Epidemiological, Clinical and Paraclinical Profile of Osteoarthritis of the Lower Limbs in Obese Patients at the Cocody University Teaching Hospital

Objective: To describe the epidemiological, clinical and paraclinical characteristics of osteoarthritis of the lower limbs in obese patients at the Cocody University Teaching Hospital. Methodology: This was an analytical cross-sectional study carried out in the rheumatology department of the Cocody UTH in Abidjan (Ivory Coast) from March 1 to April 30 2023. Patients who came for rheumatology consultation presenting with mechanical arthralgia of the lower limbs, who were obese, had radiographic images were included. All patients without radiographic images were excluded. Obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m. The Chi2 test was used to compare proportions and determine the existence of associations between osteoarthristis and obesity, obesity severity and radiographic stage of osteoarthritis as well as the functional impact. A p-value below a predefined threshold (p = 0,05) indicates a significant relationship between the variables. Result: Out of 185 patients received for osteoarthritis of the lower limbs during the study period, 136 were obese (74%). There were 115 women (84.6%) with an average age of 56.03 with a standard deviation of 12.72 years (extremes: 22 and 84 years). The main socio-professional category was the informal sector (30%). The majority of patients had a low socio-economic level (80.2%) and lived in urban areas (92.6%). The most common past medical history was hypertension (33.08%) followed by peptic ulcer disease (16.91%). Patients had a body mass index class 1 (81.6%), class 2 (15.40%) and class 3 (2.90%). The average duration of symptom progression until diagnosis was 11 months. Genu varum was the main static disorder (56.10%) and the knee joint was the dominant topography (90.4%) with a bilateral localization (80%). The average Lequesne index was greater than 8 (59.5%). The Kellgren and Lawrence radiographic stages were stage 1 (9.20%), stage 2 (46.90%), stage 3 (29.20%) and stage 4 (6.90%). The Obesity severity was significantly associated with osteoarthritis of the knee (p = 0.042). There was no statistically significant association between obesity severity and radiographic stage of osteoarthritis (p = 0.163) or functional impact (p = 0.180). Conclusion: Osteoarthritis of the lower limbs affected obese women and was dominated by stage 2 osteoarthritis of the knee (Kellgren and Lawrence). There is an association between the severity of obesity and osteoarthritis of the knee.

Etiologies of Bone Metastases at the Rheumatology Department (UTH) of Abidjan

Objectives: The aim of this study was to describe the diagnostic and etiological aspects of bone metastases in the Rheumatology Department of Cocody’s University Teaching Hospital (UTH). Methodology: This was a descriptive, 11-year retrospective study (January 1, 2006 to December 31, 2016) of inpatient records of bone metastases. The diagnosis was made on clinical (bone signs), radiological (osteolysis, bone condensation) and sometimes histological basis. Result: Eighty out of 6, 1111 inpatients suffered from bone metastasis with a hospital frequency of 1.30%. The average age was 60.74 years (range 26 to 81 years). Men were predominant (53 men for 27 women) with a sex ratio of 1.96. The main complaints were pain (97.6%). chronic (90%), severe (73.8%), inflammatory (93.8%). There was sometimes a neurological complication: a motor deficit (21.3%), sensitive (13.8%). These symptoms were associated with fever (56.3%) and altered general state (85%). Bone metastases have been revealing in the vast majority of cases (93.75%);the primary cancer was known only in 5 patients (prostate = 2, breast = 2 and cervix = 1). Bone condensation (61.3%), osteolysis (50%) and mixed lesions (7.5%) where the main radiological lesions observed. The primary tumors were: prostatic (50%), pulmonary (18.8%), mammary (11.3%), uterine (5%), renal (2.5%), hepatic (2.5%), bladder (1.3%) and adrenal (1.3%). Conclusion: Bone metastases affect mostly the elderly;inflammatory spinal pain is the main symptom. Bone condensation is the most common radiologic lesion. The prostate, breast and lungs are the main primary tumors.

Autoantibodies in Systemic Lupus Erythematosus, on Black African Subject, in Abidjan

Aim: To determine the clinical and immunological characteristics of patients with systemic erythematosus lupus in Abidjan. Patients and Method: We studied 117 patients’ files with systemic lupus erythematosus aged 12 to 73 years old, who fulfilled the American College of Rheumatology (ACR)’s criteria. Antinuclear autoantibodies (ANA) were searched by indirect immunofluorescence. Anti-DNA native autoantibodies, extractable nuclear anti-antigens autoantibodies (anti-Sm, anti-SSA, anti-SSB and anti-RNP) and anti-phospholipids autoantibodies have been searched by ELISA technic. Results: The most frequent clinical manifestations were: articular damages (86.32%), cutaneous and mucosal lesions (71.79%) and fever (76.67%). Kidney damages have been noticed in 40.17%. Neurologic manifestations have been observed in 36.75%. Pericarditis and pleurisies have been noticed in 22.22% and 11.97% of cases, and anaemia in 86.32% of cases. ANA have been detected in 94.12% of cases, anti-DNA native’s autoantibodies in 73.53% and anti-Sm autoantibodies in 75% of cases. Anti-SSA and anti-SSB autoantibodies were respectively in 75% and 56.25% of cases. Anti-RNP autoantibodies were in all the patients, and anti-phospholipids autoantibodies were in 37.50% of cases. Conclusion: Systemic lupus erythematosus of Ivorian black subject is characterised by high prevalence of autoantibodies, mostly Anti-RNP.

Multilevel Cervicothoracic and Lumbar Pott’s Disease: About Three New and Unusual Cases in the Rheumatology Department of the Teaching Hospital of Cocody in Abidjan (Côte d’Ivoire)

Pott’s disease usually affects two contiguous vertebrae or two spinal levels. The involvement of the three cervicothoracic and lumbar levels is rarely described. Only three cases have been described in the literature to our knowledge. The authors report three new cases of tuberculous spondylodiscitis of cervicothoracic and lumbar site. Our three cases were characterized by symptoms similar to the other topographical forms of Pott’s disease. A predisposing factor is often identified like the infection with human immunodeficiency virus. The definitive diagnosis was made in two cases by identifying acid and alcohol-fast bacilli for one case and by histology for the other case. For the third case, there was a diagnostic presumption reinforced by the satisfactory outcome on tuberculosis chemotherapy for a period of 12 months. The multilevel nature of diseases does not influence the effectiveness of treatment of this form of spinal tuberculosis.

Systemic Form of Juvenile Idiopathic Arthritis: Epidemiological, Clinical, Paraclinical and Therapeutic Aspects of 13 Cases in Abidjan

Objective: To describe the epidemiological, clinical, paraclinical and therapeutic aspects of systemic juvenile idiopathic arthritis observed in Abidjan. Materials and Method: This retrospective and descriptive study covered 13 children suffering from systemic juvenile idiopathic arthritis selected in the Rheumatology Department of University Hospital Center of Cocody in Abidjan (Cote d’Ivoire) from January 2005 to December 2015. We were interested to the sociodemographical, clinical, paraclinical and therapeutic aspects. Results: The systemic form of the juvenile idiopathic arthritis represented 0.2% of the 4608 rheumatologic diseases and 70.58% of the JIA. We selected 6 boys and 7 girls, with an average age of 10.8 years and mostly going to school (84.61%). The diagnostic delay was 18 months. The main clinical signs were fever and joint damage observed each in 100% of cases, impaired general condition (92.30%) and tumor syndrome (83.33%). Biological signs were characterized by hyperleukocytosis (69.20%) and the presence of a biologic inflammatory syndrome (on average, erythrocyte sedimentation rate 59.6 mm and C Reactive Protein 56.4 mg/l). The cervical damage was the essential functional complication (38.46%). The major treatment has been a therapeutic combination based on corticotherapy and methotrexate (100%) with 1 death case by macrophage activation syndrome. Conclusion: Systemic juvenile idiopathic arthritis is rarely diagnosed in the rheumatologic practice in Abidjan. It concerns children relatively big, and is characterized by a febrile polyarthritis with impaired general condition and tumor syndrome. This systemic form is treated by corticotherapy and methotrexate.

Severe Axonal Peripheral Polyneuropathy Revealing a Systemic Lupus Erythematosus: About One Case

Aim: We report a case of acute and severe sensorimotor peripheral polyneuropathy (with a severe motor damage) revealing a lupus. Case Presentation: A 48-year-old female patient was interned in rheumatology for a chronic polyarthritis. Four days after her hospitalisation, she was presenting a flask distal and proximal tetraparesia, with rapidly progressive installation. Electromyogram showed severe acute axonal sensorimotor polyneuropathy. The antinuclear antibody was positive as the anti-ds-DNA antibodies. The evolution has been unsatisfactory despite the high-dose corticotherapy and the immunosuppressor. Conclusion: Even if it is rare, peripheral neuropathy can be a lupus discovery circumstance.

Tuberculosis of the Sternoclavicular Joint: Report of 3 New Cases Observed in Abidjan

The sternoclavicular joint is a rare site of osteoarticular tuberculosis. We now report three new cases of sternoclavicular tuberculosis. The report concentrates mostly on immunocompromised patients, notably two with HIV infection and one case marked by its acute onset which is rather original because, in this case, there was a swollen sternoclavicular joint with normal X-ray and it was the CT-scan which showed the lesions. The etiological diagnosis was made in the first case by polymerase chain reaction and in the second case by identification of Mycobacterium tuberculosis. In the third case, the diagnosis was presumptive and the outcome on anti-tuberculous drugs was satisfactory. Sternoclavicular joint tuberculosis is unusual;the painful swelling of that joint should lead to realize a performed imaging such as CT-scan.

Paraclinical, Therapeutic and Evolutionary Profile of Osteoarticular Tuberculosis: A Report about 550 Cases in Abidjan

Objective: To describe paraclinical, therapeutic and evolutionary aspects of osteoarticular tuberculosis in Abidjan. Materials and Method: We realized a descriptive retrospective study carried out in the Rheumatology Department of the University Hospital Center of Cocody in Abidjan about 550 patients over a period of 10 years from January 2004 to December 2013. The paraclinical, therapeutic and evolutionary data had interested us. Results: Osteoarticular tuberculosis represented 12.13% of 4531 rheumatic diseases identified during the study period. The tuberculin skin test was positive in 78.49% of cases. An inflammatory syndrome was present with erythrocyte sedimentation rate and C-reactive protein respectively into 69.45% and 76.54% of cases. The research of Mycobacterium tuberculosis was realized into 176 of cases which 50% was positive. Polymerase chain reaction and biopsy of tissue were performed respectively in 8 and 6 cases. Plain radiography (89.82%) and computed tomography (83.63%) were the most realized imaging. Computed tomography has contributed for the diagnostic in 99.78% of cases. The majority of our patients (82.91%) received anti-tuberculous treatment which consisted of two months of combination of rifampicin (R), isoniazid (H), pyrazinamide (Z) and Ethambutol (E) (2RHZE), followed by 10 months of rifampicin (R) and isoniazid (H) (10 RH). The outcome in patients on this treatment was favorable in 528 cases (96%). Conclusion: This study revealed that the research of Mycobacterium tuberculosis was often realized and positive. On the contrary, polymerase chain reaction and biopsy of tissue were rarely performed. The main imaging is computed tomography. Our protocol of treatment is effective.

Systemic Scleroderma at University Teaching Hospital (UTH) of Cocody (Abidjan—Cote d’Ivoire): A 19 Cases Report

Objective: The aim of this study was to describe the epidemiological, clinical and therapeutic features of systemic scleroderma at Cocody UTH. Methodology: We conducted a retrospective and descriptive study over a period of 10 years (September 15, 2008 to April 15, 2019) on the files of patients hospitalized for systemic scleroderma in the rheumatology unit of the UTH of Cocody. We used the classification criteria of the American Society of Rheumatology (1980) to retain the diagnosis. Results: Nineteen patients’ files had been collected, representing a hospital frequency of 0.32%. The average age was 37.25 ± 13.82 years old. There were 15 women and 4 men. The average consultation time was 26.44 months. The mode of revelation of the disease was mostly cutaneous and articular. All patients had cutaneous sclerosis (average Rodnan score = 27.63/11.61 (min = 4, max = 49).) Scleroderma was diffuse in 70.59% of cases;a Raynaud’s phenomenon was seen in 47.37%. The main clinical manifestations were: cutaneous (100%), articular (89.47%), pulmonary (57.89%) and digestive (63.16%). No renal damage was found. Pulmonary fibrosis (5 cases), pulmonary arterial hypertension (3 cases) and pericardial effusion (2 cases) were sometimes founded in explorations. The positivity of antinuclear antibodies (ANA) was seen in 72% of patients and anti scl70 antibodies in 42.85%. The treatment included corticosteroids and immunosuppressants, respectively used in 84.2% and 63.16% of cases. The outcome was marked by 5 cases of death attributed to respiratory distress. Conclusion: Systemic scleroderma seems to be a very rare condition in Ivorian rheumatology milieu. The main systemic manifestations were digestive and pulmonary. Treatment was very often symptomatic sometimes associated with D-penicillamine.