Thérèse Moreira Diop

Presentation and severity of rheumatoid arthritis at diagnosis in Senegal

OBJECTIVE Early effective treatment slows structural damage in RA but requires an early diagnosis. Our objective was to determine symptoms duration and presentation patterns of RA at diagnosis in Senegal. METHODS We conducted a cross-sectional study over a 2-year period (from March 2006 to February 2008) at the rheumatology clinic of the Le Dantec teaching hospital in Dakar, Senegal. Consecutive new patients who met ACR criteria for RA were included. RESULTS We included 100 patients, 88 females and 12 males, with a mean age of 40.3 +/- 15.5 years and a mean symptoms duration of 54 months. One-fourth of the patients had a positive family history. Pain was the main reason for the rheumatology clinic visit. Mean pain score was 64.3 mm on a 100-mm visual analogue scale. Nocturnal arousals were reported by 69% of the patients and morning stiffness for >1 h by 74%. The tender and swollen joint counts were 10 or higher in 87% and 36% of the patients, respectively, and the mean disease activity score on 28 joints (DAS28) was 6.49 +/- 1.34. Sicca syndrome (n = 13) and rheumatoid nodules (n = 3) were the main extra-articular manifestations. Laboratory evidence of inflammation was found in 87% and RF in 78% of the patients. Antibodies to cyclic citrullinated peptides (anti-CCPs) were detected in 26 of the 29 patients. Radiographical lesions were visible in 56% of the patients; mean modified Sharp score was 21.76 +/- 47.74. CONCLUSION The diagnosis of RA is delayed in Senegal, and the disease is highly active at diagnosis, although 44 patients have no erosions, and extra-articular manifestations are rare.

Socio-demographic and clinical profile of chronic pain with neuropathic characteristics in sub-Saharan African elderly.

Data on characteristics of neuropathic pain (NP) in sub‐Saharan Africa are scarce, especially in the elderly. We conducted this study to appreciate the socio‐demographic and clinical profile of chronic pain (CP) with neuropathic characteristics in sub‐Saharan African elderly with musculoskeletal pain. From January to December 2011, we performed a cross‐sectional study in all Rheumatology outpatients over 60 years at the Center for Gerontology and Geriatrics, Dakar, Senegal. In this study, we included patients who experienced musculoskeletal pain for 3 months or longer (CP) and with a DN4 score ≥ 4 (NP). A complete clinical examination was performed to make the diagnosis of NP ‘definite’ or ‘probable’, and to identify the aetiologies of NP. During the study period, 698 outpatients were examined. There were 394 out of the 549 patients over 60 years who reported CP. Among them, 28 patients (7.1%) scored ≥4 on the DN4 questionnaire. Female patients, low educational attainment, manual professions, non‐workers and diabetes were associated with NP (p < 0.05). The symptoms described by patients with NP, often intricate, were lumboradiculalgia (n = 9), cervico‐brachial neuralgia (n = 3), polyneuropathy (n = 12) and mononeuropathy (n = 6). The presumed aetiologies in patients with NP were: chronic spine diseases (n = 14), painful diabetic peripheral neuropathy (n = 8), Sjögrens syndrome (n = 1), tarsal tunnel syndrome in rheumatoid arthritis (n = 1) and bone metastasis (n = 1). No aetiology was identified among three patients. Chronic spine diseases associated with radiculopathies and diabetic neuropathy are the main causes of NP, well detected by DN4 questionnaire and clinical examination in Senegalese sub‐Saharan African elderly.

Importance of Electrocardiogram for Detection of Preclinical Abnormalities in Patients with Rheumatoid Arthritis without Cardiovascular Events

Introduction: In patients with rheumatoid arthritis, cardiovascular involvement is common, may have serious consequences, and can contribute to worsening of patient’s outcome. The realization of systematic electrocardiogram can help to detect earlier cardiac abnormalities and place in a logical secondary prevention. Our purpose of this study was to investigate the electrocardiographic abnormalities in a population of Senegalese patients with rheumatoid arthritis without clinically evident cardiovascular manifestations. Patients and methods: The study was performed as a cross-sectional study, which included prospectively 73 patients of both sexes aged at least 18 years in the internal medicine department of University Hospital Center Aristide Le Dantec in Dakar, Senegal, fulfilling the criteria for definite or classical rheumatoid arthritis according to the criteria of the American Rheumatism Association. It focused on a sample of following clinical examination, we conducted laboratory tests (CRP, fibrinogen, ESR, Rheumatoid factors, Latex and Waaler Rose, Anti-CCP, antinuclear factors and antibodies anti-ENA), a standard ECG. Data were analyzed using a descriptive study of the different variables with the calculation of proportions for categorical variables, and the positional parameters and dispersion for quantitative variables. Results: All patients had normal ECG and no cardiac symptoms or dyspnoea on effort. The study included 73 patients (68 females and 5males) with rheumatoid arthritis without obvious cardiac events meet the criteria of definition of the ACR 1987. The mean age was 44.17 ± 14.43 years with extremes of 18 and 75 years. The mean duration of RA was 5.93 ± 4.78 years. The concept of family inflammatory arthritis was reported in 35.60% of cases and almost one in six patients had at least a factor of cardiovascular risk (16.96%). Electrocardiographic abnormalities found were dominated by left ventricular hypertrophy encountered in 34 patients (46.57%), left atrial enlargement in 32.90% of cases, 16.44% of patients had left axis deviation. The myocardial hyper excitability was present in 8 patients (11.19%), including 6 (8.45%) ventricular premature beats found in patients with active RA. Twenty-six patients had signs consistent with an ischemia and/or myocardial injury is a rate of 35.61%. Conclusion: The realization of the electrocardiogram in patients with rheumatoid arthritis without clinically evident cardiovascular manifestations allows highlighting cardiovascular abnormalities related to the natural course of the disease.

Quantitative Ultrasound Measurements at the Calcaneus in a Population of Urban Senegalese Women: Least Significant Difference and T-Score

Background: Bone ultrasound measurements can be used to evaluate osteoporosis in clinical practice. As with DXA, ultrasonography shows marked variations across racial groups. In the USA, quantitative ultrasound measures were higher in African-American women than in Caucasian women. Few data are available on these measures in African women, and there are no normative data for Senegalese women. Our objectives were to evaluate the least significant difference (LSD) and to establish reference values of quantitative ultrasound measures at the calcaneus in Senegalese women. Methods: Reference values were obtained in 50 healthy women aged 25-35 years. A UBIS 5000 ultrasound sonometer was used to determine speed of sound (SOS), broadband ultrasound attenuation (BUA), and the Strength Index (STI) at both heels. Results: In the 50 healthy controls (mean age, 29.8 ± 3.7 years, mean height, 167.3 ± 5.8 cm, mean weight 68.1 ± 13.2 kg; 38 right-handed), BUA (mean of the two sides) was 72.24 ± 6.83 dB/MHz. BUA values were higher in women with regular sporting activities (n=10) and in those with higher body weight values, indicating an increase in bone mass associated with greater loads through the calcaneus. Conclusion: Quantitative ultrasound parameters measured at the calcaneus using a UBIS 5000 sonometer in Senegalese women showed similar reproducibility to that reported previously in Caucasian women examined using the same sonometer or a comparable sonometer. The mean BUA values in our reference population can be used to compute T-scores in individual female patients in Senegal. Our data support a link between greater mechanical loads and higher bone mass.

Pulmonary fibrosis indicative of granulomatosis with polyangiitis initially believed to be sjögren's syndrome

Abstract Wegener’s disease, currently called granulomatosis with polyangiitis, is a systemic necrotizing vasculitis of small vessels. It is typically associated with nodular opacity type pulmonary lesions of varying size

Authors' reply to the comment by Pazzaglia et al

Since the aetiologies of neuropathic pain are most often degenerative or age related, it is not surprising that these conditions are more common in the elderly (Ahmad and Goucke, 2002; Pickering and Capriz-Ribière, 2008). Neuropathic pain occurs and persists in a heterogeneous group of aetiologically different diseases, with various physio-pathological mechanisms (Cruccu and Truini, 2009; Baron et al., 2012). Patients with neuropathic pain present with various pain-related sensory abnormalities (Baron et al., 2012). Subgrouping patients with neuropathic pain on the basis of individual sensory profiles could guide the choice of pharmacological agents to be proposed to each patient (Bouhassira et al., 2004; Cruccu and Truini, 2009; Baron et al., 2012). We appreciate Pazzaglia et al.’s interest in our study on the characteristics of neuropathic pain in a population of sub-Saharan African elderly, followed for chronic pain of musculoskeletal origin (Lekpa et al., 2012). In this study, we choose to use the neuropathic pain diagnostic questionnaire DN4 (Bouhassira et al., 2005) instead of other validated instruments. Apart from its good discriminative properties for the identification of neuropathic pain, the DN4 questionnaire was easy to use, especially in our sample of elderly patients with a low level of education. Thus, we were able to show through this study that: (1) neuropathic pain existed in African elderly; (2) female gender, low educational status, manual professions, unemployment and diabetes mellitus were significantly associated with the presence of neuropathic pain; (3) chronic spine diseases and painful diabetic peripheral neuropathy are the main causes of neuropathic pain in our sample; and (4) neuropathic pain were neglected by physicians with a low rate of prescription drugs directed against neuropathic pain (Lekpa et al., 2012). In his comments, Pazzaglia et al. presented the methodology and results of a multicentre study they conducted among Italian elderly over 65 years, with peripheral neuropathy (Pazzaglia et al., 2013). The methodology used in our study was different from that used by these authors (musculoskeletal pain vs. peripheral neuropathy). Despite this difference, the results are broadly comparable. Indeed, these authors showed that (Pazzaglia et al., 2013): (1) neuropathic pain are also common in elderly; (2) the aetiologies are numerous; (3) the clinical profile or sensory profile, assessed with the Neuropathic Pain Symptom Inventory (NPSI) (Bouhassira et al., 2004), varies depending on the aetiology; and (4) also the low rate of prescription drugs targeting neuropathic pain. The use of NPSI (Bouhassira et al., 2004) would not have changed the results obtained in our study. However, it would have provided important additional information. We could have had a more accurate assessment of the clinical profile of our patients, differentiating subtypes of neuropathic pain. Indeed, the NPSI was developed and validated for the assessment of different symptoms of neuropathic pain. It is also a simple and easy-to-use instrument for daily practice and clinical studies. The NPSI allows discrimination and quantification of five distinct clinically relevant dimensions of neuropathic pain: burning (superficial) spontaneous pain, pressing (deep) spontaneous pain, paroxysmal pain, evoked pain and paraesthesia/ dysaesthesia. One important feature of the NPSI is its sensitivity to treatment effects (Bouhassira et al., 2004). Subgrouping neuropathic pain in our study might have permitted us to make assumptions about the appropriate type of drug to offer to each of our patients, according to the sensory profile of the neuropathic pain presented by each patient, as suggested by Bouhassira et al. (2004), but it remains to be confirmed in controlled studies. Until then, it seems important to recommend the use of the NPSI or other neuropathic pain classification instruments (and the DN4 questionnaire) for the diagnosis and clinical assessment of neuropathic pain, both in daily practice and in further clinical studies.

Séroprévalence de l’antigène HBs au cours de la polyarthrite rhumatoïde au Sénégal

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