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1.
Nat Rev Rheumatol ; 17(6): 363-374, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33850309

RESUMO

Historically, rheumatic diseases have not received much attention in Africa, particularly in sub-Saharan Africa, possibly owing to a focus on the overwhelming incidence of infectious diseases and the decreased life span of the general population in this region. Global attention and support, together with better health policies and planning, have improved outcomes for many infectious diseases; thus, increasing attention is being turned to chronic non-communicable diseases. Rheumatic diseases were previously considered to be rare among Africans but there is now a growing interest in these conditions, particularly as the number of rheumatologists on the continent increases. This interest has resulted in a growing number of publications from Africa on the more commonly encountered rheumatic diseases, as well as case reports of rare diseases. Despite the limited amount of available data, some aspects of the epidemiology, genetics and clinical and laboratory features of rheumatic diseases in African populations are known, as is some detail on the use of therapeutics. Similarities and differences in these conditions can be seen across the multi-ethnic and genetically diverse African continent, and it is hoped that increased awareness of rheumatic diseases in Africa will lead to earlier diagnosis and better outcomes for patients.


Assuntos
Predisposição Genética para Doença/epidemiologia , Publicações/estatística & dados numéricos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/epidemiologia , Reumatologistas/estatística & dados numéricos , Adulto , África ao Sul do Saara/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Conscientização , Comorbidade , Gerenciamento Clínico , Meio Ambiente , Feminino , Predisposição Genética para Doença/etnologia , Política de Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Publicações/provisão & distribuição , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/genética , Fatores de Risco
2.
Clin Rheumatol ; 40(8): 3135-3141, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33619626

RESUMO

BACKGROUND: Osteoarthritis (OA) is a common degenerative condition leading to significant pain, functional limitation, and economic loss. Generalized OA (GOA) is associated with greater morbidity and accounts for 5-25% of total OA cases depending on definition used. This paper aims to determine the frequency and pattern of GOA, compare clinical and laboratory parameters of GOA and non-GOA subjects, then identify independent associations of GOA among Nigerians with knee OA. METHODS: A cross-sectional study of 180 knee OA patients with knee and generalized OA defined using ACR criteria. Questionnaire administration was followed by physical examination and appropriate radiographs. Data was summarized using tables and figures. Multivariate regression was done to identify independent GOA associations with statistical significance p<0.05. Ethical approval was obtained for the study. RESULTS: There were 180 participants with mean age 59.7±9.1 years. Twenty-eight patients (15.6%) had GOA of which 26 were female. The hip/knee/spine pattern was the commonest while hand OA was rare. Comparisons showed that GOA patients were significantly older with longer pain duration, higher pain score, more Heberden's nodes, and greater fatigue. There were no significant differences between both groups in levels of inflammatory markers and other laboratory parameters. Further analysis identified joint stiffness as the only independent association of GOA (OR 3.34, p=0.01). CONCLUSION: A 15.6% frequency of GOA was identified among knee OA sufferers with the hip/knee/spine pattern most frequent. Nigerians with GOA are predominantly females with a large joint phenotype. Joint stiffness was the only independent association of GOA observed. Key Points • Generalized osteoarthritis occurs in 15.6% of Nigerian patients with knee osteoarthritis. • Females are predominantly affected with a large joint phenotype involving the hip/knee/spine. • Joint stiffness is an independent association of generalized osteoarthritis.


Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Idoso , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Nigéria , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/epidemiologia , Radiografia
3.
Rheumatology (Oxford) ; 60(1): 392-398, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020845

RESUMO

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.


Assuntos
COVID-19 , Atenção à Saúde/métodos , Padrões de Prática Médica/estatística & dados numéricos , Reumatologistas , Adulto , África , Antirreumáticos/uso terapêutico , Produtos Biológicos/uso terapêutico , Atenção à Saúde/estatística & dados numéricos , Correio Eletrônico/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Equipamento de Proteção Individual , Exame Físico/métodos , Guias de Prática Clínica como Assunto , Sistema de Registros/estatística & dados numéricos , Doenças Reumáticas/terapia , Reumatologia , SARS-CoV-2 , Sociedades Médicas , Telemedicina/estatística & dados numéricos , Telefone/estatística & dados numéricos , Comunicação por Videoconferência/estatística & dados numéricos
4.
Rheumatol Int ; 41(3): 529-542, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32851423

RESUMO

Globally, increasing demand for rheumatology services has led to a greater reliance on non-physician healthcare professionals (HCPs), such as rheumatology nurse specialists, to deliver care as part of a multidisciplinary team. Across Africa and the Middle East (AfME), there remains a shortage of rheumatology HCPs, including rheumatology nurses, which presents a major challenge to the delivery of rheumatology services, and subsequently the treatment and management of conditions such as rheumatoid arthritis (RA). To further explore the importance of nurse-led care (NLC) for patients with RA and create a set of proposed strategies for the implementation of NLC in the AfME region, we used a modified Delphi technique. A review of the global literature was conducted using the PubMed search engine, with the most relevant publications selected. The findings were summarized and presented to the author group, which was composed of representatives from different countries and HCP disciplines. The authors also drew on their knowledge of the wider literature to provide context. Overall, results suggest that NLC is associated with improved patient perceptions of RA care, and equivalent or superior clinical and cost outcomes versus physician-led care in RA disease management. Expert commentary provided by the authors gives insights into the challenges of implementing nurse-led RA care. We further report practical proposed strategies for the development and implementation of NLC for patients with RA, specifically in the AfME region. These proposed strategies aim to act as a foundation for the introduction and development of NLC programs across the AfME region.

5.
Clin Rheumatol ; 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32803569

RESUMO

Interstitial lung disease (ILD) occurs in 15% of connective tissue disease (CTD) patients causing considerable morbidity and mortality. Data is scarce regarding its clinical characteristics and outcomes in Africa. We aim to study the frequency, clinico-radiological characteristics, and treatment outcomes of African CTD-ILD patients. A retrospective cross-sectional study of ILD among 318 CTD patients diagnosed using relevant ACR criteria at the rheumatology unit of Lagos State University Teaching Hospital (LASUTH), Lagos from 2012 to 2019. Socio-demographics, clinical features, radiological findings, and treatment outcomes were documented. Data was analyzed using SPSS version 21 with p < 0.05. The LASUTH ethics committee approved the study. Interstitial lung disease occurred in 31 (9.7%) of 318 CTD cases. Their mean age was 38.8 ± 13.3 years, range 19-68 years with 28 (90.3%) females. Proportions of CTD-ILD were Sjogren's syndrome (50%), UCTD (50%), systemic sclerosis (46.7%), MCTD (33.3%), PM/DM (25%), SLE (6.5%), and RA (2.6%). Commonest presentations were cough (93.5%) and bibasal inspiratory crackles (83.9%) with a restrictive pattern in 83.9%. Antinuclear antibody occurred in 100% and anti-ENA in 67.7%. Traction bronchiectasis (89.7%) and ground glass opacities (96.6%) were frequent HRCT findings. Treatments included pulse-dose prednisolone, cyclophosphamide, mycophenolate mofetil, pirfenidone, and rituximab. Outcomes were ambulatory oxygen therapy (12.9%) and mortality (16.1%) with 9.7% lost to follow-up. CTD-ILD is a female predominant disease occurring in 9.7% of CTD patients mostly those with Sjogren's syndrome and systemic sclerosis. Due to significant morbidity and mortality, we advocate routine ILD screening for all CTD patients including those with undifferentiated disease. Key Points: • Interstitial lung disease occurs in 9.7% of patients with underlying connective tissue disease. • Females are predominantly affected especially those with Sjogren's syndrome and systemic sclerosis. • Mortality occurs in roughly 1 in every 6 patients with CTD-ILD.

7.
Int J Rheum Dis ; 23(7): 970-976, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32476248

RESUMO

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.


Assuntos
Instituições de Assistência Ambulatorial , Fibromialgia/diagnóstico , Reumatologia , Inquéritos e Questionários , Avaliação de Sintomas , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Idoso de 80 Anos ou mais , Feminino , Fibromialgia/etnologia , Fibromialgia/fisiopatologia , Fibromialgia/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Nigéria/epidemiologia , Medição da Dor , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Perfil de Impacto da Doença , Sono , Adulto Jovem
8.
Ocul Immunol Inflamm ; 27(6): 905-911, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314623

RESUMO

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.


Assuntos
Doenças Autoimunes/epidemiologia , Oftalmopatias/epidemiologia , Hospitais Privados/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Reumatologia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/tratamento farmacológico , Oftalmopatias/diagnóstico , Oftalmopatias/tratamento farmacológico , Feminino , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Especialização/estatística & dados numéricos , Adulto Jovem
9.
BMJ Case Rep ; 12(6)2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31217209

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA), previously called Churg-Strauss Syndrome, is a systemic autoimmune disease that is usually associated with asthma and eosinophilia. It is a rare condition associated with antineutrophil cytoplasmic antibodies (ANCA). We report a case of a 52-year-old Nigerian woman who presented with bilateral leg swelling with multiple ulcers, background history of allergic rhinitis and chronic sinusitis since adolescence. There were also associated symptoms of peripheral neuropathy, weight loss, peripheral blood eosinophilia and positive perinuclear ANCA and she was previously managed for rheumatoid arthritis and asthma. She fulfilled the American College of Rheumatology criteria for EGPA and was treated with glucocorticoids and methotrexate which led to significant improvement of her symptoms.


Assuntos
Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/diagnóstico , Imunossupressores/uso terapêutico , Úlcera da Perna/patologia , Metotrexato/uso terapêutico , Anticorpos Anticitoplasma de Neutrófilos , Edema , Feminino , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/fisiopatologia , Humanos , Pessoa de Meia-Idade , Nigéria , Resultado do Tratamento , Perda de Peso
10.
Int J Nephrol ; 2019: 1625837, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31186960

RESUMO

Background and Objectives: The prevalence of noncommunicable diseases like chronic kidney disease is on the rise in third-world countries. In Nigeria and most sub-Saharan African countries, there is dearth of community-based studies on prevalence and predictors of chronic kidney disease, prompting us to undertake this study. Materials and Methods: This was a cross-sectional study, aimed at ascertaining the prevalence and predictors of chronic kidney disease (CKD) in a semiurban community in Lagos, Southwest Nigeria. The study's subjects were recruited from Agbowa community in Ikosi-Ejirin Local Council Development Area of Lagos state. The community was randomly selected. Questionnaires were used to obtain relevant information from the subjects. Body mass index, anthropometric measurements, and other relevant data were also collected. Results: CKD was observed in 30 subjects given prevalence of 7.5% in the community. Nine out of the 30 subjects (30%) with CKD were males, while 21 (70%) subjects were females. The prevalence of CKD was significantly higher in the female population. 28 of the subjects with CKD were in stage 3, while 2 of the subjects with CKD were in stage 4. Age, hypertension, and hyperuricemia were significantly associated with CKD. Using multiple logistic regression analysis, 4 variables predicted CKD in the study population. These were age (P =0.01, OR = 0. 274, CI = 0.102 - 0.739), hypertension (p = 0.011, OR = 0. 320, CI = 0.132 - 0.773), hyperuricemia (p=0.001, OR = 0.195, CI =0.083 - 0.461), and female sex (p = 0.009, OR = 3.775, CI = 1.401 - 10.17). Conclusion: The prevalence of CKD in the population is low compared with other studies from other parts of the country, and the predictors included age, hypertension, hyperuricemia, and female gender. This is the first community-based study in Nigeria to identify hyperuricemia as a risk factor for chronic kidney disease in the country.

11.
Int Ophthalmol ; 39(5): 1003-1012, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29564803

RESUMO

Objectives To determine the patterns, predictors and overall impact of ocular manifestations of rheumatoid arthritis (RA) on the health-related quality of life and disability index. METHODS: A total of 50 Nigerian patients with RA were studied. Full ocular evaluation was done to determine the presence of each defined ocular manifestation of RA. All patients completed the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) questionnaires. RESULTS: The mean ± SD age of the patients was 47.2 ± 12.5 years. A total of 42 cases of ocular diseases were found in 23 (46%) patients. Keratoconjunctivitis sicca was found in 15 (30%) patients; cataract, 13 (26%); scleritis/episcleritis, 4 (8%); disk edema, 4 (8%); glaucoma, 3 (6%); ulcerative keratitis, 1 (2%); vitreitis, 1 (2%); and macula edema, 1 (2%) patient. There is an association of the presence of ocular manifestations with the physical component summary (PCS) [T = - 3.398, P = 0.001] and the mental component summary (MCS) [T = - 2.616, 0.012] of the SF-36 but not with the HAQ-DI (T = 1.685, 0.099). Following multiple regression analysis, the predictors of the presence of ocular manifestations were age greater than 45 years and positive anti-citrullinated protein antibody. Following linear regression analyses, Steinbrocker's functional class independently predicted the PCS while both Steinbrocker's functional class and female sex predicted the MCS. CONCLUSIONS: The development of ocular disorders associated with RA is associated with a significant negative impact on the quality of life of the patients.


Assuntos
Atividades Cotidianas , Artrite Reumatoide/complicações , Avaliação da Deficiência , Oftalmopatias/etiologia , Nível de Saúde , Qualidade de Vida , Medição de Risco/métodos , Adulto , Idoso , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/reabilitação , Estudos Transversais , Oftalmopatias/fisiopatologia , Oftalmopatias/reabilitação , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
12.
Reumatologia ; 56(1): 17-23, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29686438

RESUMO

Objectives: To highlight common precipitants and co-morbidities of gout in Nigerians; determine the frequency of chronic kidney disease (CKD) in Nigerian gout patients, as well as identify significant associations of CKD in gout patients. Material and methods: Retrospective cross-sectional study of gout cases seen at the Rheumatology Clinic of the Lagos State University Teaching Hospital over five years from January 2011 to December 2015. Gout was diagnosed using the 1977 American Rheumatism Association (ARA) criteria. Clinical and laboratory data were extracted and examined for the presence of CKD defined using Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines as estimated glomerular filtration rate (eGFR, CKD-EPI) < 60 mls/min/1.73 m2 body surface area for > 3 months. Results: One hundred and six gout patients were identified representing 4.5% out of a total of 2330 cases seen during the study period. There were 94 males and 12 females. Oligoarthritis was most frequent (41.5%) with the knee mostly affected (20.1%). Diuretic use was the most frequent precipitant (37.9%) with hypertension the commonest co-morbidity (62.9%). Of 70 patients with complete results, 29 had eGFR (CKD-EPI) < 60 mls/min (41.4%). Age, proteinuria, body mass index (BMI) and packed cell volume (PCV) were significant associations of CKD. Gout patients with CKD were significantly older (61.79 vs. 54.41 years, p = 0.003) with a significantly higher proportion developing proteinuria (15 vs. 4 patients, p ≤ 0.0001) compared to those without CKD. In contrast, those with CKD had a significantly lower BMI (27.31 vs. 29.65 kg/m2, p = 0.026) and PCV (31.97 vs. 37.95%, p = 0.005). Conclusions: Thiazide diuretic use is the most common precipitant while hypertension is the commonest comorbidity in Nigerian gout patients. About two in five Nigerian gout patients had chronic kidney disease at presentation with age, proteinuria, BMI and PCV as significant associations. It is thus imperative to screen for chronic kidney disease when managing gout patients.

15.
J Clin Rheumatol ; 24(4): 183-187, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29298172

RESUMO

BACKGROUND: Psoriatic arthritis (PsA) is an extracutaneous manifestation of psoriasis occurring in 6% to 42% of patients. Both conditions are common among whites but rarely reported among black Africans.Few African studies, however, have reported PsA frequencies of 0% to 4.6%, with a previous case report of 2 patients from a Nigerian rheumatology clinic. METHODS: Case records of PsA patients from the Lagos State University Teaching Hospital Rheumatology Clinic seen over a 5-year period from January 2012 to December 2016 were retrieved and documented.Psoriatic arthritis was diagnosed using the Classification Criteria for Psoriatic Arthritis. Data on demography, clinical features, laboratory parameters, imaging, and treatment were extracted from case records. RESULTS: Twelve PsA cases were identified out of 2330 patients (0.5%) seen during the study period. There were 9 males and 3 females. Age range was 24 to 67 years (mean, 45.3 ± 15.1 years). Duration of psoriasis ranged between 11 and 96 months (mean, 46.8 ± 33.6 months), whereas median duration of arthritis at presentation was 15 months (range, 4-72 months).Oligoarthritis was the commonest presentation (58.3%). Dactylitis (66.7%) and enthesitis (44.7%) were frequent extra-articular features. All patients were negative for rheumatoid factor and human immunodeficiency virus. HLAB27 was negative in 5 patients tested.Treatment was mostly with nonsteroidal anti-inflammatory drugs (100%) and methotrexate (75%). Only 1 patient received the biologic etanercept. Eight subjects (66.6%) showed initial improvement in skin and joint symptoms, of which 6 had a relapse within 6 to 12 months. CONCLUSIONS: Psoriatic arthritis is rare among Nigerians and predominantly affects males in their fourth decade. Oligoarthritis is common, and extra-articular manifestations are frequent.


Assuntos
Artrite Psoriásica/diagnóstico , Artrite Psoriásica/epidemiologia , Adulto , Idoso , Artrite Psoriásica/terapia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Adulto Jovem
16.
Clin Rheumatol ; 36(11): 2541-2548, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28905144

RESUMO

Osteoarthritis (OA) of the knee is the most common type of arthritis all over the world. Obesity is the strongest modifiable risk factor and causes OA through a combination metabolic factors and mechanical loading. This study aimed to determine the frequency of metabolic syndrome (Mets) among patients with knee OA and its relationship with pain and functional status. This was a descriptive hospital-based cross-sectional study involving patients with knee OA. Pain was measured using a 0-10 numeric rating visual analog scale (VAS). Functional status was assessed using Steinbrocker's functional classification. Metabolic syndrome was diagnosed using the International Diabetic Federation criteria. Radiographs of both knees were taken and graded using Kellgren and Lawrence scale. Relationship of pain and functional status with obesity and Mets was assessed using Pearson's correlation. A p value of < 0.05 was considered significant. Two hundred and forty-four patients with knee OA comprising 63 (25.8%) males and 181 (74.2%) females were recruited. The median age was 50 years (range 18-73 years). Mets was diagnosed in 146 (59.8%). Obesity, diabetes, and hypertension were present in 154 (63.1%), 40 (16%), and 144 (59%) patients, respectively. Severe pain at first visit was present in 216 (88.5%) patients of which 128 (52.4%) had Mets compared to 85 (36.1%) without Mets (χ 2 = 2.40, p = 0.361). Two hundred and four (83.6%) had Steinbrocker's functional classes II and III. Waist circumference was higher in patients with Mets (p = 0.025) but age (p = 0.092), BMI (p = 0.831), VAS (p = 0.361), and functional class (p = 0.401) were similar in those with and without Mets. Body mass index showed significant association with severity of pain (p = 0.017) but not with functional class (p = 0.138). Kellgren and Lawrence radiographic grades III and IV were documented in 288 (48.5%) and 136 (27.2%) knees, respectively. A higher BMI correlated with more severe radiographic grading for the right (p = 0.043) and left (p < 0.001) knees, respectively. Mets is prevalent (59.8%) among Nigerians with knee OA, and those with Mets have higher waist circumference. Significant association was observed between BMI with pain and Kellgren-Lawrence (KL) grade. Mets was not associated with pain, function, or KL grade.


Assuntos
Síndrome Metabólica/complicações , Obesidade/complicações , Osteoartrite do Joelho/complicações , Idoso , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Articulação do Joelho , Masculino , Síndrome Metabólica/diagnóstico por imagem , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Nigéria , Obesidade/diagnóstico por imagem , Obesidade/metabolismo , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/metabolismo , Medição da Dor , Radiografia , Fatores de Risco , Centros de Atenção Terciária
17.
BMJ Case Rep ; 20172017 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-28720599

RESUMO

Idiopathic inflammatory myopathies are a heterogeneous group of systemic diseases characterised by variable phenotypes of chronic progressive muscle weakness. Myositis-specific antibodies (MSAs) include antibodies to cytoplasmic signal recognition particle (SRP) and various tRNA synthetases as well as the nuclear helicase protein Mi-2. These antibodies are typically found only in a fraction of true myositis cases and they tend to be mutually exclusive. Few cases of coexistence of two MSAs in the same patient have been reported and these cases all involve an antisynthetase antibody coexisting with either anti-SRP or anti-Mi-2 antibody. Peculiar clinical manifestations may be associated with different combinations of MSAs but the rarity of these cases makes their characterisation difficult. We report the first ever case of anti-SRP and anti-Mi-2 copositive polymyositis in a 19-year-old boy who presented with a week history of profound muscle weakness that attained its peak within 24 hours of onset.


Assuntos
Autoanticorpos/sangue , Complexo Mi-2 de Remodelação de Nucleossomo e Desacetilase/imunologia , Debilidade Muscular/etiologia , Polimiosite/complicações , Partícula de Reconhecimento de Sinal/imunologia , Adulto , DNA Helicases/imunologia , Dermatomiosite/complicações , Dermatomiosite/imunologia , Humanos , Masculino , Debilidade Muscular/imunologia , Miosite/sangue , Miosite/complicações , Miosite/imunologia , Polimiosite/imunologia , Adulto Jovem
18.
Case Rep Rheumatol ; 2017: 8247591, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28386505

RESUMO

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.

19.
Pediatr Rheumatol Online J ; 15(1): 7, 2017 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-28143550

RESUMO

BACKGROUND: Paediatric rheumatology service in Sub-Sahara African is virtually not available as there is a shortage of paediatric rheumatologists and other rheumatology health professionals. We aim to describe the clinical spectrum and the frequencies of paediatric rheumatic diseases (PRDs) in Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria. METHODS: This is a retrospective review of patients with PRDs seen over a five year period (March 2010 to February 2016) at the rheumatology clinic and children ward of LASUTH. We reviewed the folders of 57 patients from our records. The demographics, baseline laboratory features, clinical diagnosis, treatment patterns and patient outcomes were extracted and analyzed. Clinical and laboratory characteristics between patients with Juvenile idiopathic arthritis (JIA) and patients with juvenile connective tissue diseases (JCTD) were compared using Fisher's exact test. RESULTS: Fifty seven patients were studied with a female to male ratio of 3 to 1 (Female: 43; M: 14). The mean age at presentation in years was 14 ± 4.4 years (range: 1.5-22 years). The mean duration of symptoms before diagnosis was 18.4 ± .9 months (range: 2-60 months). The diagnostic types of PRDs included 28(49.1%) cases of JIA. These were made up of 14 cases of polyarticular JIA, nine cases of oligoarticular JIA and 5 cases of systemic onset JIA. Others were 18 (24.6%) cases of juvenile systemic lupus erythematosus (JSLE), 3 (5.3%) cases of joint hypermobility syndrome, 2 (3.5%) cases of juvenile systemic sclerosis, 2 (3.5%) cases of fibromyalgia, 2 (3.5%) cases of plantar fasciitis, 1 (1.6%) case of juvenile dermatomyositis (JDM), 1 (1.6%) case of juvenile polymyositis-systemic lupus erythematosus (PM-SLE) overlap, 1 (1.6%) case of secondary bilateral knee osteoarthritis from Blount disease, 1 (1.6%) case of secondary osteoporosis from childhood leukemia and 1 (1.6%) case of Osgood-Schlatter's disease. Constitutional symptoms and extra-articular diseases were significantly more frequent among JCTD cases than among the JIA cases (Constitutional symptoms: 100% vs 83.3%, p = 0.003; extra-articular disease: 100% vs 10.7%, p = 0.001). The percentage mortality in this study was 10.5% while 20 (35.1%) of the patients were lost to clinic follow up. CONCLUSION: The pattern of PRDs observed in this study is similar to that described in South African and North American series but it differs from patterns reported in Asian series. Although hitherto largely unrecognized, PRDs may constitute a substantial cause of morbidity and mortality in black Africans.


Assuntos
Doenças Reumáticas/epidemiologia , Adolescente , Anti-Inflamatórios não Esteroides/uso terapêutico , Fatores Biológicos/uso terapêutico , Biomarcadores/metabolismo , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Lactente , Masculino , Nigéria/epidemiologia , Estudos Retrospectivos , Doenças Reumáticas/diagnóstico , Adulto Jovem
20.
Clin Nephrol ; 86 (2016)(13): 119-122, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27509586

RESUMO

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.


Assuntos
Insuficiência Renal Crônica/patologia , Injúria Renal Aguda/patologia , Adolescente , Adulto , Biópsia/métodos , Diagnóstico Diferencial , Feminino , Glomerulonefrite/patologia , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Rim/patologia , Nefrite Lúpica/patologia , Masculino , Microscopia Eletrônica , Microscopia de Fluorescência , Pessoa de Meia-Idade , Síndrome Nefrótica/patologia , Nigéria , Estudos Prospectivos , Proteinúria/urina , Adulto Jovem
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