Presentation and severity of rheumatoid arthritis at diagnosis in Senegal.

OBJECTIVE: Early effective treatment slows structural damage in RA but requires an early diagnosis. Our objective was to determine symptoms duration and presentation patterns of RA at diagnosis in Senegal. METHODS: We conducted a cross-sectional study over a 2-year period (from March 2006 to February 2008) at the rheumatology clinic of the Le Dantec teaching hospital in Dakar, Senegal. Consecutive new patients who met ACR criteria for RA were included. RESULTS: We included 100 patients, 88 females and 12 males, with a mean age of 40.3 +/- 15.5 years and a mean symptoms duration of 54 months. One-fourth of the patients had a positive family history. Pain was the main reason for the rheumatology clinic visit. Mean pain score was 64.3 mm on a 100-mm visual analogue scale. Nocturnal arousals were reported by 69% of the patients and morning stiffness for >1 h by 74%. The tender and swollen joint counts were 10 or higher in 87% and 36% of the patients, respectively, and the mean disease activity score on 28 joints (DAS28) was 6.49 +/- 1.34. Sicca syndrome (n = 13) and rheumatoid nodules (n = 3) were the main extra-articular manifestations. Laboratory evidence of inflammation was found in 87% and RF in 78% of the patients. Antibodies to cyclic citrullinated peptides (anti-CCPs) were detected in 26 of the 29 patients. Radiographical lesions were visible in 56% of the patients; mean modified Sharp score was 21.76 +/- 47.74. CONCLUSION: The diagnosis of RA is delayed in Senegal, and the disease is highly active at diagnosis, although 44 patients have no erosions, and extra-articular manifestations are rare.

The Parathyroid carcinoma: a diagnostic challenge before surgery.

INTRODUCTION: Parathroid Carcinoma is a rare cause of primary hyperparathyroidism (PPH). His diagnosis is a real challenge. We report an observation and discuss the diagnostic guidelines before surgery. CASE: A 31-year-old Senegalese woman was admitted to our department for the exploration of diffuse bone pain and multiple pathological fractures. Physical examination revealed a right lateral mass of the neck. Serum calcium level was 142.2 mg / l and serum parathyroid hormone 42 N. Ultrasound and cervical tomodensitometry showed a parathyroid mass compressing the thyroid and trachea. The extension assessment revealed osteolytic lesions and T4-T5 epiduritis evoking metastases. Surgery and histology were performed. According to the histopathology and clinical context, the tumor was identified as a parathyroid carcinoma. CONCLUSION: The preoperative evaluation of a patient with severe hypercalcemia and high PTH levels should include the possible diagnosis of parathyroid carcinoma, especially in symptomatic patients or in case of palpable neck mass.

[Epidemiological, clinical, therapeutic and evolutive aspects of Basedow-Graves disease in the Depatment of Internal Medicine at CHU Aristide Le Dantec, Dakar (Senegal)]. / Aspects épidémiologique, clinique, thérapeutique et évolutif de la maladie de Basedow en Médecine Interne au CHU Ledantec Dakar (Sénégal).

Basedow-Graves disease is an autoimmune affection characterized by the association of thyrotoxicosis with variable frequency events such as goiter, ophthalmopathy and pretibial myxedema. Its diagnosis is often easy, while its management remains difficult. A simple medical treatment exposes patient to recurrence risk. In Senegal and Sub-Saharan Africa few studies have focused on Basedow-Graves disease. This study aims to describe the epidemiological, clinical, therapeutic and evolutionary aspects of Basedow-Graves disease at a Hospital in Dakar. This was a retrospective study conducted from 1 January 2010 to 31 December 2013 in the Department of Internal Medicine at the Aristide Le Dantec University Hospital. During this period, 108 patients receiving outpatient treatment for Basedow-Graves disease were included out of a total of 834 patients receiving outpatient treatment. The diagnosis was made on the basis of clinical, biological and immunological signs. One hundred and eight patients suffering from Basedow-Graves disease were included out of a total of 834 consultations. Sex ratio was 7.3 and the average age was 34.6 years. The main reasons for consultation were: palpitations and weight loss in 46.3% and 39.8% of cases respectively. Thyrotoxicosis syndrome was found in 93.5% of patients, goiter was found in 87% of patients and exophthalmos in 78.7% of patients. The main complication was cardiothyreosis found in 11.1% of patients. All patients underwent antithyroid synthetic drugs treatment. The evolution was favorable in 19,4% of cases. Disease recurrence was observed in 57% of cases and in 23.1% of patients were lost to follow-up. Basedow-Graves disease is the most common cause of hyperthyroidism, The patient's clinical picture is dominated by manifestations related to hypermetabolism. This study highlights that thyroidectomy isn't the first-line of treatment if we consider the high number of recurrences after medical treatment.

[A multiple myeloma long term survival case]. / Survie prolongee au cours du myelome multiple: à propos d'une observation.

Multiple myeloma is a malignant plasma cells proliferation in the bone marrow leading to a monoclonal immunoglobulin hypersecretion. The survival duration of this disease ranges usually from 2 to 3 years. However, as this reported case, a long-term survival remains possible. A 29 year old woman was admitted to the internal medicine department for bone pain, weight loss and pathologic fractures. The clinical examination revealed an anaemia, a spinal compression (D10) and atrophia of quadriceps and gluteus muscle. The radiologic findings observed were multiple fractures. The bone marrow aspiration confirmed the plasmocytosis greater than 50%, with immature plasma cells and other lineages rarefication. The disease belonged to the stage III A of the Salmon and Durie classification. Chemotherapy with melphalan associated to prednisone was started with a two to three months biological and clinical follow-up. This treatment allowed 12 years survival. Because of this variety, the search for new prognostic factors would be relevant.

[Evolution of autoantibodies profile in systemic lupus erythematosus according to age and clinical manifestations]. / Profil des réponses auto-anticorps suivant l'âge et la symptomatologie clinique chez des patients atteints de lupus érythémateux.

Clinical features and auto-antibodies profile of 35 Senegalese patients' diagnosed systemic lupus erythematosus (SLE) were analyzed after measurement of antinuclear antibodies (ANA) by IFI, detection of Abs anti-DNA native by ELISA and evaluation of antibodies anti-Sm, anti-RNP, anti-SSA anti-SSB, anti-CCP2, anti-J0, and anti-Scl70 levels by immunodot. Mean age of 33 yrs (18-50 yrs) and sex ratio (F/M) of 16 were found. The most frequent clinical features were rheumatic (88.7%) and cutaneous (79.4%) disorders. ANA and anti-DNAn Abs were detected in 85.7% and 62.5% of the patients respectively. Abs anti-RNP, anti-Sm, anti-SSA, anti-SSB and anti-CCP2 were detected in 30 to 70% of patients. In young patients, the levels of anti-DNAn and anti-Sm Abs were higher than in patients older than 40 yrs (P<0.05). In addition, associations of cutaneous and rheumatic symptoms were characterized by high levels of anti-DNAn, anti-SSA and anti-SSB Abs. Our study shows the interest of a measurement of anti-DNAn, anti-SSA and anti-SSB Abs during the follow of SLE patients particularly in those presenting both rheumatic and cutaneous symptoms.

Rheumatoid arthritis in Senegal: a comparison between patients coming from rural and urban areas, in an urban tertiary health care center in Senegal.

Several studies have suggested that rheumatoid arthritis (RA) is uncommon in rural sub-Saharan Africa. The aim of this study is to determine the potential differences between patients with RA living in rural areas and those living in urban areas. We performed a cross-sectional study from June 2006 to May 2009. We included all patients with RA (1987 ACR criteria) seen at the Rheumatology Unit of the Le Dantec Teaching Hospital, Dakar, Senegal. We compared the main socio-demographic and clinical characteristics of patients living in rural areas to those living in urban areas. We included 180 patients in our study, of whom, 143 (79.4 %) lived in urban areas and 37 (20.6 %) in rural areas. The median age was 44 years [range 34-55] in patients from rural areas vs. 41 years [range 30-53] in patients from urban areas, without any statistical significance (p = 0.24). Patients under the age of 60 mostly lived in urban areas (p = 0.03). The extra-articular manifestations were significantly more frequent in patients living in rural areas (p = 0.02). There was no statistical significance when comparing the delay in diagnosis, number of swollen joints, disease activity, hand deformities, and concentration of autoantibodies (RF and ACPA) in both populations. The percentage of patients seen from the rural areas of Senegal is low (20.6 %) compared to those seen from the urban areas. The number of extra-articular manifestations is the main difference between patients living in rural and urban areas. The role played by environmental factors seems important. Further incidence studies are needed.