COVID-19, chronic inflammatory rheumatic disease and anti-rheumatic treatments

Clinical Rheumatology - Since December 2019, the pandemic caused by coronavirus disease 2019 (COVID-19) raises a real public health problem. COVID-19 appeared in Wuhan (Hubei province) in China....     

Human immunodeficiency virus associated arthritis in Congo Brazzaville

OBJECTIVE: The authors report epidemiologic, clinical, para clinical, and evolutive aspects of arthritis related to HIV in an AIDS endemic country. MATERIAL AND METHODS: A retrospective study was made in the rheumatology department of the Brazzaville University Teaching Hospital during 15 years and 6 months, on 3.042 in-patients among whom 306 (10%) were positive for HIV, 220 (7.2%) presented with a rheumatologic manifestation, and 158 (71.8%) with HIV related arthritis. RESULTS: The 158 patients included 91 men (57.6%), 67 women (42.4%), average 34.5 years of age, ranging from 15 to 61, all heterosexual. 99 patients (62.7%) were in the B stage, 40 (25.3%) in the C stage, and 19 (12.2%) in the A stage. Arthritis was polyarthritis (83.5%) or oligoarthritis (16.5%), symmetrical (97.5%), prevailing on the lower limbs (99.3%) with involvement of the great toe in 23% of cases. There was an important inflammatory syndrome with an erythrocyte sedimentation rate exceeding 100 mm for the 1st hour in 63.3% of the cases. Rhumatoid factors were negative. Synovial fluid was sterile, without microcrystals, and inflammatory. X-rays were normal. This non-destructive arthritis, evolved by successive bouts, and resolved in 2 to 5 weeks with NSAIDs and did not meet Amor nor European spondyloarthropathy criteria. CONCLUSION: Arthritis related to HIV represents the principal expression of nonseptic rheumatologic HIV manifestations in Congo.     

Knee septic arthritis: 100 cases report in intertropical zone

The authors report 100 cases of knee septic arthritis seen during ten years among 2298 patients admitted in the rheumatology department of Brazzaville university teaching hospital. Bone and joint infection is the first hospitalisation cause in this service. Knee is the first septic localization with 42% of cases coming before hip 25%, sacro-iliac 18% and shoulder 7%. Patients are 56 males and 44 females aged from 5 to 79 years old, average 35 years. Most frequently germs are Staphylococcus aureus in half cases, Mycobacterium tuberculosis in 30% of cases and gram-negative bacillus. Contributing factors are AIDS: 12 cases, diabetes mellitus: 7 cases, alcohol-tobacco intoxications: 4 cases, ickle-cell disease: 3 cases, gout and renal failure in 2 cases each. Late diagnosis and consultation, inadapted antibiotic drugs are responsible for important articular damages compromising further functional prognosis.     

Pathological fracture revealing an osseous histoplasmosis. A case report on a 60-year patient

The authors report a new case of African Histoplasmosis in a 60-year-old patient. It was an humeral localization revealing a pathological fracture which grew into an extension of osteolysis and a cutaneous fistulization likely to be a malignant bone tumor. The case has been diagnosed by surgical biopsy and histological analysis. Its antifungal treatment in progress resulted in the drainage of the out-flow that should permit the bone reconstruction by graft. The authors stress on the need to focus on this affection whenever, in a tropical area, one is faced with any chronic bone fistula that cannot positively be cured in spite of sound medical cares.     

Subacute osteomyelitis in adults. Apropos of 3 cases

We report three cases of subacute osteomyelitis in 25, 31 and 38-year old adults. The clinical presentation was an insidious condition with persistent nondisabling pain. Radiographical signs suggested a bone tumor. Diagnosis was established from the bacteriological and pathology examinations of the surgical biopsy taken when evacuating the abscess. Cure was obtained in all three patients with combination antibiotic regimens. In two cases immobilisation was required because of bone fragility.     

Retrospective study of 53 erysipelas cases in Brazzaville University Hospital, Congo

Hospitalizations for erysipelas became frequent in the Brazzaville (Congo) service of dermatology. A link between the use of topical corticosteroids for bleaching purpose and erysipelas cases of the leg in women users has been evoked. We carried out a retrospective survey over eleven months analysing 53 files of patients hospitalized for erysipelas, among which 48 cases (91%) concerned topical corticosteroids users and 5 cases of (9%) non users. The average age of these patients was 26 years old, with extremes 18 and 55, for an hospitalization varying between 3 weeks and one month.     

Is inflammatory joint disease in HIV-infected patients a form of spondyloarthropathy?

In Congo-Brazzaville, the seroprevalence of HIV infection is in the range 7-8%, and AIDS is the leading cause of aseptic arthritis (60% of cases). PATIENTS, MATERIAL AND METHODS: The ESSG and Amor's criteria for spondyloarthropathy were evaluated in 83 patients with HIV infection admitted for aseptic arthritis to the rheumatology department of the Brazzaville teaching hospital, over an 8-year period. RESULTS: All 83 patients were CDC stage IV; 66 (80%) had polyarthritis and 17 (20%) oligoarthritis. A single patient met ESSG and Amor's criteria, with six points; one patient had five points and 15 had three points. The joint involvement was asymmetrical and nonerosive. Nonsteroidal antiinflammatory therapy ensured resolution of the manifestations within 4-8 weeks. The most common sites of involvement were the knees (84%), ankles (59%), and great toes (23%) at the lower limbs and the wrists (41%), elbows (29%), and metacarpophalangeal and interphalangeal joints (25%) at the upper limbs. CONCLUSION: Inflammatory arthritis in HIV patients does not meet ESSG or Amor's criteria for spondyloarthropathy.     

Clinical spectrum of rheumatologic diseases in a department of rheumatology in Ouagadougou (Burkina Faso)

The aim of this study is to review over a period of 5 years the clinical spectrum of rheumatic diseases seen in a tertiary hospital in Ouagadougou, Burkina Faso. A retrospective study of case records was conducted from March 1, 2006 to March 30, 2011 in the Rheumatology service, Department of Internal Medicine of the University Hospital Yalgado Ouedraogo. Of the 4,084 patients seen, 2,381 were women (58.30 %) and 1,703 were men (41.70 %). The mean age at disease onset was 42.12 years, ranging from 3 to 92 years. Among the rheumatologic conditions, mechanical and degenerative disorders were the most common, found in 3,053 cases (74.76 %). Among these cases, spinal pathology predominated, especially low back pain (19.93 %). The frequency of osteoarthritis was 19.70 % (804 cases) with a predominance of knee osteoarthritis (657 cases). Infectious pathology was dominated by osteoarticular tuberculosis (48 cases), particularly Pott’s disease (43.68 % of infectious diseases). Among the cases of inflammatory arthritides, rheumatoid arthritis was the leading cause (116 cases or 2.84 %). It was followed by spondyloarthropathies in which arthritis related to HIV predominated (21 out of 81 cases). Metabolic diseases were mainly represented by the gout (162 cases or 3.96 %) with male predominance. Comorbidities included high blood pressure (46.57 %), diabetes mellitus (13.78 %), hemoglobinopathies (9.66 %), epigastric pain (7.25 %), and peptic ulcer confirmed by endoscopy (6.75 %). Rheumatology in Burkina Faso is booming. The profile of rheumatologic diseases in Burkina Faso, after 5 years of practice, confirms the diversity and importance of these conditions dominated by a degenerative pathology of the spine and limbs, including infectious diseases such as Pott’s disease and the inflammatory and metabolic diseases.