Prevalence and Pattern of Soft-Tissue Rheumatism in a Semi-Urban Nigerian Population

International audienc

Femoral nerve stretch test predicts radiological features of lumbar spondylosis in Nigerians with low back pain

Background: Lumbar spondylosis is one of the most common cause of low back pain. The diagnosis of lumbar spondylosis often depends on  radiodiagnostic evaluations which are not readily available in primary healthcare centers. This study examined the ability of clinical test to diagnose  radiographic lumbar spondylosis compared to x-rays in subjects with low back pain. Methods: This was a secondary analysis of data from the 2016 Jos COPCORD study. The data on subjects with low back pain who had complete  clinical and radiological examinations were analyzed to determine clinical factors that were independently associated with radographic lumbar  spondylosis. A P value of <0.05 was considered significant for all statistical test. Results: The data of 187 subjects with a mean age of 46±15 years were analyzed. There were 38.5% males and 61.5% 2 2 females. Age (X2 =75.91, P  <0.001), marital status (X2 29.85,  <0.001), education (X2 11.34, P = 0.01), occupation (X2=18.44,  P <0.001) BMI (X2 =10.79, P = 0.02) hypertension (X2  =9.20, P  = 0.002), SLR (X2 =9.37, P=0.002) and FNST (X2 =50.49, P<0.001) were statistically correlated with radiographic lumbar spondylosis. On  logistic regression, age > 45years, marital status, education, occupation, hypertension, SLR and FNST remained significantly associated with  radiographic lumbar spondylosis. A positive SLR had a sensitivity of 26.32%, specificity of 91.78% and an ROC Area of 0.59, while a positive FNST had  a sensitivity of 85.96%, specificity of 64.38% and ROC Area of 0.75 in predicting radiographic lumbar spondylosis. Conclusion: A positive FNST was more discriminatory in predicting the occurrence of radiographic lumbar spondylosis compared to SLR. Therefore,  it can be used acceptably in the diagnosis of Lumbar spondylosis in centers where there are no X-ray facilities

Guillain barre syndrome as initial presentation of systemic lupus erythematosus

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by multiple organ involvement including the peripheral nervous system. Guillan- Barrè syndrome (GBS) has an established association with SLE as one of its neurologic manifestations. However, GBS as an initial manifestation of SLE is only sparingly reported in the literature.Methods: We present a case of a 26 year old woman who was initially managed by neurology unit for GBS but subsequently developed body swelling, hypertension and polyarthritis. She was evaluated and managed by both rheumatology and nephrology units.Results: Renal biopsy showed histological features of membranous nephropathy suggestive of stage V lupus nephritis. The patient responded well to high dose corticosteroid, intravenous cyclophosphamide and azathioprine.Conclusion: This case highlights that GBS can be an initial presentation of SLE and the usefulness of immunosuppressants in the management of such cases.Keywords: Guillan-Barrè syndrome, Systemic Lupus Erythematosus, Lupus Nephritis, Immunosuppressant

The duration of response to intra-articular steroid injections in patients with osteoarthritis of the knee: a single centre's experience

Background: The burden of Osteoarthritis (OA) is huge, with a sizable proportion of patients that have failed the analgesic treatment and are not candidates for surgery or have refused surgery. Intraarticular corticosteroid injections (IASI) are considered standard of care for pain relief and control of local inflammation in this category of OA patients. However, there is a wide variation in the duration of response to steroid injections. This study was designed to determine the duration of response to IASI in patients with osteoarthritis of the knee in our environment. Methods: Fifty-four patients aged between 30 and 80 years who have been diagnosed with osteoarthritis using the American College of Rheumatology criteria and have met the inclusion criteria were enrolled in the study and were given intra-articular steroid injections to the knee. Their responses were assessed using visual analogue scale (VAS) score, Western Ontario, and McMaster Universities Osteoarthritis Index (WOMAC) score at 2, 4 and 12 weeks. The patients were classified as responders if there was a fifty percent improvement in the WOMAC scores and a fifty percent reduction in the VAS score and non-responders if there is less than fifty percent improvement in the WOMAC score and less than fifty percent reduction in the VAS score. Results: Fifty-two patients completed the study; 78.4% and 100% of these had good WOMAC and VAS responses respectively at 2 weeks but this proportion gradually reduced to 47.9% and 56.3% for WOMAC and VAS respectively at 3 months. Conclusion: Intra-articular steroid injections provide sustained response in patients with osteoarthritis of the knee who have failed analgesic therapy and are not candidates for total knee replacement for up to three months and the response decreases with advancing age

Women in rheumatology in Africa

Despite the increasing occurrence of rheumatic diseases worldwide, there is poor access to rheumatology services and few rheumatologists to provide these services in many regions of the world. This fact is particularly true in areas of lower socioeconomic status and low-income and middle-income countires. Studies across various countries show a relative shortage of rheumatologists compared with the rising need for the specialty worldwide

Improving benefit-harm assessment of glucocorticoid therapy incorporating the patient perspective: The OMERACT glucocorticoid core domain set

Objective: Our primary objective was to develop an Outcome Measures in Rheumatology (OMERACT) core domain set to capture the impact of glucocorticoids (GC), both positive and negative, on patients with Rheumatic conditions. Methods: The OMERACT Filter 2.1 was used to guide core domain selection. Systematic literature reviews, qualitative studies and quantitative surveys were conducted by the OMERACT GC Impact working group to identify candidate domains for a core domain set. A summary of prior work and Delphi exercise were presented at the OMERACT 2020 virtual GC workshop. A proposed GC Impact core domain set derived from this work was presented for discussion in facilitated breakout groups. Participants voted on the proposed GC Impact core domain set. Results: 113 people, including 23 patient research partners, participated in two virtual workshops conducted at different times on the same day. The proposed mandatory domains to be evaluated in clinical trials involving GCs were: infection, bone fragility, hypertension, diabetes, weight, fatigue, mood disturbance and death. In addition, collection of disease specific outcomes was included in the core domain set as “mandatory in specific circumstances”. The proposed core domain set was endorsed by 100% (23/23) of the patient research partners and 92% (83/90) of the remaining participants, including clinicians, researchers and industry stakeholders. Conclusion: A GC Impact core domain set was endorsed at the OMERACT 2020 virtual workshop. The OMERACT GC Impact working group will now progress to identify, develop and validate measurement tools to best address these domains in clinical trials

Improving benefit-harm assessment of glucocorticoid therapy incorporating the patient perspective: The OMERACT glucocorticoid core domain set

Objective: Our primary objective was to develop an Outcome Measures in Rheumatology (OMERACT) core domain set to capture the impact of glucocorticoids (GC), both positive and negative, on patients with Rheumatic conditions. Methods: The OMERACT Filter 2.1 was used to guide core domain selection. Systematic literature reviews, qualitative studies and quantitative surveys were conducted by the OMERACT GC Impact working group to identify candidate domains for a core domain set. A summary of prior work and Delphi exercise were presented at the OMERACT 2020 virtual GC workshop. A proposed GC Impact core domain set derived from this work was presented for discussion in facilitated breakout groups. Participants voted on the proposed GC Impact core domain set. Results: 113 people, including 23 patient research partners, participated in two virtual workshops conducted at different times on the same day. The proposed mandatory domains to be evaluated in clinical trials involving GCs were: infection, bone fragility, hypertension, diabetes, weight, fatigue, mood disturbance and death. In addition, collection of disease specific outcomes was included in the core domain set as “mandatory in specific circumstances”. The proposed core domain set was endorsed by 100% (23/23) of the patient research partners and 92% (83/90) of the remaining participants, including clinicians, researchers and industry stakeholders. Conclusion: A GC Impact core domain set was endorsed at the OMERACT 2020 virtual workshop. The OMERACT GC Impact working group will now progress to identify, develop and validate measurement tools to best address these domains in clinical trials

Improving benefit-harm assessment of glucocorticoid therapy incorporating the patient perspective: The OMERACT glucocorticoid core domain set

Objective: Our primary objective was to develop an Outcome Measures in Rheumatology (OMERACT) core domain set to capture the impact of glucocorticoids (GC), both positive and negative, on patients with Rheumatic conditions. Methods: The OMERACT Filter 2.1 was used to guide core domain selection. Systematic literature reviews, qualitative studies and quantitative surveys were conducted by the OMERACT GC Impact working group to identify candidate domains for a core domain set. A summary of prior work and Delphi exercise were presented at the OMERACT 2020 virtual GC workshop. A proposed GC Impact core domain set derived from this work was presented for discussion in facilitated breakout groups. Participants voted on the proposed GC Impact core domain set. Results: 113 people, including 23 patient research partners, participated in two virtual workshops conducted at different times on the same day. The proposed mandatory domains to be evaluated in clinical trials involving GCs were: infection, bone fragility, hypertension, diabetes, weight, fatigue, mood disturbance and death. In addition, collection of disease specific outcomes was included in the core domain set as “mandatory in specific circumstances”. The proposed core domain set was endorsed by 100% (23/23) of the patient research partners and 92% (83/90) of the remaining participants, including clinicians, researchers and industry stakeholders. Conclusion: A GC Impact core domain set was endorsed at the OMERACT 2020 virtual workshop. The OMERACT GC Impact working group will now progress to identify, develop and validate measurement tools to best address these domains in clinical trials