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.

[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;

[Life conditions of Togolese doctors]. / Vécu et perçu de leur profession par des médecins togolais.

AIM: A study has been carried out by Togolese medical doctors in order to determine the perceived and the real life of their profession. METHODS: The study, which was transversal, has taken in account a sample of 52 medical doctors made on the basis of a cautious choice. Most of these medical doctors (15 general practitioners, 23 specialists and 14 hospitalo-universitaires) work in the medical cares centres of Lomé. A sheet of survey has permitted the collection of demographic data and data relating to the medical studies and career. RESULTS: The 52 medical doctors included in the study (7 women, 45 men) were between 25 and 59 years old; their age of getting their A-level was between 16 and 23 years old, and that of getting the doctorate diploma between 24 and 37. The length of professional experience stands between 8 months and 27 years. The marital status was specified by 47 of the 52 medical doctors: 13 single, one divorced, and 33 married; 5 of the 7 women who took part in the survey were single and without any child. The love of the profession (65%), the social status it confers (37%) and the honour tied to the profession (27%) were the main motives of choosing the profession. The decision of doing medical studies was taken during secondary studies by 45 of the 52 persons. The faculty of medicine of Lomé has been the study frame to general medicine studies of 35 persons (67%). The low payment (83%), the poverty of the patients (83%), the narrowness of the technical platform (79%), the insufficiency of cares structures in paramedical personnel (67%), the insufficiency of continuing education (60%), and the lack or insufficiency of drugs (58%) were the main problems encountered during their professional experience by the people questioned. 22 medical doctors (43%) have estimated that their profession has given them a particular social status. Only 8 medical doctors have found that the real things they have gone trough in the profession matches with the idea they had, while 32 (62%) are ready to choose again the profession if they have to start everything. The little time spent with the family has been stated out by 36 medical doctors (69%), the social and family prestige that came out of it by 32 (62%), and the ability to control the health of one's family by 34 (65%). The psychological impact of the profession on the medical doctors questioned was dominated by the adoption of a philosophical attitude towards life. CONCLUSION: A better productivity of the Togolese medical doctors needs the improvement of their life conditions (adjustment of texts in force, revision of the salary scale), the renovation of the facilities, the modernization of the technical platform, the continuing education of the medical doctors and the reinforcement of the practical management of the patient on bed.

[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.

[Semiological profile of avascular necrosis of the femoral head in patients with AA and AS hemoglobins]. / Profil sémiologique de l'ostéonécrose aseptique de la tête fémorale chez des sujets porteurs des hémoglobines AA et AS.

AIM: To search a possible difference in the avascular necrosis of the femoral head expression in patients with AA and AS hemoglobins seen at the Lomé Teaching Hospital Rheumatology Cinic (Togo). METHODS: Medical records of patients seen at the Lomé Teaching Hospital, Rheumatology Clinic (Togo) during 17 years were studied. Have been included in the present study the patients affected by the avascular necrosis of the femoral head and having been the object of hemoglobi electroophoresis (79 patients: AS hemoglobin (29 patients) ; AA hemoglobin (50 patients). The comparison of the parameters rested on the analysis of variance. RESULTS: Epidemiological and semiological comparison of the avascular necrosis of the femoral bead between the patients with AS hemoglobin and those having a normal hemoglobin didn't show a statistically significant difference. CONCLUSION: The presence of AS hemoglobin in avascular necrosis of the femoral head patients must not influence the gait aiming the search of an etiology or risk factor.

[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.

Poorly and well controlled spondyloarthropathies: a comparison of 2 groups of patients.

OBJECTIVE: To describe in a large population of patients with spondyloarthropathy (SpA) the proportion and characteristics of individuals whose disease was poorly controlled by their current treatment, compared to patients whose disease was well controlled. METHODS: We conducted a survey among the members of Spondylis, one of the main not-for-profit SpA patient organizations in France. One thousand anonymous questionnaires were sent to patients throughout France. Among collected data were the opinions of patients about control of their symptoms as well as their past and current treatment. RESULTS: Five hundred and seven respondents were included in the study of whom 75.9% were receiving nonsteroidal antiinflammatory drugs (NSAID), 55% reported inadequate control, and 45% good control of their nocturnal pain and morning stiffness. The Bath Ankylosing Spondylitis disease activity index (BASDAI) and functional index (BASFI) scores and the rates of occurrence of main symptoms were significantly higher in the group with poorly controlled disease. All drugs except NSAID were more often used currently and in the past by patients with poor disease control. CONCLUSION: Conventional treatments failed to provide adequate symptom relief in over half the patients with SpA, despite the use of various drugs in the vast majority of them. Although our results were obtained in a selected patient population, they suggest that a rather large proportion of SpA patients might be candidates for biotherapies.

Diagnostic value of 99mTc-HMDP bone scan in atypical osseous tuberculosis mimicking multiple secondary metastases.

STUDY DESIGN: A case of atypical osseous tuberculosis (TB) mimicking multiple secondary metastases on radiologic and nuclear imaging is presented. OBJECTIVES: To emphasize the contribution of nuclear bone scanning for the assessment of osseous tuberculosis in typical and atypical presentations. SUMMARY AND BACKGROUND DATA: Skeletal locations of TB mostly involve the dorsolumbar spine and diagnosis is often delayed. The presence of multiple TB sites can mimic secondary metastases and biopsy remains the mainstay for final diagnosis. METHODS: Clinical symptoms, lab tests, and imaging data are presented. Possible diagnoses are discussed. A review of imaging characteristics in cases of typical and atypical presentations of osseous TB is proposed. RESULTS: A dorsal spine spondylitis was first diagnosed on a 56-year-old patient presenting neurologic deficit of the left arm. Fine needle aspiration identified bacterial infection but was negative for Mycobacterium tuberculosis. Whole-body bone scan allowed the identification of an asymptomatic sacroiliac lesion, which was accessible to biopsy and gave a final diagnosis. CONCLUSION: Nuclear bone scanning should be kept in mind when assessing spinal pain in patients at high risk of TB infection or reactivation.

Infliximab therapy for rheumatic diseases in patients with chronic hepatitis B or C.

OBJECTIVE: To describe the safety of tumor necrosis factor-a blockade in 2 patients with inflammatory rheumatic disease with chronic hepatitis B and C. METHODS: We used infliximab therapy in 2 patients with chronic inflammatory joint disease and chronic hepatitis B or C. We describe the clinical and laboratory test data obtained in these patients during the first year of treatment. Disease activity, liver function tests, and HCV and HBV status were evaluated before infliximab therapy was started and were reevaluated before each infusion. Liver biopsy was performed in both patients before infliximab therapy. RESULT: After more than one year of treatment, no worsening in liver function or virological status was observed, while a dramatic clinical improvement of joint disease was observed in both patients. CONCLUSION: These cases suggest that infliximab therapy may be safe in some quiescent or controlled chronic HBV or HCV infection.