Rheumatoid polyarthritis suspected in an HIV patient with scleritis, peripheral ulcerative keratitis, and anterior uveitis

Christelle Domngang Noche,1 Madeleine Singwé-Ngandeu,2 Assumpta Lucienne Bella2 1Université des Montagnes, Yaoundé, Cameroon; 2Université de Yaoundé 1, Yaoundé, Cameroon Introduction: Scleritis and peripheral ulcerative keratitis are ocular manifestations found in many inflammations and infections. Therefore, their association should prompt a search for inflammatory or infectious causes that may be life-threatening, especially in the context of AIDS due to HIV infection. Findings: We report the case of a 37-year-old female, first seen in 2011 with a nodular scleritis in the right eye and a peripheral ulcerative keratitis, a necrotizing scleritis, and a granulomatous anterior uveitis in the left eye, in the context of chronic polyarthropathies that had evolved over 6 months. The patient was diagnosed with AIDS (HIV) in 2008 and was on antiretroviral therapy for the past 2 years. Ophthalmic workup was negative for opportunistic infections and potential causes of scleritis and peripheral ulcerative keratitis, and the patient was unresponsive to topical antibacterial and anti-inflammatory treatment. Ocular lesion resolution and articular swelling improvement was observed less than 6 weeks after sulfasalazine treatment. Based on American College of Rheumatology/European League Against Rheumatism classification criteria, and considering the good response to the treatment (sulfasalazine), diagnosis of rheumatoid arthritis was made in the absence of confirmatory lab tests results. Conclusion: In the context of ocular manifestations associated with polyarthropathies, coexisting pathologies should be considered. Diagnostic workup of chronic inflammatory rheumatism should be carried out, even in the context of HIV/AIDS. Keywords: scleritis, peripheral ulcerative keratitis, anterior uveitis, rheumatoid arthritis, HIV/AID

Acute Gout Attack in Cameroonians and Oxidative Stress: Cause and Effect?

International audienc

The severity of rheumatoid arthritis at the first rheumatology consultation and factors associated with initial structural damage in sub Saharan patients

Background: The severity of Rheumatoid Arthritis (RA) at diagnosis has not been fully described in sub-Saharan Africa in recent years, nor have been the factors associated with it.Objective: The aim of this study was to determine the frequency of severe RA at the first rheumatology consultation and assess the factors associated with this early severity.Design: This was a retrospective study.Methods: The study was carried out in the rheumatology service of the Yaoundé Central Hospital, Cameroon. Files (one patient = one file) of patients diagnosed with RA during January 2004-May 2018 were included. RA severity was defined by the presence of at least one of these markers: Disease Activity Score-28 with Erythrocyte Sedimentation Rate (DAS28-ESR) > 5.1, initial structural damage on hand X-rays which was defined by a Larsen score ≥ 2 per joint and the presence of Rheumatoid Factor (RF) and/or Anticitrullinated Protein Antibodies (ACPA). Files with no information to assess disease severity at the time of diagnosis were excluded. Data were analyzed with Epi-info version 7.0. Statistical significance was set at p-values less than 0.05.Results: Forty-nine patients were included. Their mean age was 48 ± 14 years. Eighty percent of them were females. Sixty-seven percent had established RA, 33% had early-stage RA and two patients had ever smoked. None of them had received biological diseasemodifying antirheumatic drugs. RA was severe in 82% of patients, with DAS28- ESR > 5.1 in 71%, positivity of at least one autoantibody found in 63% to 82%, and initial structural damage found in 55% of them. Initial structural damage was only associated with the presence of ≥ 10 swollen joint counts.Conclusions: RA was severe from the onset in most patients and structural damage was associated with the presence of ≥ 10 swollen joint counts. Key words: Rheumatoid arthritis, Severity, Initial presentation, Structural damage, Sub-Saharan Africa