COVID-19, chronic inflammatory rheumatic disease and anti-rheumatic treatments.

Since December 2019, the pandemic caused by coronavirus disease 2019 (COVID-19) raises a real public health problem. COVID-19 appeared in Wuhan (Hubei province) in China. Drugs that have been used in rheumatology for decades seem to be effective in this infection and are for the most part being studied. The rational use of these anti-rheumatic drugs is based on the cytokinic storm (hyperproduction of IL1, IL6, TNF α) in the body by COVID-19 in its severe form. In this review, the authors make the difference between the infectious and auto-inflammatory part of COVID-19; the disease does not seem to be a risk factor for admission to the intensive care unit for patients suffering from inflammatory rheumatism; however, the poverty of studies on this subject should be noted. The authors also review anti-rheumatic drugs while studying COVID-19 treatment.

Les rhumatismes inflammatoires chroniques (RIC) de l'enfant : à propos de cinq cas suivis dans le service de rhumatologie de CHU de Brazzaville

Introduction : En Afrique Sub-saharienne, les rhumatismes inflammatoires chroniques sont des affections peu rapportées chez l'enfant. Objectif : Contribuer à la connaissance des rhumatismes inflammatoires chroniques chez l'enfant Patients et Méthodes : Le service de Rhumatologie du CHU de Brazzaville a mis en place depuis janvier 2012, une consultation spécialisée des maladies auto immunes et des systèmes. La filière active compte 90 patients. De celle-ci sont extraits cinq dossiers de patients âgés de moins de 18 ans. Leurs données épidémiologiques, cliniques, para cliniques et évolutifs ont été colligés pour en faire ressortir les particularités éventuelles. Résultats : Il s'agissait de 3 filles et 2 garçons âgés de 8 ans à 16 ans suivis depuis 38 mois en moyenne (extrême de 33 à 42 mois). La douleur articulaire était le principal motif de consultation. Elle intéressait principalement les grosses et petites articulations des membres, d'horaire inflammatoire. Il existait une altération de l'état général dans 3 cas. Les signes de synovites étaient présents à l'examen physique. Il existait un syndrome inflammatoire biologique dans trois cas. Le bilan auto immun (FR, Ac anticcp, AAN, Ac anti DNA, ANCA) a été réalisé chez quatre patients. Les diagnostics retenus étaient l'arthrite juvénile idiopathique dans deux cas, sclérodermie systémique, connectivite mixte et la maladie de Still et dans 1 cas chacun. Tous ont bénéficié d'une corticothérapie et d'un traitement de fond. Trois enfants sont en rémission, deux autres sont contrôlés. Un seul cas d'intolérance a été observé (rash cutané sous plaquenil). Conclusion : Affection peu fréquente. Le diagnostic repose sur une démarche clinico-biologique et une approche pluridisciplinaire, gage d'un traitement efficace et bien toléré

[Secondary cutaneous plasmacytoma revealing multiple myeloma: about a case]. / Plasmocytome cutané secondaire révélant un myélome multiple: à propos d'un cas.

Secondary metastatic cutaneous plasmacytoma is a multiple extramedullary plasma cell proliferation involving skin. Its diagnosis is based on the identification of malignant plasma cells proliferation in the bone marrow and in the skin. Its occurrence is associated with advanced myeloma and a poor prognosis.

Improving the Quality of Host Country Ethical Oversight of International Research: The Use of a Collaborative 'Pre-Review' Mechanism for a Study of Fexinidazole for Human African Trypanosomiasis.

Developing countries face numerous barriers to conducting effective and efficient ethics reviews of international collaborative research. In addition to potentially overlooking important scientific and ethical considerations, inadequate or insufficiently trained ethics committees may insist on unwarranted changes to protocols that can impair a study's scientific or ethical validity. Moreover, poorly functioning review systems can impose substantial delays on the commencement of research, which needlessly undermine the development of new interventions for urgent medical needs. In response to these concerns, the Drugs for Neglected Diseases Initiative (DNDi), an independent nonprofit organization founded by a coalition of public sector and international organizations, developed a mechanism to facilitate more effective and efficient host country ethics review for a study of the use of fexinidazole for the treatment of late stage African Trypanosomiasis (HAT). The project involved the implementation of a novel 'pre-review' process of ethical oversight, conducted by an ad hoc committee of ethics committee representatives from African and European countries, in collaboration with internationally recognized scientific experts. This article examines the process and outcomes of this collaborative process.

Clinical spectrum of rheumatologic diseases in a department of rheumatology in Ouagadougou (Burkina Faso).

The aim of this study is to review over a period of 5 years the clinical spectrum of rheumatic diseases seen in a tertiary hospital in Ouagadougou, Burkina Faso. A retrospective study of case records was conducted from March 1, 2006 to March 30, 2011 in the Rheumatology service, Department of Internal Medicine of the University Hospital Yalgado Ouedraogo. Of the 4,084 patients seen, 2,381 were women (58.30%) and 1,703 were men (41.70%). The mean age at disease onset was 42.12 years, ranging from 3 to 92 years. Among the rheumatologic conditions, mechanical and degenerative disorders were the most common, found in 3,053 cases (74.76%). Among these cases, spinal pathology predominated, especially low back pain (19.93 %). The frequency of osteoarthritis was 19.70 % (804 cases) with a predominance of knee osteoarthritis (657 cases). Infectious pathology was dominated by osteoarticular tuberculosis (48 cases), particularly Pott's disease (43.68% of infectious diseases). Among the cases of inflammatory arthritides, rheumatoid arthritis was the leading cause (116 cases or 2.84%). It was followed by spondyloarthropathies in which arthritis related to HIV predominated (21 out of 81 cases). Metabolic diseases were mainly represented by the gout (162 cases or 3.96%) with male predominance. Comorbidities included high blood pressure (46.57%), diabetes mellitus (13.78%), hemoglobinopathies (9.66%), epigastric pain (7.25%), and peptic ulcer confirmed by endoscopy (6.75%). Rheumatology in Burkina Faso is booming. The profile of rheumatologic diseases in Burkina Faso, after 5 years of practice, confirms the diversity and importance of these conditions dominated by a degenerative pathology of the spine and limbs, including infectious diseases such as Pott's disease and the inflammatory and metabolic diseases.

[Synovial Osteochondromatosis At The Rheumatology Unit Of The Yaounde Central Hospital]. / Osteochondromatose Synoviale En Rhumatologie A L'Hopital Central De Yaounde, Cameroun.

Synovial osteochondromatosis is a disease characterized by a benign metaplastic cartilaginous proliferation. There are very few studies on synovial osteochondromatosis in Sub Saharan Africa. We report on 10 observations.We conducted a retrospective study carried out from January 2004 to December 2008, in Synovial osteochondromatosis patients attending the Rheumatology Unit of the Yaounde Central Hospital. We studied 3 women and 7 men, with an average age of 27 years±13 (range: 14 and 89 years old). The knee was the most affected joint (observed in 9 cases) and the metacarpophalangeal joint of the thumb was affected in 1 case. Pain was constant, and joint motion limitation was observed in 6 cases, swelling of the joint in 4 cases, cracking of the joint in 2 cases and nodules were noted in 1 case. None of these patients presented an inflammatory syndrome. Radiological signs were: calcified chondromas in all 10 cases, associated with degenerative lesions in 3 cases. Every patient received an analgesic and a non-steroidal anti-inflammatory medication. Only 3 patients (patients 1, 4 and 5) underwent surgical synovectomy. None of the patients underwent arthroscopic surgery or synoviorthesis.Synovial osteochondromatosis manifestations in our patients were similar to what has been described in the literature, only differing in that surgical care was not constant.

L'ostéochondromatose synoviale est une maladie, qui se caractérise par une prolifération métaplasique bénigne cartilagineuse. Elle est peu décrite en Afrique Sub Saharienne. Nous rapportons dix observations.Il s'agissait d'une étude rétrospective sur dossier des cas d'ostéochondromatose synoviale colligés dans le service de rhumatologie de l'Hôpital Central de Yaoundé de Janvier 2004 à Décembre 2008.Dix observations ont été retenues chez trois femmes et de Sept hommes, dont l'âge moyen était de 27 ans±13, avec les extrêmes de 14 et 89 ans. Le genou était atteint dans 9 cas et l'atteinte de l'articulation métacarpophalangienne a été observée dans un cas. La douleur était constante, le blocage articulaire était noté dans 6 cas, la tuméfaction articulaire dans 4 cas, le craquement articulaire dans 2 cas et la présence de nodules dans un cas. Aucun patient n'avait eu un syndrome inflammatoire. Les signes radiologiques observés étaient les suivants : chondromes calcifiés dans les 10 cas, associés à des lésions dégénératives dans 3 cas. Tous les patients avaient reçu un traitement associant un antalgique et un anti-inflammatoire non stéroïdien. Seuls trois patients avaient eu un traitement chirurgical (patients 1, 4, 5), consistant en une synovectomie totale. Aucun patient de cette série n'avait eu une arthroscopie ni une synoviorthèse.La présentation de l'ostéochondromatose synoviale des patients de cette série était superposable aux données de la littérature, à la seule différence de la prise en charge chirurgicale qui n'était pas constante.

Thoracic spinal cord compression by a tophus.

We report a case of thoracic (T10) spinal cord compression by a tophus in a patient with known chronic gout. Spastic paraplegia developed gradually over 6 months in this 43-year-old man with hypertension, alcohol abuse, and chronic gouty arthritis with tophi. Magnetic resonance imaging and computed tomography visualized an intradural nodule measuring 1.5cm in diameter at the level of T10, as well as geodes in the left T10 lamina and left T9-T10 articular processes. The nodule was removed surgically and shown by histological examination to be a tophus. The neurological impairments resolved rapidly and completely. We found about 60 similar cases in the literature. Spinal cord compression in a patient with chronic gout can be caused by a tophus.

Is inflammatory joint disease in HIV-infected patients a form of spondyloarthropathy?

UNLABELLED: In Congo-Brazzaville, the seroprevalence of HIV infection is in the range 7-8%, and AIDS is the leading cause of aseptic arthritis (60% of cases). PATIENTS, MATERIAL AND METHODS: The ESSG and Amor's criteria for spondyloarthropathy were evaluated in 83 patients with HIV infection admitted for aseptic arthritis to the rheumatology department of the Brazzaville teaching hospital, over an 8-year period. RESULTS: All 83 patients were CDC stage IV; 66 (80%) had polyarthritis and 17 (20%) oligoarthritis. A single patient met ESSG and Amor's criteria, with six points; one patient had five points and 15 had three points. The joint involvement was asymmetrical and nonerosive. Nonsteroidal antiinflammatory therapy ensured resolution of the manifestations within 4-8 weeks. The most common sites of involvement were the knees (84%), ankles (59%), and great toes (23%) at the lower limbs and the wrists (41%), elbows (29%), and metacarpophalangeal and interphalangeal joints (25%) at the upper limbs. CONCLUSION: Inflammatory arthritis in HIV patients does not meet ESSG or Amor's criteria for spondyloarthropathy.