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.

Undifferentiated Arthritis Revealing Cogan’s Disease

Background: Cogan’s syndrome is a rare autoimmune vasculitis (less than 300 cases described in the literature) characterized in its typical form by cochleovestibular involvement, interstitial keratitis, and an inflammatory involvement of large vessels. It is frequently accompanied by general signs and cardio-vascular, rheumatologic, and digestive complications. Its management is essentially based on the use of corticosteroids and immunosuppressants. The outcome of the treatment, even if rapid, does not always avoid functional complications. This disease is probably under-diagnosed in Africa. Objective: The objective of this study was to report a case of Cogan syndrome in sub-Saharan Africa. Case report: A 78 year old black African female patient presented with arthritis of the left knee without fever. The examination also revealed a bilateral deafness of rapidly progressive onset. The patient was known to be diabetic and hypertensive, and was regularly monitored. The biology revealed an inflammatory syndrome and an inflammatory joint puncture fluid. Pure tone audiometry confirmed a 77% hearing loss. The ophthalmological examination revealed stromal oedema and hypertensive retinopathy of Kendall stage III. The rheumatological evolution was good under methylprednisolone and methotrexate, but the deafness persisted. The occurrence of a fever on day 12 of treatment required further investigations (blood culture, PCR-Covid 19 test, cytobacteriological examination of sputum, thoracic CT). The evolution was unfavourable with the death of the patient. Conclusion: Cogan’s disease is a rare inflammatory disease. Its diagnosis and management are multidisciplinary. The treatment can be disappointing.

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.