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Women in rheumatology in Africa

The Lancet Rheumatology

BMC Medical Research Methodology, Jun 21, 2023

Objective To develop and validate a screening tool to identify patients with a high likelihood fo... more Objective To develop and validate a screening tool to identify patients with a high likelihood for Spondyloarthritis (SpA) in the Democratic Republic of the Congo (DR Congo). The development of the SpA Screening questionnaire in Sub Saharian Africa (SpASSS) questionnaire followed 3 steps: The item generation was carried out by a systematic literature review according to the PRISMA guidelines on the clinical manifestations of SpA, interviewing clinical experts and the classification criteria for Spondyloarthritis. The candidate questions were tested in a population of 50 consecutive patients with confirmed diagnosis of spondyloarthritis, in a control population of rheumatic disease excluding SpA and in a group of 200 non-rheumatic participants, randomly chosen in the general population for question reduction and validation. Descriptive statistical analyses were performed to assess socio-demographic characteristics and response distribution for each item. Their diagnostic performance was investigated using ROC curves. For validation, principal component analysis was performed using factor analysis. Referral strategy score for SpA was determined by adjusted Cronbach's alpha coefficient. Mean ± SD age of SpA cases was 41.8 ± 14.4 years, 56% were men compared to diseased controls 60.0 ± 12.5 years, 28.7% men (p < 0.001). 14/20 items showed a statistically significant difference (p < 0.05) between SpA cases and control groups. All items were factorable and 6 components were identified. Only the two first components (C1 with 8 items, C2 with 3 items) showed a significant threshold for reliability in detection of suspected SpA with a Cronbach's alpha of 0.830 and 0.708. All validated items of these two components showed the global reliability threshold with α-adjusted Cronbach calculated at 66.9%. The performance for correctly screening SpA was demonstrated with an area under the curve of 0.938 (0.884-0.991) and 0.794 (0.728-0.861) for C1 and C2 respectively. Conclusions This validation and item reduction of the SpASSS questionnaire for SpA might identify patients to refer for case ascertainment and will help conducting future epidemiological and clinical studies in the DR Congo. • To the best of our knowledge, this is the first study in Sub-Saharan Africa based on local data to develop a screening tool for SpA in the population for epidemiological and clinical use. • Referral strategies based on context-specific data are necessary to provide accurate case definition and epidemiological data, thus reducing methodological bias. • In the SpA group, no discrimination was made regarding SpA subtypes, disease duration, activity and severity.

BMC rheumatology, Sep 9, 2019

Background: Rheumatoid arthritis (RA) is associated with a 5 to 10 years reduction in life expect... more Background: Rheumatoid arthritis (RA) is associated with a 5 to 10 years reduction in life expectancy due to premature atherosclerosis. This reduction is the consequence of traditional cardiovascular risk factors (TCRF) as well as systemic inflammation. The aim of the present study was to describe the prevalence and factors associated with subclinical atherosclerosis in RA at the University Hospital of Kinshasa (UHK). Methods: Patients with a diagnosis of RA based on the 2010 ACR/EULAR criteria were included in this crosssectional study from 1 June 2014 to 31 May 2015 at the UHK. RA disease activity was measured using the DAS28-ESR. Active RA was defined by a DAS 28 > 2.6. Severe RA was defined by the presence of extra-articular manifestation, joint erosions on X-rays or HAQ ≥0.5. An assessment of subclinical atherosclerosis was performed by the measurement of the carotid intima-media thickness (cIMT) using two-dimensional ultrasonography. Subclinical atherosclerosis was defined by a cIMT ≥0.9 mm. A diagnosis of atheroma plaque was retained when the cIMT was ≥1.5 mm. The association between subclinical atherosclerosis and potential risk factors was modeled using logistic regression analysis. Results: We recruited 75 patients. The average age was 51.8 ± 14.6 years, with a sex ratio F/M of 4. The prevalence of subclinical atherosclerosis was 32%. In logistic regression being a woman of ≥55 years old (aOR 10.6,], p = 0.028), DAS28-ESR > 2.6 (aOR 3.5,95% ], p = 0.044), severe RA (aOR 32.6,95% CI [1.761-60.37],p = 0.035), high blood pressure (aOR 22.4,], p = 0.005) and obesity (aOR 32.3,], p = 0.026) emerged as factors associated with subclinical atherosclerosis. Conclusion: Subclinical atherosclerosis is common in RA patients attending the UHK. It appears to be associated with RA disease activity and severity apart from traditional cardiovascular risk factors. These results suggest that early management of subclinical atherosclerosis targeting remaining RA disease activity and cardiovascular risk factors could slow down progression to clinical cardiovascular disease.

$Research paper thumbnail of Ostéoporose et évaluation du risque fracturaire par l’outil frax chez des patients Congolais présentant un rhumatisme axial : Une série des cas multicentriques$

Annales Africaines de Médecine, Dec 12, 2022

Context and objective. The major challenge in the management of osteoporosis is the identificatio... more Context and objective. The major challenge in the management of osteoporosis is the identification of subjects at risk by quantifying the fracture risk in order to prevent the fracture cascade. The aim of the present study was to evaluate the fracture risk in patients who had consulted for axial skeletal pain. Methods. This was a multicenter case series carried out on patients with axial rheumatism recruited in 8 hospitals in Kinshasa. The parameters of interest such as age, sex, alcoholism, smoking, hip fracture in a 1st degree relative or personal fragility fracture were collected from each patient. Bone mineral density was measured by dual energy x-ray absorptiometry. Fracture risk was assessed by calculating the FRAX fracture index. This risk was considered high when the probability of occurrence of a hip fracture was ≥ 3% and/or major osteoporotic fractures ≥ 20%. Standard statistical tests were used to analyze the results. Results. 90 patients including 75 women (83.3%) were involved. Their average age was 63.5±12 years. Osteoporosis was diagnosed in 34.4% of patients, osteopenia in 43.9% of patients and 16.7% of patients had normal bone mineral density. No osteoporotic fractures were observed, but nearly 30% of the entire sample had a high fracture risk. Osteoporosis (T-score ≤-2.5) was associated, in approximately 80% of cases (p<0.005), with a high fracture risk. Conclusion. The present study showed that fracture risk was Résumé Contexte et objectif. L'enjeu majeur dans le management de l'ostéoporose est l'identification des sujets à risque par la quantification du risque fracturaire. L'objectif de l'étude était d'évaluer le risque fracturaire chez les patients ayant consulté pour douleur du squelette axial. Méthodes. Il s'agissait d'une série des cas multicentriques menée sur des patients recrutés dans 8 hôpitaux de Kinshasa. Les paramètres d'intérêt comme l'âge, le sexe, l'alcoolisme, le tabagisme, la fracture de hanche chez un parent de 1er degré ou une fracture personnelle de fragilité ont été collectés auprès de chaque patient. La mesure de la densité osseuse avait été réalisée par absorptiométrie biphotonique à rayons X. Le risque fracturaire a été évalué par le calcul de l'indice fracturaire FRAX. Ce risque était élevé lorsque la probabilité de survenue de fracture de hanche était ≥ 3% et/ou des fractures ostéoporotiques majeures ≥ 20%. Des tests statistiques usuels ont été utilisés pour l'analyse des résultats. Résultats. 90 patients dont 75 femmes étaient inclus. Leur âge moyen était de 63,5±12 ans. L'ostéoporose était diagnostiquée chez 34,4% des patients, l'ostéopénie chez 43,9% et 16,7% avaient une densité minérale osseuse normale. Aucune fracture ostéoporotique n'a été observée dans la présente étude, mais près de 30% de l'ensemble de l'échantillon avaient un risque fracturaire élevé. L'ostéoporose était associée, dans environ 80% des cas (p<0,005), à un risque fracturaire élevé. Conclusion. La présente étude a montré que le risque fracturaire était élevé chez les patients atteints d'ostéoporose. Elle met en lumière la nécessité d'un dépistage précoce de cette pathologie. Mots-clés : Ostéoporose, rhumatisme axial, risque fracturaire, FRAX Reçu le 4 septembre 2022 Accepté le 9 novembre 2022

BACKGROUND. Fibromyalgia is a controversial and often underreported clinical entity in routine me... more BACKGROUND. Fibromyalgia is a controversial and often underreported clinical entity in routine medical practice. The present study aimed to describe its epidemiological and clinical profile in patients attending the Kinshasa University Hospital. METHODS. This is a series of clinical cases carried out in patients attending rheumatology practice at the Kinshasa University Hospital from December 2020 to March 2022. The following informations including age, sex, painful symptomatology, psychosomatic signs, the circumstances of the disease onset, factors that emphasize or reduce symptoms, the number of previous medical visits and, the impact on socio-professional life were collected. The diagnosis of fibromyalgia was defined according to the ACR 2010 criteria. Fibromyalgia was considered severe when it was associated with disability. Standard statistical tests were used to analyze the results. RESULTS. 585 patients were followed during the study period. The diagnosis of fibromyalgia was ...

AB0697 PERFORMANCE of Different Criteria Sets for Inflammatory Back Pain in Patients with Axial Spondyloarthritis in Democratic Republic of Congo

Annals of the Rheumatic Diseases, 2020

Background:Inflammatory back pain (IBP) is the most prominent clinical feature for an early diagn... more Background:Inflammatory back pain (IBP) is the most prominent clinical feature for an early diagnosis of axial spondyloarthritis. The performance of the criteria sets for IBP has not yet been assessed in clinical practice in the Democratic Republic of Congo (DRC).Objectives:To assess and to compare the performance of different IBP criteria sets in axial spondyloarthritis (SpA) outpatients attending the rheumatology unit of the University Hospital of Kinshasa, DRC.Methods:One hundred and eight Congolese outpatients with axial SpA defined by rheumatologist’s clinical judgment were included in the spondyloarthritis cohort of the University Hospital of Kinshasa from March 1st2015 to February 28, 2017. Calin criteria, Berlin criteria and ASAS criteria sets for IBP were performed to assess their performance against clinical judgment. Detailed history, clinical examination and imaging of sacroiliac joints by plain radiography were obtained. Sacroiliac joint radiographic lesions were scored...

Different subtypes of Spondyloarthritis in the University Hospital of Kinshasa and Provincial General Hospital of Kinshasa

Different subtypes of Spondyloarthritis in the University Hospital of Kinshasa and Provincial Gen... more Different subtypes of Spondyloarthritis in the University Hospital of Kinshasa and Provincial General Hospital of Kinshas

Nouvelle base de données sur validation critères SpA VERSION 1

Pan African Medical Journal, 2019

Introduction: the aim of the present study was to describe the clinical and radiological features... more Introduction: the aim of the present study was to describe the clinical and radiological features of knee osteoarthritis in Congolese outpatients attending the University Hospital of Kinshasa (UHK). Methods: a cross-sectional study was performed in the rheumatology unit of the UHK from January to August 2012. Patients were consecutively recruited. The diagnosis of Osteoarthritis (OA) was based on the criteria of the American College for Rheumatology. Demographic, clinical and x-rays data were collected. The X-rays severity was assessed according to Kellgren and Lawrence's method. Results: 1049 patients attended the Rheumatology unit of the UHK during the study period. An accurate diagnosis was reported for 839 patients, of whom 376 (44.8%) suffered from OA. Knee OA was diagnosed in 118 patients (31.4% of all OA patients). 101 patients accepted to be included in the study, 78 women (77.2%) and 23 men (22.8%). Their average age was 58.9 ± 10 years. A body mass index (BMI) ≥ 25kg/m 2 was observed in 68 patients of whom 28 were obese (BMI ≥ 30kg/m 2 ). The main symptoms were a mechanical pain (100%), swelling (40.6%), crepitus (79.2%) and mobility reduction (X%). Knee deformities were observed in some patients. At baseline, radiological damages > stage 2 of Kellgren-Lawrence were found in 70 patients. Conclusion: knee OA is a common disease among outpatients who attend the unit of Rheumatology of the UHK. Its clinical profile is the same as what is reported in the literature. Obesity and skeletal abnormalities are encountered in the majority of patients.

BMJ open, Jan 9, 2018

To determine the spectrum of spondyloarthritis (SpA) in outpatients with symptoms of rheumatism a... more To determine the spectrum of spondyloarthritis (SpA) in outpatients with symptoms of rheumatism attending two rheumatology practices in the Democratic Republic of the Congo. A descriptive prospective multicentre outpatient study. The present study analysed 6 months data (from 1 December 2012 till 31 May 2013). Nine hundred and eighty-four consecutive outpatients were studied. A clinical diagnosis of SpA was made and several classification criteria were applied afterwards. Radiographic lesions in the sacroiliac joint were scored with the modified New York criteria. BASDAI and BASFI were evaluated in axial SpA (axSpA). The primary end point was the prevalence of SpA and the secondary end points were the spectrum of SpA and its subtypes. One hundred and five patients (10.7%) were diagnosed among 984 consecutive outpatients with a sex ratio (male to female) of 1.4. The average age at disease onset was 41.3±12.4 years. Non-radiographical axSpA was the most frequent subtype (5.0%) followe...

Data from: Spondyloarthritis in the Democratic Republic of the Congo: a prospective hospital-based study

Abstract Objectives: To determine the spectrum of SpA in outpatients with rheumatic complaints at... more Abstract Objectives: To determine the spectrum of SpA in outpatients with rheumatic complaints attending two rheumatology practices in the Democratic Republic of Congo. Design: A descriptive prospective multicenter outpatient study. Setting: The present study analyzed 6 months data (from December 1st, 2012 till May 31st, 2013). Participants: 984 consecutive outpatients were studied. Interventions: none Primary and secondary outcome measures: A clinical diagnosis of SpA was made and several classification criteria were applied afterwards. Sacroiliac joint radiographic lesions were scored with the modified New York criteria. BASDAI and BASFI were evaluated in axial SpA. The primary end point was the prevalence of SpA and the secondary endpoints were the spectrum of SpA and its subtypes. Results: One hundred and five patients (10.7%) were diagnosed among 984 consecutive outpatients with a sex ratio (male to female) of 1.4. The average age at disease onset was 41.3±12.4 years. Non-radiographical axial spondyloarthritis was the most frequent subtype (5.0%) followed by reactive arthritis (4.3%). Other subtypes were: ankylosing spondylitis (1.0%), psoriatic arthritis (0.1%), SAPHO syndrome (0.1%) and IBD associated arthritis (0.1%). Mean BASDAI and BASFI in axial SpA were 42.7/100 and 46.4/100 respectively. Peripheral enthesitis was found in 43% of SpA patients and uveitis (10.4%) was the most frequent extra-articular manifestation. We did not detect any family history. Median erythrocyte sedimentation rate and C reactive protein were 37(range: 7-110) mm/h and 22 (range: 4-48) mg/l respectively. Conclusions: This hospital-based study suggests a substantial occurrence of some subtypes of SpA in central Africa. A population-based study is needed