M.S. Doualla

Serum Uric Acid Is Associated with Poor Outcome in Black Africans in the Acute Phase of Stroke

Background Prognostic significance of serum uric acid (SUA) in acute stroke still remains controversial. Objectives To determine the prevalence of hyperuricemia and its association with outcome of stroke patients in the Douala General Hospital (DGH). Methods This was a hospital based prospective cohort study which included acute stroke patients with baseline SUA levels and 3-month poststroke follow-up data. Associations between high SUA levels and stroke outcomes were analyzed using multiple logistic regression and survival analysis (Cox regression and Kaplan-Meier). Results A total of 701 acute stroke patients were included and the prevalence of hyperuricemia was 46.6% with a mean SUA level of 68.625 ± 24 mg/l. Elevated SUA after stroke was associated with death (OR = 2.067; 95% CI: 1.449–2.950; p < 0.001) but did not predict this issue. However, an independent association between increasing SUA concentration and mortality was noted in a Cox proportional hazards regression model (adjusted HR = 1.740; 95% CI: 1.305–2.320; p < 0.001). Furthermore, hyperuricemia was an independent predictor of poor functional outcome within 3 months after stroke (OR = 2.482; 95% CI: 1.399–4.404; p = 0.002). Conclusion The prevalence of hyperuricemia in black African stroke patients is quite high and still remains a predictor of poor outcome.

Glucose homeostasis abnormalities among Cameroon patients with newly diagnosed hypertension

The authors assessed the frequency of glucose homeostasis abnormalities among 839 Cameroonians with newly diagnosed hypertension (mean age: 50.8±11 years; 49.9% female) in a cross‐sectional survey conducted at the Douala General Hospital, Douala, Cameroon. In all participants, blood pressure, fasting plasma glucose (FPG), and lipids were recorded. Impaired fasting glycemia was described as an FPG level between 100 and 125 mg/dL and provisional diabetes as an FPG level ≥126 mg/dL. The FPG was 101±30 mg/dL. The overall proportion of abnormal glucose homeostasis was 38.3%, while 7.7% of patients (n=65) had known diabetes. A total of 23.7% (n=199) had impaired fasting glycemia and 6.8% (n=57) had provisional diabetes. Multivariable logistic regression revealed that male sex (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.15–2.06), age older than 55 years (OR, 1.55; 95% CI, 1.15–2.09), and low‐density lipoprotein cholesterol >1 g/L (OR, 1.34; 95% CI, 1.00–1.82) were independently associated with abnormal glucose homeostasis (all P<.05). Glucose homeostasis abnormalities are highly prevalent among Cameroonian patients with newly diagnosed hypertension.

Hyperuricaemia in patients with type 2 diabetes in a tertiary healthcare centre in sub-Saharan Africa: prevalence and determinants.

Hyperuricaemia in type 2 diabetes mellitus (T2DM) has been less well investigated in sub-Saharan Africans. Our study of 438 patients found that alcohol intake, body mass index ≥25 kg/m2, hydrochlorothiazide use, statin use, diabetic retinopathy and glomerular filtration rate <60 mL/min/1.73m2 were independently positively associated with hyperuricaemia; whereas smoking reduced this risk. Hyperuricaemia is strongly associated with some modifiable factors, diabetic complications and certain drugs. Our results suggest that further studies should evaluate the potential cost–benefit of screening for hyperuricaemia in type 2 diabetes.

Prevalence and factors associated with hyperuricaemia in newly diagnosed and untreated hypertensives in a sub-Saharan African setting

BACKGROUND Few studies have evaluated the link between hyperuricaemia and cardiovascular disease in sub-Saharan Africa. AIMS To assess the prevalence of and factors associated with hyperuricaemia among newly diagnosed treatment-naïve hypertensive patients in sub-Saharan Africa. METHODS We performed a community-based cross-sectional study from January to December 2012 in Douala, Cameroon (Central Africa). We enrolled newly diagnosed treatment-naïve hypertensive patients, and excluded those with gout or a history of gout. Serum uric acid concentrations were measured by enzymatic colourimetric methods, and hyperuricaemia was defined as a serum uric acid concentration>70IU/mL. Fasting blood sugar concentrations, serum creatinine concentrations and lipid profiles were also measured. Logistic regression was used to study factors associated with hyperuricaemia. RESULTS We included 839 newly diagnosed treatment-naïve hypertensive patients (427 women and 412 men; mean age 51±11 years; mean serum uric acid concentration 60.5±16.5IU/L). The prevalence of hyperuricaemia was 31.8% (95% confidence interval [CI] 28.7-34.9) and did not differ by sex (132 women vs. 135 men; P=0.56). Multivariable logistic regression identified age>55 years (adjusted odds ratio [AOR] 1.65, 95% CI 1.12-2.29), family history of hypertension (AOR 1.65, 95% CI 1.01-2.67), waist circumference>102cm in men or>88cm in women (AOR 1.60, 95% CI 1.12-2.29), low-density lipoprotein cholesterol>1g/L (AOR 1.33, 95% CI 0.97-1.82) and triglycerides>1.5g/L (AOR 1.63, 95% CI 1.01-2.65) as independently associated with hyperuricaemia. CONCLUSION Hyperuricaemia is common among newly diagnosed treatment-naïve hypertensive patients in sub-Saharan Africa and is associated with some components of the metabolic syndrome.

The antiphospholipid antibody syndrome: a case report

Antiphospholipid antibody syndrome is defined by the presence of thromboembolic complications and/or pregnancy morbidity in the presence of persistently increased titers of antiphospholipid antibodies. Its clinical presentation can be diverse and any organ can be involved, with a current impact in most surgical and medical specialties. The authors present the case of a 43-year-old man who, over a 13-year period of follow-up, presented with thrombosis of the mesenteric vein, inferior vena cava, and axillary and subclavian veins in a setting where diagnostic and therapeutic options are limited and costly. Through this case report, the authors aim to describe the evolution of this complex pathology, which to date has not been described in the authors’ milieu – probably because of its challenging diagnosis and the limited treatment options available. The authors conclude that clinicians need to have a high index of suspicion of APS in patients who present with a thrombotic episode – clinicians should investigate for the presence of antiphospholipid antibodies, as early diagnosis may influence the course of the disease. Furthermore, resources for the detection of antiphospholipid antibodies should be made readily available in resource-limited settings. Finally, patient education on the importance of drug compliance, periodic monitoring, and prevention of thrombosis is indispensable, especially as mortality could be associated with the effects of vascular thrombosis and/or the effects of bleeding due to anticoagulants.

AB0848 Spinal Pain Is The Main Complaint of Outpatients Seen in Rheumatology in Cameroon, Sub-Saharan Africa

Background The prevalence of spinal pain or back pain among Africans may be comparable to that reported in research undertaken in developed nations. However, studies evaluating the epidemiological characteristics of spinal pain are rare in sub-Saharan Africa (1). Objectives To determine the main epidemiological characteristics of spinal pain in a tertiary healthcare center in Cameroon, sub-Saharan Africa; To describe the profile of specific spinal pain found in Cameroon. Methods We performed a cross-sectional study among outpatients seen in Rheumatology consultation at Douala General Hospital, Cameroon, between January 2004 and December 2013. All patients followed for spinal pain (pain experienced in all the regions of the spine) were screened. Results During the study period, 7024 patients were seen in Rheumatology Department but only 6804 cases (4433 women and 2371 men) were selected for analysis because it had a clearly defined rheumatic disease. The mean age of patients was 52.3±14.3 years. The mean body mass index was 29.3 kg/m2±5.1, with 5194 patients with overweight and obesity. The main reason for consultation concerned the peripheral skeleton in 3230 patients (47.5%) and 3574 (52.5%) in the axial skeleton. The pain was present in all patients with axial involvement and was localized in the lumbar spine in 3008 patients (84.2%) [Table 1]. Most cases are nonspecific, but in 223 (6.2%) of cases a specific cause was suspected, especially of infectious origin (Table 2). Indeed, 64 cases of infectious spondylodiscitis were collected. Tuberculosis was suspected in the majority of patients, but only one case had been documented.Table 1. Distribution of patients according to the affected anatomical region Anatomic region n (%) Axial skeleton, n=3574 (52.5%) Cervical spine 449 (12.5) Dorsal spine 114 (3.2) Lombar spine 3011 (84.2) Sacro-iliac joints 3 (0.1)Table 2. Distribution of patients with specific back pain n (%) Infectious spondylodiscitis 64 (0.9) Osteoporosis 59 (0.8) Axial spondyloarthritis 40 (0.6) Cancer 36 (0.5) Others 21 (0.3) Conclusions Spinal pain, especially in the lumbar region of the spine is the main location of pain in Rheumatology in Cameroon. The infectious and inflammatory etiologies are rare. References Louw QA et al. BMC Musculoskelet Disord 2007;8:105. Disclosure of Interest None declared

THU0610 The Spondyloarthritis in Sub-Saharan Africa in The Era of Asas Classification Criteria for Axial and Peripheral Spondyloarthritis

Background The ASAS classification criteria for axial and peripheral spondyloarthritis have revolutionized the management of patients with suspicion of spondyloarthritis (1,2). These criteria have not been validated in sub-Saharan Africans. Moreover, the application of these new criteria on a population of sub-Saharan Africa with spondyloarthritis has not yet been published. Objectives To classify sub-Saharan Africans followed for spondyloarthritis according to the new ASAS classification criteria for axial spondyloarthritis and peripheral spondyloarthritis (1,2). Methods We performed a cross-sectional study among 6804 patients seen in the Rheumatology Unit of the Douala General Hospital, a tertiary healthcare centre in Cameroon, between January 2004 and December 2013. All patients followed for spondyloarthritis according to the Amor and/or ESSG criteria were collected to classify them according to the ASAS classification criteria for axial spondyloarthritis and peripheral spondyloarthritis. Results Seventy two (27 men and 45 women) patients fulfilled Amor and/or ESSG criteria. The mean age of these patients was 34 ± 13.9 years. The diagnosis was made primarily on the basis of clinical examination and X-rays of the spine and pelvis. No patient achieved a magnetic resonance imaging (MRI). The HLA B27 was negative in all patients tested. Ankylosing spondylitis was the most common spondyloarthritis, followed by reactive arthritis. The distribution of patients according to nosological entities and the predominant topography, axial and/or peripheral are respectively shown in Table 1 and Table 2. Two patients were not classified according to the ASAS criteria.Table 1 , Distribution of patients according to disease entities n (%) Mean age ± SD Sex (M/F) Ankylosing spondylitis 36 (50.0) 46±13.6 19/17 Reactive arthritis 29 (40.2) 38±8.2 7/22 Psoriatic arthritis 3 (4.2) 34±7.0 0/3 Spondyloarthritis associated to inflammatory bowel diseases 2 (2.8) 32±3.8 1/1 Undifferentiated spondyloarthritis 2 (2.8) 21±15.7 0/2Table 2. Distribution of patients according to ASAS classification n (%) Mean age ± SD Sex (M/F) Spondyloarthritis (all the patients) 72 (100) 36±13.9 27/45 Axial Spondyloarthritis 40 (55.5) 39±12.6 11/29 Peripheral Spondyloarthritis 29 (40.3) 34±16.7 14/15 “Unclassified Spondyloarthritis” according to ASAS classification 3 (4.2) 27±11.5 1/1 Conclusions The ASAS criteria have not changed the epidemiology of spondyloarthritis in Cameroon (prevalence 1.05%), and probably in all the sub-Saharan Africa. The diagnosis is difficult because of the lack of biological markers (HLA B27 negative) and limited access to MRI (available since 2014 in our hospital). Improving the performance of the ASAS criteria for axial and peripheral spondyloarthritis will require numerous other modifications. References Rudwaleit M. Ann Rheum Dis. 2009 Jun;68(6):777–83. Rudwaleit M. Ann Rheum Dis. 2011 Jan;70(1):25–31. Acknowledgement We gratefully acknowledge Prof. Pascal Claudepierre (Rheumatology, LIC EA4393, Henri Mondor Hospital, Creteil, France) for his critical review and advice on preparing the manuscript. Disclosure of Interest None declared

AB0809 Efficacy and Safety of A Personalized Nutritional Diet in Gouty Patients in Cameroon: A Pilot Study

Background Many guidelines from different parts of the world mention the impact of diet on gout (1). However, data are scarce in sub-Saharan Africa. Objectives To evaluate the efficacy and safety of a gouty apurinic personalized diet based on ethnic origin, dietary habits and patient comorbidities. Methods Gout (177 ACR preliminary criteria) patients with serum urate levels >70g/dL were recruited. Patients were randomized to receive a standard diet apurinic gout or a personalized diet. At 1 month, all patients in the standard diet group were put under the personalized diet. The primary endpoint was the reduction of serum uric acid at 1 month (M1) and 3 months (M3). Secondary outcomes were the number of gout attacks and changes in anthropometric measures at M1 and M3. A p<0.05 was considered statistically significant. Results Of the 30 patients randomized, 12 patients have not respected their diet. Only 18 were retained in the final analysis: 10 patients on personalized diet group and 8 on standard diet group. The baseline characteristics of both groups were similar at baseline (p>0.05). At M1, we have observed a significant decrease in serum uric acid in the personalized diet group compared to the standard diet group (p=0.0001). We have observed 5 acute gout attacks in the standard diet group against 2 acute gout attacks in the personalized diet group (p=0.03). A trend of decrease was observed for all other parameters without significance (p>0.05) [Table 1]. At M3, all patients received personalized diet. Initial efficacy was maintained in all the patients of the personalized diet group. For patients of the standard diet group, we observed a significant decrease in serum uric acid (p=0.02). There was no difference in the number of acute gout attacks (p=0.08). A trend of decrease was also observed for all other parameters without significance (Table 1). No adverse events related to both diet group were observed.Table 1. Comparison of personalized diet group and standard diet group at baseline and at 1 month Baseline Month 1 p* Month 3** p*** Weight Standard diet 90.12±16.72 89.37±16.31 0.46 88.02±52.31 0.31 Personalized diet 89.30±24.66 87.40±23.35 0.33 86.76±53.46 0.06 BMI Standard diet 32.63±5.11 32.35±8.52 0.45 30.95±8.23 0.12 Personalized diet 31.49±8.52 30.88±8.25 0.43 28.74±6.21 0.08 Waist-to-hip ratio Standard diet 0.89±0.14 0.88±0.10 0.63 0.87±0.21 0.09 Personalized diet 0.90±0.17 0.89±0.13 0.44 0.88±0.15 0.08 Uricemia Standard diet 87.37±8.68 88.30±12.68 0.57 75.56±5.97 0.02 Personalized diet 89±19.21 65.32±41.19 0.0001 59.05±17.13 0.0001 Uricemia without urate-lowering therapy Standard diet 87.37±8.68 88.30±12.68 0.57 88.30±12.68 0.03 Personalized diet 89.02±19.21 61.15±12.36 0.004 57.88±12.13 0.0001 Uricemia with urate-lowering therapy Standard diet 87.37±8.68 – – – – Personalized diet 105.50±10.81 75.90±11.85 0.0001 63.79±15.32 0.0001 Acute gout attacks Standard diet – 5 0.04 0 0.08 Personalized diet – 2 1 *p: baseline vs. Month 1. **Only 7 patients of Standard diet group and 9 patients of Personalized diet group ended the study. ***p: baseline vs. Month 3. Conclusions This study shows that the diet should be personalized in gouty patients according to socio-cultural environment, lifestyle, and comorbidities of each patients. Efforts should be made to improve compliance to diet like other non-pharmacological and pharmacological treatment. References Khanna D et al. Arthritis Care Res (Hoboken) 2012;64:1447–61. Disclosure of Interest None declared

AB0807 Gout in Rural Area in Sub-Saharan Africa: A Comparison between Patients Coming from Rural and Urban Areas, in An Urban Tertiary Healthcare Center in Cameroon

Background Gout, the disease of kings is seen today in both urban and rural areas. However, few data are available on the characteristics of gout in the rural area, especially in sub-Saharan Africa. Objectives To evaluate the differences between gouty patients in rural and urban areas in Cameroon, Central Africa. Methods We performed a cross-sectional study in all 511 patients (96 women and 415 men) seen at General Hospital, Douala, Cameroon, between January 2004 and December 2013. The main demographic and clinical features of gouty patients living in rural and urban were compared. A p< 0.05 was considered statistically significant. Results The baseline characteristics of patients are presented in Table 1. Patients living in rural areas were older, had an oligoarticular clinical presentation, more hyperuricemia and higher serum uric acid levels and a more frequent chronic inflammation compared to patients living in urban areas. Chronic kidney disease and dyslipidemia were more frequent in rural areas while obesity and hypertension were more frequent in urban areas.Table 1. Main baseline characteristics of patients Variables Rural area (n=49) Urban area (n=462) p Age (years), mean ± SD 60±12.05 56±10.63 0.001 Sex Men 34 381 <0.001 Women 15 81 Obesity 24 297 0.01 Arthritis 16 182 0.001 Tophi 9 183 0.01 Presentation at diagnosis Acute gout 25 230 <0.001 Chronic gout 24 232 <0.001 Clinical presentation, n Monoarticular 25 230 <0.001 Oligoarticular 22 173 <0.001 Polyarticular 2 59 0.12 Fever, n 2 19 0.21 Elevated uric acid levels, n 26 231 <0.001 Serum uric acid, mean ± SD, mg/dL (μmol/L) 84.68±3.22 82.21±1.07 <0.001 MSU cristal (synovial fluid)†, n 2 20 0.21 Acute phase reactants, n Elevated CRP 13 151 <0.001 Elevated ESR 28 223 <0.001 Urate arthropathies, n‡ 6 62 <0.001 Conclusions Gout is characterized in patients living in rural area by a late age at onset and hyperuricemia higher compared to patients living in urban area. Cardiovascular risk factors are common. Further studies are needed to evaluate lifestyle changes in rural area. Disclosure of Interest None declared

AB0808 Comorbidities Associated with Gout Are Also Common in Sub-Saharan Africa than in Developed Countries: A Cross-Sectional Study in Cameroon: Table 1.

Background Comorbidities associated with gout are frequently described in developed countries. Data are scarce in sub-Saharan Africa. Objectives To identify the main comorbidities associated with gout in Cameroon, Central Africa. Methods We performed a cross-sectional study on patients seen in the Rheumatology department of the Douala General Hospital, Douala, Cameroon, between January 2004 and December 2013. We have included the records of patients with diagnosis of gout according to ACR criteria 1977. The main comorbidities of gouty patients were recorded. A p<0.05 was considered statistically significant. Results We included 511 patients (415 men and 96 women). The mean age was 55.9±10.8 years. The main comorbidities associated with gout in our study are summarized in Table 1. Metabolic syndrome was present in 101 patients (19.7%). Chronic kidney disease and dyslipidemia were more frequent in rural areas while the obesity and hypertension were more frequent in urban areas (p<0.05) [Table 2]. The association between gout and components of metabolic syndrome were all significant (p<0.001), particularly for obesity and dyslipidemia in men and hypertension and diabetes in women.Table 1. Main comorbidities associated with gout Comorbidities n (%) Obesity 256 (52.2%) Hypertension 208 (40.7%) Osteoarthritis 111 (21.7%) Dyslipidemia 80 (15.9%) Digestive diseases (epigastralgia, gastroduodenal ulcer, upper gastrointestinal haemorrhages) 74 (14.5%) Diabetes 52 (10.2%) Chronic kidney diseases 42 (8.2%) Heart failure 16 (3.1%) HIV infection 10 (2%) Others 13 (2.6%) Conclusions Comorbidities are common in Cameroonians with gout like in developed countries. These data should encourage seeking and treating gastrointestinal adverse events and cardiovascular risk factors in gouty patients to reduce morbidity and mortality linked to gout. Disclosure of Interest None declared