Physiotherapy Management of Rheumatic Diseases

Introduction: Physiotherapy is an integral part of the non-drug treatment strategy for rheumatological conditions. The evidence for its effects is not formal. The objective was to evaluate the impact of physiotherapy in the management of rheumatological disorders. Methods: 6-month case-control study (December 15, 2021 to June 20, 2022) at Ignace Deen University Hospital (Conakry). Patients with rheumatological disease who received drug therapy and physiotherapy were included in the case group. Age- and sex-matched controls had rheumatological conditions, treated without physiotherapy. The evaluation questionnaires were used: WOMAC (osteoarthritis), EIFEL (low back pain), NDI (neck pain), SPADI (shoulder). Patients with heart failure, respiratory failure and/or skin infection were not included. Results: We collected 773 patients (389 cases and 384 controls) with a mean age of 53.8 years ± 12.2 with female predominance (56.8%). Patients were mainly followed for osteoarthritis (65.2%). Rheumatological conditions managed were knee-based (119;30.6%), lumbar spine (220;56.6%), shoulders (27;6.9%) and cervical spine (23;5.9%). For an average duration of 53.4 ± 12.2 minutes per session, patients had benefited from a median of 19 physiotherapy sessions. After 3 months, the baseline mean VAS of 6/10 improved to 2.2 ± 1.6 for cases and 5.7 ± 1.2 for controls. Functional capacity was improved (WOMAC: 41.8 ± 22.7 vs. 18.3 ± 7.3). The satisfaction of patients treated with physiotherapy was 20 times higher than in controls. Conclusion: Physiotherapy performed in the management of rheumatological conditions significantly reduced pain and improved functional capacity.

Osgood Schlatter Disease: Study of 2 Observations in Conakry, Guinea

Introduction: OSD is a growth osteochondrosis affecting the apophyseal cartilage of the anterior tibial tuberosity of the knee, 20 to 30% of young growing athletes suffer from this pathology, described by Osgood and Schlatter in 1903. Objective: To report 2 observations and review the literature. Observation 1: This was a 14-year-old Guinean teenager, Halpoular, living in Conakry, a right-handed footballer who presented with a painful swelling of the right knee that looked mechanical, whose father had HLA B27 positive ankylosing spondylitis. X-ray of the right knee showed fragmentation of the anterior tibial tuberosities, and ossicle with edema of the patellar tendons at stage 4 according to Ehrenbord and Lagergren (1961). Thus, the disease of OSD is retained, He received 120 mg of diclofenac, 20 mg omeprazole for 1 month and the cessation of sports activity, the evolution was favorably marked by the regression of pain. Observation 2: A 16-year-old girl, initials M.L.T, Guinean, residing in Coyah (Republic of Guinea), a handball player, consulted for intense pain (VAS: 8/10) in her knees after a violent shock received when she hit the post. The physical examination found a painful, soft swelling at the anterior tibial tuberosity of the right knee, the rest of the examination was normal. The X-ray of the right knee shows fragmentation of the anterior tibial tuberosity, and ossicle with edema of the patellar tendon at stage 4 according to Ehrenbord and Lagergren 1961, thus the OSD disease is retained, the treatment instituted was 120 mg of diclofenac, the cessation of sports activity which gives a good evolution (EVA at 2/10). Conclusion: OSD is a growth osteochondrosis affecting the apophyseal cartilage of the anterior tibial tuberosity of the knee in young growing athletes, resolving at rest.

Ankylosing Spondylitis in a West African Hospital

Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by predominant axial and peripheral (enthesitis, sacroiliitis) involvement affecting young subjects aged 30 to 40 years, 80% to 98% of cases are associated with HLA-B27. Objective: To determine the epidemiological profile of ankylosing spondylitis in the rheumatology department of the Ignace Deen National Hospital in Conakry (Guinea). Materials and Methods: This was a descriptive cross-sectional study carried out within the said department over a period of 18 months from July 1, 2018 to December 31, 2020, including all patients seen in consultation and/or hospitalized in the department in which the diagnosis of ankylosing spondylitis had been retained according to the modified New York criterion. The parameters studied were sociodemographic, clinical, paraclinical and therapeutic. Result: We collected 73 cases or 4.1% of ankylosing spondylitis out of a total of 1781 patients seen during the study period. The male gender was represented with 54.8% for a sex ratio of 1.2 M/F. The average age of our patients was 32.18 ± 12.44 years with extremes ranging from 17 to 54 years. Axial involvement was present in 89.9% of cases with a lumbar predominance (95.2%), followed by the sacroiliac seat (35.5%), cervical (14.5%) and dorsal at 4.8%. The pain was chronic in 93.2% of cases. The most common drug treatment was taking analgesics and NSAIDs (100%) followed by cortisone infiltration (41.1%), corticosteroids (30%), and physiotherapy (21.9%). Ankylosing spondylitis represents 83% of spondyloarthritis followed by undifferentiated spondyloarthritis (9.1%) and juvenile spondylitis (3.4%) were the most common conditions.

Asymptomatic Cardiac Manifestations in Rheumatoid Arthritis in Conakry (Guinea)

Introduction: Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease. It is a systemic disease with extra-articular manifestations that can be life-threatening. In sub-Saharan Africa, there is little published information on cardiovascular manifestations in RA. Objective: The objective is to determine the asymptomatic cardiac manifestations during rheumatoid arthritis in Conakry. Patients and Methods: This was a cross-sectional study lasting 6 months from January 1, 2020 to June 30, 2020 in the rheumatology and cardiology departments of the Ignace Deen National Hospital. Patients with RA diagnosed according to the 2010 ACR/EULAR criteria, asymptomatic at the cardiovascular level, which had an ECG and echocardiography, were included in the study. Left ventricular diastolic dysfunction was considered in any patient with an E/A ratio 1, an E/E’ ratio > 10, and an LVEF = 50%, assessed by the Simpson biplane method and classified according to Redfield. Epidemiological, clinical and paraclinical data were analyzed using SPSS statistics 21.0 software. Results: Seventeen cases of rheumatoid arthritis (5.9%) were collected. There was a predominance of women with 14 cases (82.4%). The mean age of patients was 48.2 ± 11.9 years. The average duration of RA was 7.2 ± 4.2 years. Cardiovascular risk factors were dominated by overweight and obesity (58.8%) and sedentary lifestyle (35.3%). RA was predominantly high activity (DAS 28 ≥ 5.1) in 82.4% of patients. Anti-CCP antibodies were positive in 76.9% of cases. Fourteen patients (82.4%) had abnormal cardiac results. The electrocardiogram showed left atrial hypertrophy in 29.4% of cases, left ventricular hypertrophy (11.8%) and ventricular extrasystole (11.8%). The cardiac Doppler scan showed diastolic dysfunction of the left ventricle (47.1%) and moderate pericardial effusion in 11.8% of cases. Conclusion: The study found asymptomatic cardiac manifestations of rheumatoid arthritis. They were dominated by ventricular hypertrophy on electrocardiogram and left ventricular diastolic dysfunction on cardiac Doppler ultrasound. Systematic examination of patients with RA is necessary to detect them early and avoid complications.

Sexuality of Women with Rheumatoid Arthritis in a West African Hospital

Background: Rheumatoid arthritis is a chronic autoimmune disease that causes socio-economic, psychological and sexual problems. It imposes limitations on sexual relationships and these issues are still taboo in African society. Objective: The objective is to assess the impact of rheumatoid arthritis (RA) on women’s sexuality at the Ignace Deen National Hospital. Patients and Methods: This was an analytic case-control study of 8 months (from April 6, 2020 to December 11, 2020). All patients followed for rheumatoid arthritis diagnosed according to 2010 ACR/EULAR criteria for RA had been included. Results: One hundred and five women (52 RA patients and 53 controls) were collected. The two groups were comparable in terms of demographic characteristics. Sexual dysfunction was found in 69.2% of cases versus 35.8% of controls. Women with RA had poorer sexual functioning in the categories of desire, arousal, lubrication, orgasm, satisfaction, and pain of the FSFI score compared to healthy women (p = 0.01;p = 0.7;p = 0.3;p = 0.8;p = 0.1;and p = 0.3 respectively). Patients were 4 times more likely to have sexual dysfunction than healthy individuals and this result was statistically significant with a p-value less than 0.05. Conclusion: Sexual dysfunction was noted in a large number of RA patients surveyed at the rheumatology department of the Ignace Deen national hospital. A larger study is needed to better assess this issue and seek management solutions.