamination was heterosexual in 23 patients, iatrogenic in 3 other ones. HIV infection was at the CDC stades II (7 patients) or IV (19 patients). The prevalence of osteo-articular manifestations in HIV infected patients who are admitted in the hospital of Brazzaville, Congo is evaluated at only 4%.