Non-radiographic axial spondyloarthritis: what is it?

The classification criteria recently developed by the Assessment of Spondyloarthritis International Society (ASAS) highlighted a specific entity: non radiographic axial spondyloarthritis (nr-axSpA). Although more and more widely used in the literature as well as clinical trials, limits and profile of this entity is still under known or debated. Some studies have already compared those forms to classical AS, even in recent forms. They showed that, apart from the difference in the ossification process, and the greater degree and frequency of systemic and MRI inflammation in AS, those 2 forms of SpA share the same genetic background, clinical patterns, and burden of disease. TNF antagonists seemed as effective in controlling symptoms in patients with nr-axSpA. Concerning the long-term outcome of nr-ax-SpA, only long-term ongoing cohorts of patients with recent nr-axSpA will be able to determine what proportion of patients have persistent non-radiographic disease and what proportion do progress to AS.

[Infectious arthritis in hospital patients in Lomé, Togo]. / Arthrites infectieuses en consultation rhumatologique a Lomé (Togo).

OBJECTIVE AND METHODS: The purpose of this study was to determine the frequency and semiological profile of infectious arthritis in the outpatient clinic of the Tokoin University Hospital Center in Lomé, Togo. PATIENTS AND METHODS: This study was based on a review of the charts of patients hospitalized in the rheumatology department over a period of 16 years. RESULTS: During the 16-year study period, 198 of the 13517 patients (1.5%) examined were hospitalized for infectious arthritis. There were 100 women and 98 men with a mean age of 36.3 +/- 17.5 years. Mean disease duration was 9.3 +/- 9.8 months. Diagnosis was banal germ arthritis in 157 cases (79.3%) and likely tuberculosis arthritis in 41 (20.7%). The knee was the most common location (34.3%). Arthritis affected a single joint in 159 cases (80.3%). Isolation of offending microorganism was achieved in 39 patients (19.7%). The most frequently identified agent was Staphylococcus aureus (42.5%). In addition to underdevelopment and poor hygiene observed in most patients in this series, risk factors included human immunodeficiency virus infection in 28 cases, alcoholism in 10, sickle cell anemia in 8, cancer in 3, and diabetes mellitus in 2. Outcome was favorable in 181 patients (88.7%). Four patients died. CONCLUSION: The frequency of infectious arthritis is correlated with underdevelopment and poor hygiene in black Africa.

[Risk factors of hip osteoarthritis in Lomé, Togo]. / Facteurs de risque de la coxarthrose a Lomé (Togo).

The medical records of the Lomé Teaching Hospital Rheumatology Unit (Togo) were retrospectively reviewed to study risk factors for osteoarthritis of hip. Among the 14,090 patients examined over a period of 17 years, 89 (0.63%) including 37 women and 52 men had osteoarthritis of the hip as defined according to the criteria of Kellgren and Lawrence. The mean duration of osteoarthritis of the hip was six years. Involvement was unilateral in 77 patients (86.5%) and bilateral in 12 (13.5%). Osteoarthritis of the hip was primary in 41 patients (46.1%) and secondary in 48 (53.9). Risk factors for secondary osteoarthritis of the hip were necrosis of the femoral head (n = 14), epiphysitis (n = 13), dysplasia (n = 11), traumatism (n = 6) including two femoral neck fractures, and tuberculosis of the hip joint (n = 2). In the 14 subjects with necrosis of the femoral head, hemoglobin was type SC in three cases and SS in two. Necrosis of the femoral head appears to be the main risk factor for osteoarthritis of the hip in black Africa. The impact of this risk factor may increase with longer life expectancies of subjects with hemoglobin SS and SC.

[Spondylodiscitis at a hospital outpatient clinic in Lome, Togo]. / Spondylodiscites infectieuses en milieu hospitalier à Lomé (Togo).

PURPOSE: This investigation was carried out to determine the frequency and features of spondylodiscitis in patients attending the Tokoin University Hospital Center in Togo. PATIENTS AND METHODS: A retrospective study of patients examined in the Rheumatology Outpatient Clinic over a 17-year period was conducted. RESULTS: Out of 14,708 patients examined during the study period, 222 (1.5%) presented spondylodiscitis. There wire 108 women and 114 men with a mean age of 38 years. The mean duration of symptoms was 6 months. Spondylodiscitis was related to presumptive tuberculosis in 169 patients (76.1%). The most common locations were the lumbar (56.8%) or thoracic (21.6%) spine. It was associated with a pulmonary location in 39 patients (17.6%). In addition to underdevelopment and poor hygiene in most patients, risk factors for spondylodiscitis included HIV infection (n=23), alcoholism (n=27), diabetes mellitus (n=7), and sickle cell anemia (n=7). Response to medical treatment was favorable in 197 patients (88.7%). CONCLUSION: Spondylodiscitis is still a frequent reason for seeking medical care in Black Africa.

Panorama of inflammatory arthropathies in rheumatologic consultations in Northern Togo.

To determine the frequency and epidemiological profile of inflammatory arthropathies seen during rheumatologic consultations in Togo. This retrospective study examined the records of patients with inflammatory arthropathy seen at a rheumatologic consultation at Kara Teaching Hospital (Northern Togo) over a four-year period. Among the 2361 patients with rheumatic disorders, 152 (6.43%) had an inflammatory arthropathy: 57.24% were men and 42.76% women. The main causes observed were: chronic inflammatory rheumatism (CIR) and connective tissue disease (49.34%), infectious arthritis (26.32%), and gout (24.34%). The mean age of the 75 patients with CIR at the onset of the disease was 40 years and the average duration of evolution was 3.11 years. The main clinical forms of CIR were rheumatoid arthritis (11 cases), spondylarthropathies (20 cases within 11 cases of reactive arthritis), connective tissue diseases (4 cases), and unclassified CIR (31 cases). Nine patients with reactive arthritis were HIV positive. The infectious arthritis was caused by a banal germ in 31 cases and by Koch bacillus in nine other cases. Gout patients (35 men and 2 women) had a mean age of 43 years at the onset of the disease, and the mean duration of the disease was 4.1 years. Gout was monoarticular in 8 cases, oligoarticular in 19 cases and polyarticular in the other 10 cases. This study demonstrates the high incidence of chronic inflammatory rheumatism in Northern Togo.

[Lumbar spinal stenosis in an outpatient clinic in Lome, Togo]. / Le canal lombaire rétréci en consultation rhumatologique à Lomé (Togo).

The purpose of this study was to determine the frequency and semiological characteristics of lumbar spinal stenosis in patients attending the rheumatology outpatient clinic at the Lomé Teaching Hospital. Medical records of 13081 patients seen over a 15-year period were retrospectively reviewed. A total of 760 (5.8%) had lumbar spinal stenosis. There were 556 women (73.2%) and 204 men (26.8%) with a mean age at onset of 52 years (range, 25 to 65 years). The mean duration of lumbar spinal stenosis was 4.5 years. The main symptom was nerve root pain in 712 (93.7%) involving one root in 248 cases and more than one root in 464. Most patients in this group were between the ages of 35 and 65 years. Pain was relieved by bending the spine forward in 456 patients (60%) and claudication was present in 643 patients (84.6%). Walking distance was less than 500 meters in 491 patients and more than 500 meters in 152. Pain was exacerbated by extension of the spine in 475 patients (62.5%) and associated with paresthesia in 532 patients (70%) and sphincter dysfunction in 155 patients (20.4%). Roentgenography of the lumbar spine was performed in 504 patients and showed abnormalities in 475. The most common radiographic abnormality was degenerative disk disease (n = 251). Myelography was performed in 56 patients, showing a rosary-like image in 31 cases and disk herniation in 23. Lumbar spinal stenosis in Black Africa appears to be more common than in industrialized countries and to affect mainly women in the fifth decade of life. The semiological profile of lumbar spinal stenosis appeared to be similar in Black Africa and industrialized countries.

[Thorn synovitis: Report of 2 cases]. / Synovites à piquants : à propos de deux cas.

INTRODUCTION: Thorn synovitis is related to plant or animal thorn punctures. We report two cases of thorn synovitis. CASE REPORTS: The first patient was a 41-year-old-woman who presented with recurrent arthritis of the right knee after needle fish injury. The immunological tests and cultures were negative. X-rays and MRI showed the foreign bodies in the soft parts on the outer side of the knee. An arthroscopy was performed and the thorn removed. Clinical outcome was favourable with complete symptoms resolution. The second patient was a 58-year-old-man, with a family history of spondylarthritis, who was admitted with a monoarthritis of the left wrist that occurred 10 weeks after palm tree thorn injury. Patient received unsuccessfully antibiotics and anti-inflammatory drugs. Immunological tests and cultures were negative. Wrist ultrasound showed erosive synovitis. Intra-articular lesion removal by arthroscopy allowed favourable outcome. CONCLUSION: Thorn synovitis diagnosis is based on the discovery of a foreign body. Treatment is based on their removal. Suspicion of infection with deficient pathogen, especially Pantoea agglomerans, remains difficult for the practitioner.

[Osteoarthritis of the knee in hospital outpatients in Lomé (Togo)]. / Gonarthrose en Consultation Rhumatologique a Lome (Togo).

OBJECTIVE AND METHODS: Medical records of patients seen at the Lomé Teaching Hospital rheumatology unit (Togo) were studied retrospectively to determine the frequency and semiological characteristics of osteoarthritis of knee. RESULTS: Among the 12251 patients seen, 993 (8%, 844 women and 149 men) had osteoarthritis of the knee responding to ACR criteria. Mean age at onset was 51 years and mean duration of osteoarthritis of the knee was four years. The osteoarthritis affected one joint in 470 patients (47%) and two joints in 523 other patients (53%). Mechanic pain (923 patients, 93%) and claudication 251 patients, 25%) were the frequent symptoms. At the knee, the lesions involved the medial femorotibial compartment in 493 patients, the lateral femorotibial compartment in 223 patients, the patellofemoral compartment in 42 patients, and the femorotibial and patellofemoral compartment in 235 patients. 764 of 993 patients (77%) with knee osteoarthritis were obese (femmes: 699, 82.8%) and 729 had varus and/or valgus (73.4%). CONCLUSION: This study confirms the high prevalence of osteoarthritis of the knee in black Africa. Female sex, obesity, and varus or valgus deformities are the main risk factors for femorotibial osteoarthritis in black Africa.