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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
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References
- References
- D’Cruz DP, Khamashta MA, Hughes GRV. Systemic lupus erythematosus. Lancet. 2007;369:587-96.
- Pons-Estel GJ, Alarcón GS, Scofield L, Reinlib L, Cooper GS. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum. 2010;39:257-68.
- Molokhia M, McKeigue PM, Cuadrado M, Hughes G. Systemic lupus erythematosus in migrants from west Africa compared with Afro-Caribbean people in the UK. Lancet. 2001;357:1414-5.
- Molokhia M, Hoggart C, Patrick AL, Shriver M, Parra E, Ye J, Silman AJ, McKeigue PM. Relation of risk of systemic lupus erythematosus to west African admixture in a Caribbean population. Hum Genet. 2003;112:310-8.
- Jacyk WK, Steenkamp KJ. Systemic lupus erythematosus in South African blacks: prospective study. Int J Dermatol. 1996;35:707-10.
- Adelowo OO, Oguntona SA. Pattern of systemic lupus erythematosus among Nigerians. Clin Rheumatol. 2009;28:699-703.
- Basset A, Hocquet P, Sow AM, Richir CL. A propos d’un cas de lupus érythémateux disséminé. Bull Soc Med Afr Noire Langue Française. 1960;5:172-5.
- Ka MM, Diallo S, Kane A, Wade B, Diouf B, Diallo A, Moreira-Diop T. Systemic lupus erythematosus and lupus syndromes in Senegal. A retrospective study of 30 patients seen over 10 years. Rev Rhum Engl Ed. 1998;65:471-6.
- Ndiaye FS, Ka MM, Fall S, Dioum A, Pouye A, Moreira-Diop T. Hematologic and immunologic signs of lupus: the experience of the hospital of Dakar. Sante. 2011;21:143-8.
- Fall S, Pouye A, Ndiaye FS, Ndongo S, Leye Y, Dioum A, Dieng MT, Ka EF, Ka MM, Moreira-Diop T. Présentation initiale du lupus érythémateux systémique au Sénégal. Med Afr Noire. 2011;58:156-60.
- Seedat YK, Pudifin D. Systemic lupus erythematosus in Black and Indian patients in Natal. S Afr Med. 1977;51:335-7.
- Tikly M, Burgin S, Mohanlal P, Bellingaw A, George J. Auto-antibodies in black South Africans with systemic lupus erythematosus: spectrum and clinical associations. Clin Rheumatol. 1996;15:261-5.
- Youmbissi TJ, Emole-Ngondi D, Mpoudi-Ngolle E, Mbakop A. Profil clinico-pathologique du lupus éythémateux disséminé chez un groupe de malades noirs Africains à Yaoundé. Sem Hôp Paris. 1996;72:826-27.
- Ngandeu MS, Ndobo P, Gabay C. Non infectious lupus pericarditis: a retrospective hospital-based observation in Yaoundé-Cameroon. Clin Rheumatol. 2009;28:465-8.
- Taylor HG, Stein CM. Systemic lupus erythematosus in Zimbabwe. Ann Rheum Dis. 1986;45:645-8.
- Dessein PH, Gledhill RF, Rossouw DS. Systemic lupus erythematosus in black South Africans. S Afr Med J. 1988;74:387-9.
- Mody GM, Parag KB, Nathoo BC, Pudifin DJ, Duursma J, Seedat YK. High mortality with systemic lupus erythematosus in hospitalized African blacks. Br J Rheumatol. 1994;33:1151-3.
- Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.
- Alarcón GS, Friedman AW, Straaton KV, Moulds JM, Lisse J, Bastian HM, et al. Systemic lupus erythematosus in three ethnic groups: III A comparison of characteristics early in the natural history of the LUMINA cohort. Lupus. 1998;8:197-209.
- Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore). 2003;82:299-308.
- Moody GM, Brooks PM. Improving musculoskeletal heath: Global issues. Best Practice & Research Clinical Rheumatology 2012; 26: 237-249.
- Louzir B, Othmani S, Ben Abdelhafidh N, et al. Le lupus érythémateux systémique en Tunisie. Etude multicentrique nationale. Apropos de 295 observations. Rev Med Int 2003; 24(12):768-774
References
References
D’Cruz DP, Khamashta MA, Hughes GRV. Systemic lupus erythematosus. Lancet. 2007;369:587-96.
Pons-Estel GJ, Alarcón GS, Scofield L, Reinlib L, Cooper GS. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum. 2010;39:257-68.
Molokhia M, McKeigue PM, Cuadrado M, Hughes G. Systemic lupus erythematosus in migrants from west Africa compared with Afro-Caribbean people in the UK. Lancet. 2001;357:1414-5.
Molokhia M, Hoggart C, Patrick AL, Shriver M, Parra E, Ye J, Silman AJ, McKeigue PM. Relation of risk of systemic lupus erythematosus to west African admixture in a Caribbean population. Hum Genet. 2003;112:310-8.
Jacyk WK, Steenkamp KJ. Systemic lupus erythematosus in South African blacks: prospective study. Int J Dermatol. 1996;35:707-10.
Adelowo OO, Oguntona SA. Pattern of systemic lupus erythematosus among Nigerians. Clin Rheumatol. 2009;28:699-703.
Basset A, Hocquet P, Sow AM, Richir CL. A propos d’un cas de lupus érythémateux disséminé. Bull Soc Med Afr Noire Langue Française. 1960;5:172-5.
Ka MM, Diallo S, Kane A, Wade B, Diouf B, Diallo A, Moreira-Diop T. Systemic lupus erythematosus and lupus syndromes in Senegal. A retrospective study of 30 patients seen over 10 years. Rev Rhum Engl Ed. 1998;65:471-6.
Ndiaye FS, Ka MM, Fall S, Dioum A, Pouye A, Moreira-Diop T. Hematologic and immunologic signs of lupus: the experience of the hospital of Dakar. Sante. 2011;21:143-8.
Fall S, Pouye A, Ndiaye FS, Ndongo S, Leye Y, Dioum A, Dieng MT, Ka EF, Ka MM, Moreira-Diop T. Présentation initiale du lupus érythémateux systémique au Sénégal. Med Afr Noire. 2011;58:156-60.
Seedat YK, Pudifin D. Systemic lupus erythematosus in Black and Indian patients in Natal. S Afr Med. 1977;51:335-7.
Tikly M, Burgin S, Mohanlal P, Bellingaw A, George J. Auto-antibodies in black South Africans with systemic lupus erythematosus: spectrum and clinical associations. Clin Rheumatol. 1996;15:261-5.
Youmbissi TJ, Emole-Ngondi D, Mpoudi-Ngolle E, Mbakop A. Profil clinico-pathologique du lupus éythémateux disséminé chez un groupe de malades noirs Africains à Yaoundé. Sem Hôp Paris. 1996;72:826-27.
Ngandeu MS, Ndobo P, Gabay C. Non infectious lupus pericarditis: a retrospective hospital-based observation in Yaoundé-Cameroon. Clin Rheumatol. 2009;28:465-8.
Taylor HG, Stein CM. Systemic lupus erythematosus in Zimbabwe. Ann Rheum Dis. 1986;45:645-8.
Dessein PH, Gledhill RF, Rossouw DS. Systemic lupus erythematosus in black South Africans. S Afr Med J. 1988;74:387-9.
Mody GM, Parag KB, Nathoo BC, Pudifin DJ, Duursma J, Seedat YK. High mortality with systemic lupus erythematosus in hospitalized African blacks. Br J Rheumatol. 1994;33:1151-3.
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.
Alarcón GS, Friedman AW, Straaton KV, Moulds JM, Lisse J, Bastian HM, et al. Systemic lupus erythematosus in three ethnic groups: III A comparison of characteristics early in the natural history of the LUMINA cohort. Lupus. 1998;8:197-209.
Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore). 2003;82:299-308.
Moody GM, Brooks PM. Improving musculoskeletal heath: Global issues. Best Practice & Research Clinical Rheumatology 2012; 26: 237-249.
Louzir B, Othmani S, Ben Abdelhafidh N, et al. Le lupus érythémateux systémique en Tunisie. Etude multicentrique nationale. Apropos de 295 observations. Rev Med Int 2003; 24(12):768-774