Persistent Xerophthalmia in a Patient with Rheumatological Disease and Priiviary Sjogren’s Syndrome: Case Report from Northern Brazil

This case study aims to contribute to the literature in order to highlight the importance of this collaboration between medical specialties. A female patient R.N.N. F, age 66, from the city of Manaus, with a previous diagnosis of Sjogren’s syndrome in regular follow-up by the Rheumatology team at the Araujo Lima outpatient clinic and referred to the Ophthalmology sector for complementary evaluation related to visual discomfort. The fundoscopy performed in the patient was within normal limits, but the symptoms experienced by her proved to be an important clinical finding, which has ratified the need for regular and multidisciplinary follow-up. This report unequivocally demonstrates that even in the face of tests considered within the expected limits for a given population, the clinical presentation can be specific and particular for each analyzed individual. Early screening exams should contemplate the patient in a holistic and individualized way whenever possible.

Dysphagia in rheumatological disorders

Dysphagia can be seen in rheumatological diseases. Due to life-threatening complications, early diagnosis and treatment of dysphagia is important. However, sufficient data is not available for the diagnosis and treatment of dysphagia especially in the group of rheumatological diseases. In this paper, the presentation of dysphagia in rheumatological diseases will be reviewed.

Rheumatologic manifestations of hepatic diseases

A possible link is suggested between hepatic diseases and rheumatic disease. Polyarthralgia and polyarthritis may be seen during the prodromal period of acute viral hepatitis, especially in hepatitis B virus (HBV). The symptoms of arthritis, mild, localized or generalized, mostly involve the small joints of hands. Joint symptoms frequently precede the onset of jaundice, no residual joint deformities. Circulating immune complexes are believed to play a causative role in the development of vasculitis and arthritis. Hemochromatosis is an antosomal recessive disorder of iron. About 43%-81% of patients with hemochromatosis have arthritis. The common extrahepatic manifestations of autoimmune hepatitis are arthralgia and skin rash. The reported prevalence of symptomatic inflammatory arthropathy in patients with primary biliary cirrhosis ranges from 4% to 50%. Skeletal involvement with Wilson's disease is common. Such patients may complain of pain and stiffness, mainly in the knee, wrist, or other large joints. Shwachman's syndrome is a disorder of pancreatic exocrine. Symmetric bone lesions have been reported in 10% to 15% of patients. They are involved predominantly at the femoral neck. Rheumatic symptoms are seen in one third of adult patients with cystic fibrosis and arthritis in 2.5% to 12% of patients. The arthritis caused by pancreatic panniculitis is usually symmetrical and involves the small joints of the hand, wrist, and feet, but may involve such larger joints as the elbow, ankle, and knee.

Association between sarcopenia and rheumatological diseases

Sarcopenia("sarx" for muscle,"penia" for loss) is an important problem in the elderly.Although muscle loss is a part of natural aging,excessive loss that limits physical activity is considered pathological.Sarcopenia is associated with age,malnutrition,physical inactivity,inflammatory stress and hormonal changes.Although relationships between sarcopenia and various chronic inflammatory diseases have been shown,the role of rheumatologic disease in sarcopenia development is currently unknown.Our aim in this mini-review was to increase the awareness of clinicians to sarcopenia,and to evaluate studies in which the relationship between sarcopenia and rheumatologic diseases was investigated.We also aimed to determine whether the available literature was sufficient to confirm a strong relationship between these conditions.Although our findings showed that diseases such as rheumatoid arthritis,osteoarthritis and systemic sclerosis may have a role in sarcopenia development and progress,the methodologies and results of the majority of studies were insufficient in determining direct causal relationships.We believe future studies would benefit from focusing on the factors and causes of sarcopenia,with a goal of determining the factors associated with rheumatologic disease that are most effective in sarcopenia development.

Epidemiological Aspects of Osteoarticular and Rheumatological Diseases Related to Diabetes in Niger

Type 1 or 2 diabetes can be complicated by numerous non-specific joint conditions. Sometimes revealing, these affections are frequent but often remain unrecognized. However, they are the cause of a significant functional handicap. The objective of this work is to describe the osteoarticular rheumatological disorders in diabetics consulting or hospitalized in the rheumatology and internal medicine departments of the National Hospital of Niamey and the Magori Polyclinic. This was a cross-sectional study at the Rheumatology Department in collaboration with the Internal Medicine Department within the National Hospital of Niamey and Polyclinic Magori over a period of 7 months (December 2018 to July 2019). One hundred (100) diabetic patients with osteoarticular diseases were collected, 75% of whom were women with a female/male sex ratio of 0.33. The average age was 56 years with extremes of 21 and 90 years. Forty-three percent (43%) of the patients had diabetes for more than 10 years, with an average age of 13 years. The average BMI was 28.08 ± 5.42 kg/m2. Poor glycemic control was found in the majority of patients (92%). Gonarthrosis was the most common disease associated with diabetes (89%). In the context of joint stiffening syndrome, the most frequent problem was a protruding finger, found in 4% of patients, followed by retractile capsulitis in 3% of the 100 cases. Infectious complications were dominated by septic arthritis in 4% of patients. The presence of one or more degenerative complications of diabetes (nephropathy, retinopathy, nephropathy) was the most frequent factor associated with osteoarticular diseases in our diabetic patients. This work underlines the great variety and frequency of osteoarticular affections during diabetes, hence the interest in optimal glycemic control of a close collaboration between rheumatologists and endocrinologists in order to avoid as much as possible the development of these rheumatological affections which are the source of pain and functional handicap, being able to even engage the vital prognosis.

Co-Creation of a Working Model to Improve Sexual Health for Persons Living with Rheumatological Diseases

Background: Sexual health needs are insufficiently met for persons living with rheumatological diseases and it is necessary to create better ways to meet these needs. Objective: To co-create a working model to improve sexual health for persons living with rheumatological diseases, that can be used by rheumatological teams in regular rheumatology practice. Design: This study applied a co-creation design with three key features: 1) it took a systems perspective with emergent multiple interactive entities;2) the research process was viewed as a creative endeavour with strong links to design, while human imagination and the individual experience of patient and staff were at the core of the creative design effort;3) the process of the co-creative efforts was as important as the generated product. Results: A model defining the role of the patient, the professionals, and the team in optimizing sexual health for persons living with rheumatological diseases was co-created. The model can be seen as a practice guideline, which includes the support needed from and to each participant in the process of promoting sexual health, while being within the professional scope of the professionals’ knowledge and capacity, and in line with the needs of the persons living with rheumatological diseases. Discussion and Conclusions: The co-creative work process identified crucial factors in promoting sexual health, resulting in a useful model for patients, professionals and teams. Co-creation was experienced to be a useful research design to improve rheumatological care, through valuing and using the competence of all research members equally.

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.

Clinical Experience of Hulisan Used in Rheumatology

Hulisan is a commonly used medicine in rheumatism clinical practice. The clinical experience of Chief Chinese Medicine Specialist Zhou Lamei using Hulisan to treat rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and gout is discussed, to provide a basis for the clinical promotion of Hulisan in the Department of Rheumatology.

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.

Spontaneous liver rupture as first sign of polyarteritis nodosa

Polyarteritis nodosa(PAN) is one of the systemic vasculitis that affects the media wall of arteries of small and medium diameter. Diagnosis proves difficult due to the unspecific symptoms that dominate the clinical profile. Liver involvement is very diverse, ranging from the development of cirrhotic liver disease to acute abdomen presentation that requires surgery because of liver rupture. The management of these patients requires an expert multidisciplinary team. There are several cases in the literature that describe a sudden liver rupture as the first manifestation of a PAN. In this paper we present the case of a 75 years old patient without any previous disease, who is subjected to major hepatic resection for spontaneous liver rupture.

Rituximab as a treatment for human immunodeficiency virusassociated nemaline myopathy:What does the literature have to tell us?

We presented a letter about a case of a 37-year-old Black female with a history of human immunodeficiency virus and an undetectable viral load.She was evaluated with weakness in the scapular(grade III)and pelvic girdles(grade II),elevation of creatine phosphokinase levels and muscle biopsy compatible with nemaline myopathy.She was treated with rituximab showing improvement of the condition.

A Simple Approach of Low Back Pain

Low back pain (LBP) is primarily managed in general practice and commonly underestimated or misdiagnosed by physicians. This article presents comprehensive review for diagnosis and evaluation of LBP according to current clinical studies guidelines. Our objectives are to define LBP, to establish how to take a detailed history and how to physically examine it in order to enable physicians to make an appropriate differential diagnosis for LBP, and to identify relevant investigations and referrals of patients with LBP. The article first offers a quick description of inflammatory back pain then discusses the importance of screening red flag patients with LBP and the importance of its early detection. Finally, we summarize how to outline a primary plan for managing and treating LBP. The article is prepared in the format of question and answer to make it targeted and accessible.

Complementary medicine use in rheumatology: A review

Complementary and alternative medicine(CAM) use is increasing worldwide; specifically it appears that these treatment modalities are popular among rheumatology patients.The most commonly reported CAM therapies are herbal medicines,homeopathy,chiropractic,acupuncture and reflexology.Despite high reported rates of CAM use,the number of patients disclosing use to their rheumatologists remains low.This review highlights rates of current CAM use in rheumatology in studies performed worldwide,and discusses potential reasons for nondisclosure of CAM use to clinicians.

What is the purpose of launching World Journal of Rheumatology?

The first issue of World Journal of Rheumatology(WJR),whose preparatory work was initiated on December 16,2010,will be published on December 31,2011.The WJR Editorial Board has now been established and consists of 116 distinguished experts from 29 countries.Our purpose of launching WJR is to publish peer-reviewed,high-quality articles via an open-access online publishing model,thereby acting as a platform for communication between peers and the wider public,and maximizing the benefits to editorial board members,authors and readers.

Profile of Malignant Bone Tumors among Rheumatology Inpatients in Lome (Togo)

Background: The reel impact of malignant bone tumors in adults seems unclear in Black Africa. Aim: The aim of this study is to determine the epidemiological and the semiological profile of malignant bone tumors in rheumatology inpatients at Hospital University Center Sylvanus Olympio in Lome. Methods: It was a retrospective study of recorded cases conducted over a period of 19 years in the rheumatology department at Hospital University center Sylvanus Olympio in Lome, Togo. Results: One hundred and sixty-six patients (68 women and 98 men) suffered from a bone tumor. The average age of patients was 55 years old with some extremes cases of 14 and 98 years old. The most affected age group was the one between 46 and 55 years old (40 cases, 24.1%). The disease’s average duration was 17 months. These tumors were primary in 43 cases (26%) and secondary in 123 (74%). Metastases were those of prostate (44 cases, 35.7%), breast (12 cases, 9.7%), bronchus (7 cases, 5.7%), cervix (5.7%), and liver (2 cases, 1.6%). Myeloma (34 cases;79.0%) and osteosarcoma (9 cases;20.9%) were the main primary malignant bone tumors. However, 41 cases (33.3%) of malignant bone tumors had not been able to label. The spine was the predilection part for all above-mentioned tumors. Conclusion: This study shows the significant part occupied by malignant bone tumors in musculoskeletal diseases within the sub-Saharan population in general and Togo in particular.

Comparative Study of Radiological Changes in Hands and Feet in Patients Suffering from Early Rheumatoid Arthritis by Power Doppler Ultrasound and Direct Digital Radiography

Rheumatoid arthritis is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis. The natural history of disease is such that the early months of the disease are critical period during which reversible joint damage occurs. So early diagnosis of RA and appropriate drug application is the only way to save a patient from this crippling disease. In India, the cost of investigations is a significant factor for most of the patients. Ultrasonography or Power Doppler Ultra Sound (PDUS) has the advantage of being economic in spite of its sensitivity in assessing both inflammatory and destructive changes. The aim of the present study was to evaluate the diagnostic efficiency of PDUS in early rheumatoid arthritis. The study was performed with the patients attending Rheumatology Clinic. A total number of 106 patients of clinically suspected rheumatoid arthritis were studied as per selection criteria. Radiological examinations of hands were done by digital radiography and PDUS in a group of 53 patients, assessment of foot changes by PDUS and Digital Radiography were done in another similar group of 53 patients. Final diagnosis by ACR EULAR-2010 criteria is done for all the patients. The comparative study reveals that synovial vascularity as demonstrated by PDUS is much more effective in diagnosing early rheumatoid arthritis, both in hand and in feet than digital radiograph. PDUS of feet may yield earlier and better findings than hands, which is conventionally used in patients suffering from early rheumatoid arthritis.

West Meets East——Observations on Integrative Medicine in Rheumatology from the USA

Integrating concepts and methods from Asia into standard academic Western medicine has been felt to offer important potential advantages. Western medicine methods of objective systematic evaluation can also offer potential advantages to traditional Asian medicine. Neither is easy but nevertheless important.

Current progress on internal medicine in China—2006 PartⅡ

A lot of progress has been made on internal medicine in the past year.Here a great deal of data were collected about internal medicine in China by searching for some most important medicine magazines published in China in 2006.Because there are so many articles on internal medicine,some representative reports were selected and further reviewed.In the partⅡ,a summary of advances made in four branches includes nephrology,hematology,endocrinology and metabolism,rheumatology.

注重学科发展 专心学术研究——记本刊副总编辑张奉春教授

张奉春,《中国骨与关节杂志》副总编辑。主任医师,博士生/博士后导师,国务院特殊津贴专家。1982年毕业于北京医科大学（现北京大学医学部）,1987年开始从事风湿专科临床和基础研究。1993年至1998年期间,先后两次赴美作博士后研究。1996年任中华医学会风湿免疫学分会青年委员。2000年任中华医学会风湿病学分会常委兼学术秘书,