Cost of common low back pain and lumbar radiculopathy in rheumatologic consultation in Lomé.

BACKGROUND: The cost of low back pain was the subject of few studies in black Africa. AIM: To assess the cost of common low back pain and lumbar radiculopathy in Lomé. METHODS: A six months study was realised in the rheumatologic department of CHU Sylvanus Olympio. 103 consecutive patients suffering from a common low back pain or lumbar radiculopathy were included. To assess direct, indirect and non-financial costs they were questioned about their expense during the year. RESULTS: Financial cost of common low back pain and lumbar radiculopathy amounted to 107.2 $ US (extremes: 5.8 and 726.1 $ US). This amount, quadruple of guaranteed minimum wage, felled under two headings: direct cost (56.3 $ US; 53% of total sum), indirect cost (50.3 $ US; 47% of total sum). Non-financial cost were: disruption in daily activities (94%), impact in emotional and sexual life (59%), impact on the family's budget (69%), abandon of family's projects (58%) or of leisure (42%). CONCLUSION: In black Africa top priority is given to the fight against infectious diseases those cause an important mortality. But common low back pain and lumbar radiculopathy, those have social and economic impact, should be given more attention.

Profile of bone malignancy among rheumatology inpatients in Lomé (Togo).

BACKGROUND: The incidence of bone malignancy in adulthood seems poorly known in Black Africa. AIM: To determine the epidemiological, clinical, and paraclinical profile of bone malignancy in patients admitted to the Rheumatology Department in Lomé (Togo). METHODS: A retrospective study was conducted over 19 years on records of hospital patients admitted for bone malignancy. RESULTS: One hundred sixty-six of 2018 (8.2%) patients (98 men and 68 women) admitted suffered from bone malignancy. The mean age at admission of those 166 patients was 55 years with extremes of 14 and 98 years. The most affected age group was between 46 and 55 years (40 cases, 24.1%). The mean disease duration was 17 months. These tumors were primitive in 43 cases (26%) and secondary in 123 cases (74%). Metastases were prostate (44 cases, 35.7%), breast (12 cases, 9.7%) bronchi (7 cases, 5.7%), uterus cervix (5.7%), and liver (2 cases, 1.6%). Myeloma (34 cases; 79.0%) and osteosarcoma (9 cases; 20.9%) were the main primary malignant bone tumors. However 41 cases (33.3%) of tumors malignant bone could not be labeled. The spine was the main seat of those tumors. CONCLUSION: This study demonstrates the substantial part occupy malignant bone tumors in the musculoskeletal diseases within the Sub-Saharan population in general and in Togo in particular.

Facteurs associés aux érosions osseuses dans la polyarthrite rhumatoïde à Abidjan

Objectif : Identifier les facteurs associés aux érosions osseuses dans la polyarthrite rhumatoïde observée à Abidjan. Matériels et méthode : Etude rétrospective et descriptive menée au service de rhumatologie du CHU de Cocody de Janvier 2005 à Avril 2017. Ont été inclus les patients souffrant d'une polyarthrite rhumatoïde répondant aux critères de l'ACR 1987 et de l'ACR-EULAR 2010, avec des érosions osseuses. Résultats : La fréquence des érosions osseuses étaient de 51,72% soit 58 sur 112 patients recrutés pendant la période d'étude. Notre effectif comportait 41 femmes et 17 hommes âgés de 46,62+/-13,02 ans. La majorité des patients étaient de niveau socioéconomique précaire (68,96%) et scolarisés (65,51%). Le délai diagnostique moyen était 28,9+/-9,7 mois. Tous les patients présentaient une polyarthrite proximale et distale. Une raideur matinale supérieure à 1 heure (44,8%), une atteinte cervicale (51,72%), des déformations (51,72%), une atteinte viscérale (48,27%), une fièvre (41,37%) et un amaigrissement (58,62%) ont été notés. On notait une vitesse de sédimentation moyenne à 22,9mm et une CRP moyenne à 47,7mg/l. Les facteurs rhumatoïdes et les anti-CCP étaient positifs respectivement chez 37,93% et 34,4% des patients. Les facteurs associés significativement aux érosions osseuses étaient la durée de la raideur matinale (P=0,04), l'atteinte des grosses articulations (P=0,025), l'atteinte du rachis cervical (0,038), la présence de déformations (0,025), l'élévation de la CRP (P=0,004) et la positivité des antiCCP (P=0,01). Conclusion : La durée de la raideur matinale, l'atteinte des grosses articulations, l'atteinte du rachis cervical (0,038), la présence de déformations, l'élévation de la CRP et la positivité des anti-CCP (P=0,01) sont associés aux érosions osseuses dans la polyarthrite rhumatoïde à Abidjan

[Cervical spondylodiscitis in hospital environment in Lomé (Togo)]. / Spondylodiscite cervicale en milieu hospitalier à Lomé (Togo).

BACKGROUND: The spine is a frequent site of infection but cervical spine localization seems to be rare. OBJECTIVE: to determine the frequency and features of cervical spondylodiscitis in patients attending the Sylvanus Olympio University Hospital Center in Togo. METHODS: A retrospective study of patients hospitalized in the Department of Rheumatology over a 20-year period was conducted. The positive diagnosis of infectious spondylodiscitis has been clinical and radiological. The etiological presumption was founded on clinical and epidemiological arguments. RESULTS: Of the 2881 patients hospitalized, 356 had infectious spondylodiscitis of which 15 cases of cervical spondylodiscitis (eight men and seven women). The average age of these 15 patients was 37 years at the onset of the disease of which the mean disease duration was six months. The disease was essentially located at the levels of C3C4 (seven patients) and C5C6 (four patients). Spondylodiscitis was related to presumptive tuberculosis in 10 patients and banal germ in the remaining five others. There were three HIV infected patients. The onset of the symptomatology was progressive in all the 10 patients suffering from tuberculosis spondylodiscitis. The symptomatology has been characterized by inflammatory pains (10 patients), mechanic pains (five patients), and a gibbosity (four patients). CONCLUSION: This study attests of the scarcity of the cervical spondylodiscitis.

[Rheumatic diseases profile of 13517 West African patients]. / Profil des affections rheumatismales chez 13517 patients ouest africains.

AIM: To determine the patterns of rheumatic diseases in patients attending the rheumatology unit of the Lomé Tokoin teaching hospital. METHODS: Medical records of patients seen over 16 years period were studied transversally. All the patients suffering of rheumatic disease were including in the study. RESULTS: 13517 patients (7755 women, 5762 men) had suffered of rheumatic disease. Degenerative spinal involvement, n= 6319 (46.47%); tendinitis, n= 1625 (12.02 %); knee osteoarthritis, n= 1084 (8.02 %); chronic inflammatory rheumatism and connective tissue disorders, n= 626 (4.64 %); infectious pathology, n= 376 (2.78 %) and hip involvement, n= 322 (2.39 %) were the diseases more observed. The features of degenerative spinal disease included low back pain (n= 2325), lumbar and radicular pain suggestive of disc herniation (n= 2035) and lumbar spinal stenosis (n= 709). More women (n= 874) than men (n= 210) had suffered of knee osteoarthritis. Spondylarthropathies (n=93), rheumatoid arthritis (n= 62), dermatomyositis and polymyositis (n= 13) were the main forms of chronic inflammatory rheumatism and connective tissue disorders. The infection was localized in spine for 191 patients and in other bone and joints for the 185 others. The cause of infection was likely Koch bacillus for 178 patients and trivial germs for the 198 others. Necrosis of the femoral head (n= 89) had been the main form of hip involvement. CONCLUSION: This study shows the high variety of rheumatism diseases in Black Africa;

[Semiological profile of gout in patients with AA, AS and AC hemoglobins]. / Profil sémiologique de la goutte chez des sujets porteurs des hémoglobines AA, AS et AC.

AIM: To search a possible difference in gout and in the risk factors for gout expression according to the of hemoglobin in patients seen at the lomé teaching hospital rheumatology clinic (Togo). PATIENTS AND METHODS: Medical records of patients seen during 17 years were studied. The patients affected by the gout and answering New York criteria have been included. All patients object of the comparison, benefitted from a hemoglobin electrophoresis and the search of possible risk factors for gout. RESULTS: Among the 14902 patients seen over a 17 year period, 214 had gout (210 males, 4 famales). These 214 patients were carriers of an AA hemoglobin (147 cases), of an AS hemoglobin (41 cases), or of an AC hemoglobin (26 cases). The alcoholism, the obesity, and the arterial hypertension were the main risk factors associated with gout in 207 patients (97%). Semiological and risk factors comparison according to the type of hemoglobin didn't show statistically significant difference. CONCLUSION: it results from this study that the AS hemoglobin and AC hemoglobin don't exercise any influence on the gout semiological expression. Thus, the presence of one of these hemoglobins in gout patient must exercise no influence in the diagnostic gait and in the etiological investigation.

[Patterns of osteoarthritis in patients attending a teaching hospital clinic]. / Formes topographiques des arthroses des membres en consultation rhumatologique à Lomé (Togo).

AIM: determine the prevalence and topographic patterns of osteoarthritis. METHODS: Medical records of patients seen at the Lomé Teaching Hospital, Rheumatology Clinic (Togo) were studied retrospectively. RESULTS: Among the 12251 patients seen over a 15 year period, 1085 had appendicular osteoarthritis. Mean age at onset was 50, 3 years (extremes: 7 and 85 years), and mean duration of osteoarthritis was 4.4 years. Principal distribution of affected joints was as follows: knee, 993 patients (844 females, 85%; 149 males); hip, 77 patients (primary osteoarthritis: 36 patients, secondary osteoarthritis: 41 patients) ; scapulohumeral joint, 5 patients; and fingers, 5 patients. At the knee, the lesions involved the medial femorotibial compartment in 493 patients (unilateral: 117 patients, bilateral: 376 patients), the lateral femorotibial compartment in 223 patients (unilateral: 74 patients, bilateral: 149 patients) and the patellofemoral compartment in 42 patients (unilateral: 17 patients, bilateral: 25 patients). Mean age at onset of knee osteoarthritis was 50, 3 years. Among females with knee osteoarthritis, 83% were obese and 63, 5% had varus or valgus deformities. CONCLUSION: This study confirms that in black Africa the high prevalence of knee osteoarthritis contrasts with the low prevalence of primary osteoarthritis of the hip and of osteoarthritis of the fingers. Female sex, obesity, and varus or valgus deformities are the main risk factors for femorotibial osteoarthritis in black Africa.