The impact of COVID-19 on rheumatology practice across Africa.

OBJECTIVES: To identify the changes in rheumatology service delivery across the five regions of Africa from the impact of the COVID-19 pandemic. METHODS: The COVID-19 African Rheumatology Study Group created an online survey consisting of 40 questions relating to the current practices and experiences of rheumatologists across Africa. The CHERRIES checklist for reporting results of internet e-surveys was adhered to. RESULTS: A total of 554 completed responses were received from 20 countries, which include six in Northern Africa, six in West Africa, four in Southern Africa, three in East Africa and one in Central Africa. Consultant grade rheumatologists constituted 436 (78.7%) of respondents with a mean of 14.5 ± 10.3 years of experience. A total of 77 (13.9%) rheumatologists avoided starting a new biologic. Face-to-face clinics with the use of some personal protective equipment continued to be held in only 293 (52.9%) rheumatologists' practices. Teleconsultation modalities found usage as follows: telephone in 335 (60.5%), WhatsApp in 241 (43.5%), emails in 90 (16.3%) and video calls in 53 (9.6%). Physical examinations were mostly reduced in 295 (53.3%) or done with personal protective equipment in 128 (23.1%) practices. Only 316 (57.0%) reported that the national rheumatology society in their country had produced any recommendation around COVID-19 while only 73 (13.2%) confirmed the availability of a national rheumatology COVID-19 registry in their country. CONCLUSION: COVID-19 has shifted daily rheumatology practices across Africa to more virtual consultations and regional disparities are more apparent in the availability of local protocols and registries.

Renal histology patterns in a prospective study of nephrology clinics in Lagos, Nigeria.

BACKGROUND: The burden of chronic kidney disease (CKD) in Nigeria is quite alarming. The prevalence of CKD ranges from 11 - 23.5%. Hypertension and chronic glomerulonephritis (CGN) remain the two leading causes of CKD in Nigeria. The etiology of CKD in many of these patients remains unknown, as few biopsies are done. In order to demystify the various glomerular diseases that culminate in CGN, performing a kidney biopsy offers a ray of hope. Few studies on renal biopsies have emanated from Nigeria; this study, however, is unique as the histopathological analysis involves light, immunofluorescence, and electron microscopies. METHODS: This study involved two teaching hospitals in Lagos. Patients from these centers, who met the inclusion criteria, underwent real-time renal biopsy; after providing written informed consent. RESULTS: Among the 52 patients analyzed 26, (50%) were males. The mean age was 31.7 ± 12.8, with age range of 13 - 56 years. The most common indication for kidney biopsy was nephrotic syndrome, accounting for 73%. Focal segmental glomerulosclerosis (FSGS) was the most frequent histopathological diagnosis seen in 25 patients (48.1%). CONCLUSION: The findings from this study highlight the role that renal biopsy plays in making a concrete diagnosis in nephrology practice in a developing country like Nigeria. As almost 80% of the study population was made up of patients with FSGS and lupus nephritis, it remains to be determined by further studies among our patients, the role that Apolipoprotein L1 (APOL 1) gene mutation will play in the etiology of renal diseases in Nigeria.

Fibromyalgia in a rheumatology clinic in north-central Nigeria: An audit of the characteristics of the syndrome and the sensitivities of 4 sets of American College of Rheumatology criteria.

OBJECTIVES: To describe the characteristics of fibromyalgia among Nigerian patients and assess the sensitivities of the American College of Rheumatology (ACR) criteria of 1990, 2010, 2011, and 2016 for making the diagnosis of fibromyalgia. METHODS: Consecutive patients diagnosed clinically with fibromyalgia by a rheumatologist were assessed. ACR criteria for fibromyalgia of 1990, 2010, 2011, and 2016 were applied to each patient. Polysymptomatic distress scores (PSD) were calculated from the Widespread Pain Index and Symptom Severity Scores. Sleep was assessed using the Pittsburgh Sleep Quality Index; fatigue by the Fatigue Severity Scale and the severity of fibromyalgia was determined using the Revised Fibromyalgia Impact Questionnaire (FIQR). RESULTS: A total of 660 new patients were seen out of which a diagnosis of fibromyalgia was made in 114 (17.3%). The mean age of the patients was 44.6 ± 15.6 years and females accounted for 84.2%. Twenty-one (18.4%) patients had changed or quit their jobs due to fibromyalgia. Problematic fatigue was present in 80 (70.2%), and sleep disturbance was reported in 83 (72.8%) patients. The severity of fibromyalgia, poor sleep, severe or very severe PSD, and male gender were associated with problematic fatigue, but only moderate/severe fibromyalgia independently predicted problematic fatigue (P = .004). The number of tender points (P = .001) and FIQR score (P = .038) were associated with changing or quitting jobs. The sensitivities of the ACR1990, ACR2010, ACR2011 and ACR2016 were 38.5%, 68.2%, 76.7% and 76.7%, respectively. CONCLUSION: The ACR1990 had low sensitivity when used to diagnose fibromyalgia in this population and the ACR2010 encounters problems while applying the somatic symptom list.

Case Series and Literature Review of Ophthalmologic Disorders Seen in a Specialist Rheumatology Clinic in Lagos, Nigeria.

Purpose: To highlight the pattern and treatment outcomes of ophthalmologic disorders referred to a private specialist rheumatology clinic. Methods: Retrospective review (January 2015-December 2016) of referrals from Eye Foundation Hospital, Lagos to Arthrimed Specialist Clinic, Lagos. Case records were retrieved and relevant information extracted. Ethical standards were observed. Results: Twenty-two referrals (35 eyes) were received out of 643 patients (3.4%) seen during the study period. The majority were female (63.6%) with mean age 48.9 ± 19.3 years and bilateral disease (59%). Diagnoses included uveitis (45.5%), optic neuritis (36.4%), non-specific autoimmune eye disease (9.1%), keratoconjunctivitis sicca (4.5%), and giant cell arteritis (4.5%). Treatment was with steroids and immunosuppressive agents. Fourteen patients improved (63.6%), five remained unchanged (22.7%), while three worsened (13.6%). Conclusions: Our patients were mostly fourth-decade females with bilateral disease. Uveitis was the commonest presentation, and two-thirds of the treated patients improved after treatment. Early specialist referral and co-management of severe autoimmune eye diseases are desirable.

The Child as a Surrogate for Diagnosis of Lupus in the Mother.

Introduction. Neonatal lupus erythematosus (NLE) is an acquired disease of the newborn caused by transplacental transfer of maternal anti-Ro/SSA, anti-La/SSB, and infrequently anti-U1 RNP antibodies. Methodology. This is a case report of a male infant delivered via Caesarean section at 36-week gestation following detection of fetal bradycardia during routine antenatal clinic visit. Results. The mother was seropositive for antinuclear antibody (ANA) and anti-Ro/SSA and had elevated erythrocyte sedimentation rate. The baby was positive for ANA, extractable nuclear antigen (ENA), and anti-Ro/SSA. Pediatric echocardiography was abnormal and electrocardiography confirmed complete heart block.

Juvenile idiopathic arthritis among Nigerians: a case study.

Juvenile idiopathic arthritis (JIA) has rarely been reported among Black Africans. This retrospective case study was part of an audit of cases presenting to a private practice rheumatology clinic in Lagos, Nigeria. The objective of this study was to determine the clinical, laboratory, and radiographic features of patients with JIA, as well as to highlight their management. A total of 23 cases (F-16:M-7) were seen over an 8.5-year period. Polyarticular presentation was the commonest while systemic onset was the least. The mean age at presentation was 12.7 years. Most of the patients presented late with mean of 3.7 years before presentation. The knees and ankles were most commonly involved. ESR was elevated in most of the cases. Rheumatoid factor and Antinuclear antibodies were invariably negative. Treatments were with standard drugs. Although JIA is uncommonly seen in our population, the clinical and laboratory features are similar as elsewhere, though there are some differences.

Rheumatoid arthritis among Nigerians: the first 200 patients from a rheumatology clinic.

Rheumatoid arthritis has uncommonly been reported among Africans and rarely among West Africans. Most of the reported cases have been from Southern Africa. A recent awareness of increased reports of RA among Nigerians necessitated this study. The objective of this retrospective study was to identify the clinical presentations, laboratory characteristics as well as treatment regimens of Nigerians presenting with rheumatoid arthritis to a private rheumatology clinic in Lagos, Nigeria. This is a retrospective study of consecutive rheumatoid arthritis patients seen over a period covering 7 years and 10 months diagnosed using the ARA Criteria for RA. Laboratory tests and radiographic investigations were carried out. Treatment was with NSAIDs, prednisolone, disease modifying anti-rheumatic drugs (DMARDs), and biologics. RA accounted for 12.3% of a total of 1,623 patients presenting to the clinic with rheumatologic complaints over the study period. Females were mostly affected (F:M-2.4:1) and mean age is 46.9 years. Duration of symptoms before presentation was 4-264 months with a mean of 63.4 months. The proximal interphalangeal joints were mostly involved. Subcutaneous nodules were seen in 29.5% of the cases while rheumatoid factor was found in 38.5% of the subjects. ESR was mostly elevated and radiographic changes were mostly mild with 29.2% showing erosive changes on radiographs of the hands. Treatment was variously with non-steroidal antiinflammatory drugs (NSAIDs), prednisolone, and DMARDs. Rheumatoid arthritis is not uncommon among Nigerian; and clinical, serologic acumen are necessary for early diagnosis and appropriate referral.