Clinical presentation, treatment and outcome of patients with Systemic Lupus Erythematosus seen at a rheumatology clinic in Douala, Cameroon

Marie Doualla Bija, Henry Luma Namme, Gloria Ashuntantang, Helene Epée, Fernando Kemta, Felix Kwedi, Clarisse Ngatat, Madeleine Ngandeu Singwe

Abstract


Background: Systemic lupus erythematosus (SLE) was reported to be rare in sub-Saharan Africa. We aimed to present our experience on SLE clinical and biological characteristics

Patients and methods: We reviewed all the clinical records of patients suspected SLE in the General Hospital, Douala- Cameroon from 1999 to 2009. Patients fulfilling the 1987 ACR criteria for SLE were included

Results: 83 patients were diagnosed SLE, 39 fulfilling ACR criteria were analyzed: 36 female; mean age 39.2 ± 10.2 (19 – 59) years at the time of diagnosis. Dermatological (n= 25), musculoskeletal (n=23) and renal involvements (n = 7) were the main presenting complains. Clinical features in the course of disease included: musculoskeletal (n=39); hematologic (n=25); skin (n=22); renal (n=12); cardiac (n=16); neuropsychiatric (n=8); Constitutional symptoms included fever (n =20), fatigue (n = 20), weight loss (n = 12), and anorexia (n = 11). Raised erythrocyte sedimentation rate (n=35); positive anti nuclear antibodies (n= 31) urinalysis abnormalities (n=16)

All patients received corticosteroids at some stage of the disease. Antimalarial were administered to 27 patients.12 patients with lupus nephritis received Intravenous cyclophosphamide. Improvement was noted in 27 patients. Severe complications included chronic kidney disease (n=3); encephalitis (n=3); infection (n=2). There were 2 deaths, from neurologic involvement and from dialysis-related sepsis

Conclusion: Clinical presentation of SLE in Cameroon is similar to data available from other sub-Saharan Africa countries, but complications and mortality rates appear to be lower than previously described. Multicentric prospective studies are needed to better appreciate epidemiology and severity of SLE in sub-Saharan Africa


 

ABSTRACT

Background: Le Lupus érythémateux systémique (LES) est décrit comme rare en Afrique subsaharienne

But: Décrire le mode de présentation, les caractéristiques clinique et biologique du LES à l’Hôpital Général de Douala, Cameroun

Patients et méthodes: Une étude retrospective a été menée sur les dossiers de patients suivis pour LES de 1999 à 2009. Etaient inclus ceux remplissant les critères de l’American College of Rheumatology (ACR) du LES. Les données démographiques, cliniques, biologiques et les traitements utilisés ont été analysés

Résultats: 83 patients portaient le diagnostic de LES, 39 remplissaient les critères ACR; 36 étaient des femmes. L’âge moyen au moment du diagnostic était de 39.2 ± 10.2 (19 – 59) ans. Le mode de présentation était dermatologique (n= 25), musculosquelettique (n=23) et rénal (n=7). Les manifestations cliniques relevées au cours de l’évolution étaient: fièvre (n =20), fatigue (n = 20), amaigrissement (n = 12), anorexie (n = 11); arthralgies (n=25); dermatologiques (n=22); serites (n=21); neuropsychiatriques (n=8). Parmi les anomalies biologiques: une vitesse de sedimentation élevée (n=35); anémie (n= 18); leucopénie (n= 14 ;  proteinurie (n= 11), facteur antinucléaire positif (n= 31) anomalies du sediment urinaire (n=16)

Les traitements reçus comportaient: corticothérapie chez tous les patients, antimalariques (n= 27); Cyclophosphamide (n=12) chez patients avec nephropathie lupique. Les complications sévères recencées: maladie rénale chronique (n=3); encéphalite (n=3) et infection (n=2). Deux décès étaient enregistrés (septicemie chez patient hemodialysé et état de mal convulsif)

Conclusion: La présentation clinique du LES est similaire aux données de la littérature, cependant les complications sévères et la mortalité semblent moins fréquentes


Keywords


systemic lupus; epidemiology; complications; Africa

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