Diagnostic value of anti-cyclic citrullinated peptides and association with HLA-DRB1 shared epitope alleles in African rheumatoid arthritis patients

INTRODUCTION: The purpose of this study was to examine the diagnostic performance of autoantibodies against citrullinated peptides/proteins (ACPA) and to determine the prevalence of HLA-DRB1 shared epitope alleles (SE) in African patients with rheumatoid arthritis (RA). METHODS: Serum levels of anti-cyclic citrullinated peptides antibodies (anti-CCP2, anti-CCP3), IgM and IgA rheumatoid factors (RF) were measured by enzyme-linked immunosorbent assay in the serum of 56 consecutive RA patients regularly followed in the Rheumatology Unit of the School of Medicine, University of Yaounde, Yaounde, Cameroon. Genotyping of HLA-DRB1 alleles was performed by polymerase chain reaction and hybridization with sequence-specific oligonucleotide probes on microbeads arrays. Fifty-one patients with other inflammatory rheumatic diseases and 50 healthy individuals were included as controls. RESULTS: An anti-CCP2 assay showed the best diagnosis sensitivity (82%) and specificity (98%) with high positive predictive (PPV) (96%) and negative predictive values (NPV) (91%). Thirty percent of RA patients were carrying at least one copy of the HLA-DRB1 shared epitope (SE) compared to 10% and 14% of patients with other inflammatory rheumatic diseases and healthy individuals, respectively. The presence of the SE was associated with the production of ACPA. CONCLUSIONS: Anti-CCP2 antibodies are useful markers of RA in African patients. In this cohort, the prevalence of the SE is higher in RA patients than in controls but lower than that reported in patient cohorts of European ancestry. The discrepancy between the high prevalence of ACPA-positive patients and the relatively low number of SE-positive cases suggest that, in addition to SE, other genetic factors control the development of ACPA in African RA patients

African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

Objectives To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic. Method A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1–3, 4–6 and 7–9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a ‘low’ level of agreement. Results A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting. Conclusions The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges

Non-infectious lupus pericarditis: a retrospective hospital-based observation in Yaounde-Cameroon

To determine the frequency of non-infectious lupus pericarditis in patients with systemic lupus erythematosus (SLE) seen in the Yaounde Central and General Hospitals. A descriptive retrospective study was carried out in Rheumatology Units of Yaounde Central and General Hospitals, from January 2001 to January 2004. Inclusion criteria: patients fulfilling the American College of Rheumatology criteria for SLE and presenting with pericarditis. The study consisted of 22 female and one male SLE patients with a mean age of 26 years (range=13-65). Ten out of 23 patients (43%) presented pericarditis with a mean duration of illness before the diagnosis of pericarditis of 2 years. Pericardial rub was the commonest sign (seven cases), followed by dyspnea (six cases) and chest pain (six cases). The diagnosis of pericarditis was proven by echocardiography in all cases. Typical serological findings included anti-nuclear antibodies, anti-double-stranded DNA, and anti-Sm antibodies. Chest X-ray revealed cardiomegaly in all the patients. Electrocardiogram showed abnormal repolarization (seven patients) and low voltage QRS complexes (three cases). Treatment consisted of steroids administration. Four patients had relapse of pericarditis during subsequent lupus flares. This short series shows that non-infectious pericarditis is common in SLE patients in Africa

Le kyste synovial lombaire intra rachidien totalement calcifié. Une étiologie rare de lombocruralgie

Les auteurs rapportent un cas rare d’un volumineux kyste synovial lombaire, intra rachidien primitivement et totalement calcifié, opéré avec succès à l’Hôpital Général deYaoundé. Cette lésion a été révélée par une lombocruralgie. La littérature médicale récente sur le sujet est revue. Les différentes techniques chirurgicales sont discutées

Aspects diagnostiques et thérapeutiques des déformations d’axe des membres inférieurs de l’enfant africain. Revue de 43 cas.

La description des aspects cliniques des déformations d’axe des membres inférieurs de l’enfant intéresse de plus en plus, les auteurs africains. Toutefois, leur prise en charge thérapeutique et notamment le volet chirurgical mérite d’être mieux codifiée. L’étude rétrospective de juillet 1998 à décembre 2003, dans deux services d’Orthopédie-Traumatologie de Yaoundé et Douala avait pour but de dégager les aspects diagnostiques et thérapeutiques de ces affections dans notre contexte. Elle a porté sur les dossiers médicaux des enfants opérés pour déformations d’axe des membres inférieurs. Pour chaque patient, le diagnostic était radio-clinique et l’essentiel du geste chirurgical représenté par les ostéotomies tibiales et ou fémorales cunéiformes et les épiphysiodèses par agrafage. Quarante trois dossiers ont été colligés parmi lesquels 31 filles et 12 garçons, soit un sex ratio de 0,3. L’âge moyen de nos patients était de 9,5 ans. Trente huit pour cent et demi des patients présentaient une déviation angulaire supérieure ou égale à 45°. Soixante dix ostéotomies cunéiformes et 3 épiphysiodèses par agrafage étaient réalisées. Le taux de complication était de 0,6 par genou opéré. La chirurgie est une méthode efficace pour traiter les déformations d’axe des membres inférieurs dans leurs formes sévères, fréquentes en Afrique

Canal lombaire étroit : à propos de 102 cas à l’Hôpital Central de Yaoundé

Le canal lombaire étroit est une pathologie fréquente en Afrique Sub-saharienne. Le profil épidémiologique de la population africaine semble se démarquer de celui de la population occidentale. Très peu d’études ont été menées sur le canal lombaire étroit au Cameroun. Il s’agit d’une étude rétrospective et descriptive incluant tous les patients opérés d’un canal lombaire étroit de Janvier 2000 à Décembre 2007 à l’Hôpital Central de Yaoundé. L’utilisation d’une classification clinique et radiologique permettant de comparer les résultats est discutée. Au total, 102 patients ont été recrutés. L’âge moyen était de 57,3 ans. La tranche d’âge la plus représentée était celle de 51 – 60 ans. Le sex ratio était de 1 homme pour 2,4 femmes. Le surpoids, l’obésité et les travaux lourds étaient les facteurs de risques retrouvés. Les lomboradiculalgies (79,4%), les radiculalgies (12,7%) et les lombalgies (7,9%) dominaient la symptomatologie. Il s’agissait d’une claudication radiculaire intermittente dans 70,5%. Le diagnostic reposait essentiellement sur la saccoradiculographie (87,2%), la tomodensitométrie (28,4%) et le Myéloscanner (5%). La laminectomie décompressive (97%) ou la foraminotomie (3%) étaient associées à une stabilisation du rachis (25%). Les résultats étaient excellents dans 16% de cas, bons dans 78,4%des cas et médiocres dans 4,9% des cas. Les complications étaient marquées par les suppurations (4 cas), les hématomes (2 cas) et les brèches durales (5 cas). La sévérité de la claudication neurogène, des radiculalgies et l’absence de déficit neurologique constituaient des éléments de bon pronostic. Le canal lombaire étroit est une pathologie fréquente en milieu neurochirurgical camerounais. Il touche ssentiellement l’adulte ou le sujet âgé et fréquemment le sexe féminin. Les résultats de la chirurgie sont plus influencés par des éléments cliniques que par la sévérité radiologique de la sténose en préopératoire

Systemic lupus erythematosus in native sub-saharan africans: a systematic review and meta-analysis

International audienceThe prevalence and phenotype of systemic lupus erythematosus (SLE) have not been thoroughly investigated in Native sub-Saharan Africans despite knowledge that the highest burden of SLE occurs in people with an African trait. Through this systematic review of literature and meta-analysis, we wished to fill this gap.PubMed, EMBASE, Web of Science, African Journals Online, and Global Index Medicus as well as references of retrieved papers were searched to select studies addressing SLE in Native sub-Saharan Africans and published between January 1, 2008 and October 7, 2018. The prevalence of SLE and its characteristics were pooled through narrative review and random-effects model. Heterogeneity (I22Out of 1502 papers, 15 hospital-based studies were included. The pooled prevalence of SLE among 28,575 participants was 1.7% (0.8-2.9), with substantial heterogeneity between studies (I2Over the last 30 years, SLE was not rare among Native sub-Saharan Africans and its featured characteristics were earlier onset, female predominance, and high seropositivity for extractable nuclear antigen autoantibodies. Corticosteroids and antimalarials were the standard treatments. The mortality rate was high. Population prevalence and incidence as well as full description of SLE characteristics in Native sub-Saharan Africans are needed

Occupational factors are not factors for chronicity in patients with low back pain in sub-Saharan Africans: a hospital-based study from Cameroon

Background: Factors associated to chronicity of nonspecific Low Back Pain (LBP) are scarce in sub-Saharan Africa (SSA). Objectives: To identify the factors associated to the persistence at two years of nonspecific LBP in rheumatology outpatients seen in a teaching hospital in Cameroon. Design: This was a cross-sectional study done in the General Hospital, Douala. Methods: Adult patients with chronic LBP were included and divided into two groups according to disease duration (<2 years and ≥2 years). Factors associated to the persistence at 2 years of LBP was statistically significant if p<0.05. Results: Two hundred and three patients (157 women) with nonspecific LBP with mean age 55.9±12.8 years were included. The patients  were grouped into workers involved in heavy labour or in jobs that require physical efforts (n = 122; 60.1%) and workers in blue-collar jobs with prolonged standing and/or sitting (n = 81; 31.9%). The following factors were significantly associated with the persistence at two years of LBP: advanced age, female gender, high number of children (for women), history of LBP, multiple recurrences with persistent pain and the high pain intensity. Even though there is a tendency towards the statistical significance of the lifting of heavy loads (p=0.06), we did not find any significant association between the occupational factors and the persistence at two years of LBP. Conclusion: There is a lack of association between the occupational factors and the persistence at two years of the LBP in a sub-Saharan population in Cameroon. Only some socio-demographic and clinical factors are statistically significant

In Black Africans with rheumatoid arthritis, ACPA recognize citrullinated fibrinogen and the derived peptides α36-50Cit38,42 and β60-74Cit60,72,74, like in Caucasians

Well documented in Caucasians and Asians, the diagnostic value of anti-CCP2 antibodies has been confirmed in Black African populations. However, autoantibodies to other citrullinated peptides/proteins and their fine specificities have not yet been studied. Here, we show that in Cameroonian patients, anti-citrullinated fibrinogen autoantibodies (AhFibA) are sensitive (73%) diagnostic markers for RA. We also determine that autoantibodies directed to α36-50Cit38,42 or β60-74Cit60,72,74 peptides which bear the immunodominant epitopes of citrullinated fibrin, are present in similar proportions in Black Africans and Caucasians with 25/56 (45%) and 41/56 (73%) positive RA-sera in Cameroonians, respectively. They also account for almost all the AhFibA reactivities since 38/41 (93%) AhFibA-positive sera contain anti-α36-50Cit38,42 and/or anti-β60-74Cit60,72,74 autoantibodies. Finally, HLA-DRB1 SE alleles were associated with higher titres of AhFibA and anti-β60-74Cit60,72,74 autoantibodies. In the genetic and environmental backgrounds of Black Africans, AhFibA are a hallmark of RA like in Caucasians, moreover they recognize the same fibrin epitopes

RHEUMATIC DISEASES IN PATIENTS ATTENDING A CLINIC AT A REFERRAL HOSPITAL IN YAOUNDE, CAMEROON

ABSTRACTBackground: The spectrum of rheumatic diseases in sub-Saharan Africa remains poorly defi ned.Objectives: To determine the spectrum of rheumatic diseases in Yaounde.Design: Descriptive cross-sectional study.Setting: Rheumatology clinic at the Yaounde General Hospital, Cameroon.Subjects: Twelve thousand four hundred and ninety four patients were referred to the outpatientdepartment of the Internal Medicine service of the General Hospital of Yaounde over a 12-monthperiod. Of these cases, 536 (9.4%) were diagnosed as belonging to the general class of rheumaticconditions. There were 334 (62.31%) females and 202 (37.69%) males. The mean age was 52.72 ±5.3 years.Results: The 536 cases were further classifi ed as follows: degenerative disease of the spine 196(36.5%), osteoarthritis of the limbs 110 (20.5%), regional musculo-skeletal disorders 83 (15.5%),arthritis associated with infections 50 (9.3%), chronic infl ammatory and connective tissue diseases44 (8.2%), crystalline arthropathies 32 (5.9%) and miscellaneous (unclassifi ed) rheumatic conditions21 (4.1%).Conclusion: From these results, we concluded that degenerative disease of the spine and limbsare the most common forms of rheumatic disease in this region. Gout is the most commnon acuteinfl ammatory arthropathy and rheumatoid arthritis the most prevalent arthropathy due to chronicinfl ammation