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2.
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
3.
Clin Rheumatol ; 40(9): 3401-3410, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33559776

RESUMO

Spondyloarthritis (SpA) has been less well studied than rheumatoid arthritis in North Africa, due to a belief that it is rare and benign in certain populations. The main genetic trait of SpA is its association with human leukocyte antigen (HLA)-B27. The distribution of this allele largely explains the prevalence and severity of SpA. The prevalence of HLA-B27 in the general population of North Africa is estimated at about 4%, and rises to about 60% among people affected with SpA. Coxitis is one of the main features of North African SpA, but the response to treatment is comparable to the literature from the West. The major challenge in North Africa remains accessibility to specialized care and means of early diagnosis. Prevalent infections in North Africa do not seem to be a major obstacle to optimal treatment strategies.


Assuntos
Espondilartrite , África do Norte/epidemiologia , Diagnóstico Precoce , Antígeno HLA-B27/genética , Humanos , Prevalência , Espondilartrite/diagnóstico , Espondilartrite/epidemiologia
4.
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
5.
Clin Rheumatol ; 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32876786

RESUMO

OBJECTIVES: To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic. METHOD: A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1-3, 4-6 and 7-9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a 'low' level of agreement. RESULTS: A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting. CONCLUSIONS: The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges. Key Points • AFLAR has developed preliminary recommendations for the management of RMDs in the face of the COVID-19 pandemic. • COVID-19 is an unprecedented experience which has brought new concerns regarding the use of some disease-modifying anti-rheumatic drugs (DMARDs), and these recommendations seek to provide guidelines to the African rheumatologists. • Hydroxychloroquine shortage has become rampart across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of treatment plan for some patients with RMDs. • Breastfeeding should continue for as long as possible if a woman is positive for SARS-CoV-2 as there is currently no evidence that the infection can be transmitted through breast milk.

8.
Diabetes Metab Syndr ; 11 Suppl 1: S425-S427, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28395950

RESUMO

BACKGROUND: There is evidence that rheumatoid arthritis (RA) patients have an over-risk of cardiovascular disease. This may be mainly due to an increase in the prevalence of metabolic syndrome (MetS). The prevalence of MetS among adults in Algeria is 19.1%. OBJECTIVES: The aim of the study was to evaluate the prevalence of MetS among RA patients in Algeria. Another aim was to evaluate the relationship between MetS, inflammation biomarkers and disease scores. METHODS: The study was performed on a cohort of 249 patients meeting the ACR/EULAR criteria for RA, followed in 11 Algerian centers. The diagnosis of MetS was based on the NCEP/ATP III (MetS+ if ≥3/5) definition. Prevalence of MetS was calculated, and patients were divided in two groups (MetS+ and MetS-). Comparison between the groups was performed using a t-test. RESULTS: Among the 249 RA patients, 213 were females and 36 males of a mean age of 50.1±14.5years and a mean disease duration of 8.4±7.8years. The overall prevalence of MetS was 13.9% (CI95%: 9.5-20.1%); it was 14.3% in males and 13.8% in females. The ESR level was significantly higher in MetS+ patients than in MetS- patients (p=0.036). CONCLUSION: In this multicenter study, unlike most studies on RA patients, the prevalence of MetS was as not higher in Algerian RA patients (13.9%) than in the Algerian general population (19.1%). Only ESR levels correlate with the presence of MetS, this may be due to the modest cohort size and needs to be confirmed.


Assuntos
Artrite Reumatoide/complicações , Síndrome Metabólica/epidemiologia , Adulto , Argélia/epidemiologia , Biomarcadores/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Prevalência
9.
Eur J Rheumatol ; 2(2): 78-79, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27708932

RESUMO

Acrodermatitis continua of Hallopeau (ACH) is a rare form of pustular psoriasis, mainly affecting distal phalanges of hands and feet. Many therapeutic options exist; however, it tends to be resistant to treatment. We report a 26-year-old man presented with a very severe psoriatic arthritis associated with ACH. Although this patient was resistant to a first line treatment (glucocorticoids and methotrexate), a rapid and dramatic improvement was observed after adalimumab was introduced. The effectiveness and tolerance of the treatment were maintained during the 12-month period of follow-up. This is the first report of the efficacy of adalimumab on ACH in a patient presented with psoriatic arthropathy.

11.
Rheumatol Int ; 34(9): 1235-9, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24633899

RESUMO

The aim of this study was to compare the epidemiology of rheumatoid arthritis (RA) in North Africa to that of Western countries. We have enrolled in a cross-sectional study all consecutive patients presenting with the diagnosis of RA according to the 1987 ACR criteria, and during a 5-month period, patients were included in 11 centers across northern Algeria. Demographics, clinical data, and health assessment questionnaires (HAQ) were collected for each patient. We have estimated means, standard deviations, and 95 % confidence intervals for all parameters. Of the 249 patients (213 females and 36 males) enrolled in the study, 10 (4 %) had juvenile onset of the disease. The mean age was 50.1 ± 14.5 years, and the mean duration of RA was 8.4 ± 7.8 years. In terms of comorbidities, 18.9 % of patients reported hypertension and 5.2 % had diabetes. The mean DAS28 at inclusion was 4.3 (95 % CI 4.1-4.5); 14.0 % were in remission (DAS28 ≤ 2.6). The mean HAQ score was 0.81 ± 0.82. Rheumatoid factor was positive in 78.5 % of cases, and anti-citrullinated protein/peptide antibodies, when measured, was positive in 69.0 % of cases. Seronegative patients were older and had a relatively less severe disease. For treatment, 89.7 % of patients were taking disease-modifying anti-rheumatic drugs and only 4 % were taking biologics (rituximab); 90.8 % of patients were taking glucocorticoids, and none of the patients satisfied the recommended calcium intake guidelines. RA in Algeria is more common in women. Compared to reports from Western countries, RA in Algeria appears to be less aggressive, with more dominant seronegative oligoarthritis forms. The remission rate is comparable to that of Western populations.


Assuntos
Artrite Reumatoide , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Argélia/epidemiologia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/imunologia , Autoanticorpos/sangue , Produtos Biológicos/uso terapêutico , Cálcio/uso terapêutico , Comorbidade , Estudos Transversais , Suplementos Nutricionais , Feminino , Glucocorticoides/uso terapêutico , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeos Cíclicos/imunologia , Valor Preditivo dos Testes , Indução de Remissão , Testes Sorológicos , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
BMJ Case Rep ; 20132013 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-23813581

RESUMO

Melorheostosis is a very rare sclerosing bone disorder that involves frequently one limb. It may be asymptomatic, but pain and limb deformity may occur and can be very debilitating. Different reports have indicated efficacy of bisphosphonates (pamidronate and etidronate) on symptoms. We report an adult patient with a very painful melorheostosis, who  improved after treatment with zoledronate, either on symptoms or on bone scans.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Osso e Ossos/diagnóstico por imagem , Difosfonatos/uso terapêutico , Imidazóis/uso terapêutico , Melorreostose/tratamento farmacológico , Dor Musculoesquelética/tratamento farmacológico , Adulto , Feminino , Humanos , Melorreostose/complicações , Melorreostose/diagnóstico por imagem , Dor Musculoesquelética/etiologia , Medição da Dor , Cintilografia , Resultado do Tratamento , Ácido Zoledrônico
14.
Joint Bone Spine ; 78(5): 484-7, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21196130

RESUMO

OBJECTIVE: To determine in real-life conditions the safety of treatment with rituximab (RTX) in patients with rheumatoid arthritis (RA) regarding malignancies. METHODS: Analysis of safety data from a cohort of RA patients who received at least one course of RTX. RA patients with previous malignancies were followed-up and compared to the group of patients with no history of malignancy. RESULTS: One hundred and eighty-six RA patients, 33 (17.7%) males, the mean age and disease duration were 55.8 ± 13.0 and 14.5 ± 11.1 years, respectively. The mean follow-up was 22.3 ± 15.1 months, corresponding to a follow-up of 346 pt-years of RTX exposure. Among these, 24 (12.9%) patients had a history of a prior malignancy. Five cancers were diagnosed during follow-up with four new malignancies (1 prostate, 1 breast, 1 colon and 1 cervical cancers) and one recurrence of a known breast cancer. The overall cancer rate was 1.45/100 pt-years (95%CI: 0.19 to 2.70), which is comparable to previously studied DMARD-treated cohorts. No new hematopoietic neoplasms were reported and the six lymphomas that have been in remission prior to RTX-therapy remained under follow-up. The baseline demographic and disease characteristics and the cancer-risk of the 24 patients who presented with a prior malignancy were similar to those with no cancer history (162 patients). CONCLUSIONS: Although based on a modest number of observed cancers, and despite selection bias (12.9% of prior malignancies in our RTX treated RA), this observational study suggests that RTX does not increase the cancer risk in RA patients.


Assuntos
Anticorpos Monoclonais Murinos/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Neoplasias/epidemiologia , Adulto , Idoso , Anticorpos Monoclonais Murinos/administração & dosagem , Antirreumáticos/administração & dosagem , Estudos de Coortes , Feminino , Seguimentos , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Rituximab
15.
Rheumatol Int ; 31(2): 273-6, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20661739

RESUMO

Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive hereditary disorder (less than 80 cases reported), characterized by multiple nodular lesions on the skin and musculoskeletal involvement, very debilitating because most adolescents and adults become bedridden. Only 10 cases have been reported on JHF in adulthood. We report the case of a 34-year-old male patient in whom clinical and histological findings were consistent with a mild JHF and focus on the radiographic features. The main purpose of this report is to increase the information available related to the radiographic manifestations and prognosis of JHF.


Assuntos
Hialinose Sistêmica/diagnóstico por imagem , Adulto , Artralgia/diagnóstico por imagem , Humanos , Masculino , Prognóstico , Radiografia , Índice de Gravidade de Doença
17.
Joint Bone Spine ; 77(1): 70-2, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20031471

RESUMO

A 14-year-old girl with juvenile dermatomyositis developed extensive and debilitating calcinosis, unresponsive to colchicine, while muscle involvement subsided. Pamidronate (2mg/kg/year) produced dramatic improvement of pain and function within 2 months and calcinosis had completely resolved by 2 years. No new calcifications have been noted with a 5-year follow-up.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Calcinose/tratamento farmacológico , Dermatomiosite/tratamento farmacológico , Difosfonatos/uso terapêutico , Adolescente , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Cálcio/administração & dosagem , Colecalciferol/administração & dosagem , Dermatomiosite/complicações , Dermatomiosite/diagnóstico por imagem , Quimioterapia Combinada , Feminino , Humanos , Metilprednisolona/uso terapêutico , Pamidronato , Radiografia , Recuperação de Função Fisiológica , Resultado do Tratamento
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