Childhood-onset rheumatoid arthritis at a tertiary hospital in Senegal, West Africa.
Childhood-onset
Disease activity
Functional disability
Rheumatoid arthritis
Senegal
Journal
Pediatric rheumatology online journal
ISSN: 1546-0096
Titre abrégé: Pediatr Rheumatol Online J
Pays: England
ID NLM: 101248897
Informations de publication
Date de publication:
12 Sep 2023
12 Sep 2023
Historique:
received:
12
06
2023
accepted:
31
08
2023
medline:
14
9
2023
pubmed:
13
9
2023
entrez:
12
9
2023
Statut:
epublish
Résumé
Childhood-onset rheumatoid arthritis (CORA), known as rheumatoid factor (RF)-positive juvenile idiopathic arthritis is a type of juvenile idiopathic arthritis that shares the same genetic factors and clinical features as adult-onset rheumatoid arthritis. In Africa, CORA hasn't been the subject of a specific study. The aim of this study is to describe the clinical features, disease activity, functional disability, and treatment of CORA at diagnosis in Senegal and compare the findings to other CORA populations. We conducted a mixed cohort study by reviewing the medical records of patients diagnosed with CORA with an age of symptom onset < 18 years according to the 2019 PRINTO provisional criteria for RF-positive JIA from January 2020 to December 2022 at rheumatology department of Aristide Le Dantec Hospital in Dakar, Senegal. We collected demographic, clinical, paraclinical and therapeutic data. Disease activity score was assessed by DAS28-ESR and DAS28-CRP. Functional disability was assessed using Health Assessment Questionnaire (HAQ) or Childhood HAQ. A total of 21 patients were included. Eighteen (85.7%) were Females. The mean age at symptom onset was 13.0 ± 3.0 years, and at diagnosis was 16.4 ± 4.2 years. Morning stiffness, joint swelling, and joint deformities were found in 20, 18 and 13 patients respectively. Four patients had a family history of rheumatoid arthritis. Five patients had extra-articular involvement such as rheumatoid nodules. Two patients had interstitial lung disease. The biological inflammatory syndrome was found in 90% of cases. 16 of 21 (76.2%) patients had positive RF, and 18 of 20 (90%) patients had positive Anti-CCP. Seven of 12 (58.3%) patients had positive anti-nuclear antibodies. The mean DAS28-ESR was 5.7 ± 1.0. Fifteen (71.4%) patients had high disease activity (DAS28-ESR > 5.1). The mean DAS28-CRP was 5.4 ± 1.1. The median HAQ was 2.12 with a mean HAQ of 1.9. Nineteen (90.5%) patients were treated with methotrexate, while 17 (81%) had a combination of methotrexate and hydroxychloroquine. Oral prednisone was used in 17 (81%) cases. Non-steroidal anti-inflammatory drugs were used in 4 cases (19%). After 6 months of treatment, mean DAS28-CRP was 2.9. In our study, CORA mainly affects 13-year-old girls, characterised by high disease activity with joint deformity and significant functional impairment. Treatment is mainly based on methotrexate, prednisone and hydroxychloroquine. Further studies are needed to determine the exact clinical phenotype of this disease.
Sections du résumé
BACKGROUND
BACKGROUND
Childhood-onset rheumatoid arthritis (CORA), known as rheumatoid factor (RF)-positive juvenile idiopathic arthritis is a type of juvenile idiopathic arthritis that shares the same genetic factors and clinical features as adult-onset rheumatoid arthritis. In Africa, CORA hasn't been the subject of a specific study.
OBJECTIVES
OBJECTIVE
The aim of this study is to describe the clinical features, disease activity, functional disability, and treatment of CORA at diagnosis in Senegal and compare the findings to other CORA populations.
METHODS
METHODS
We conducted a mixed cohort study by reviewing the medical records of patients diagnosed with CORA with an age of symptom onset < 18 years according to the 2019 PRINTO provisional criteria for RF-positive JIA from January 2020 to December 2022 at rheumatology department of Aristide Le Dantec Hospital in Dakar, Senegal. We collected demographic, clinical, paraclinical and therapeutic data. Disease activity score was assessed by DAS28-ESR and DAS28-CRP. Functional disability was assessed using Health Assessment Questionnaire (HAQ) or Childhood HAQ.
RESULTS
RESULTS
A total of 21 patients were included. Eighteen (85.7%) were Females. The mean age at symptom onset was 13.0 ± 3.0 years, and at diagnosis was 16.4 ± 4.2 years. Morning stiffness, joint swelling, and joint deformities were found in 20, 18 and 13 patients respectively. Four patients had a family history of rheumatoid arthritis. Five patients had extra-articular involvement such as rheumatoid nodules. Two patients had interstitial lung disease. The biological inflammatory syndrome was found in 90% of cases. 16 of 21 (76.2%) patients had positive RF, and 18 of 20 (90%) patients had positive Anti-CCP. Seven of 12 (58.3%) patients had positive anti-nuclear antibodies. The mean DAS28-ESR was 5.7 ± 1.0. Fifteen (71.4%) patients had high disease activity (DAS28-ESR > 5.1). The mean DAS28-CRP was 5.4 ± 1.1. The median HAQ was 2.12 with a mean HAQ of 1.9. Nineteen (90.5%) patients were treated with methotrexate, while 17 (81%) had a combination of methotrexate and hydroxychloroquine. Oral prednisone was used in 17 (81%) cases. Non-steroidal anti-inflammatory drugs were used in 4 cases (19%). After 6 months of treatment, mean DAS28-CRP was 2.9.
CONCLUSION
CONCLUSIONS
In our study, CORA mainly affects 13-year-old girls, characterised by high disease activity with joint deformity and significant functional impairment. Treatment is mainly based on methotrexate, prednisone and hydroxychloroquine. Further studies are needed to determine the exact clinical phenotype of this disease.
Identifiants
pubmed: 37700346
doi: 10.1186/s12969-023-00889-6
pii: 10.1186/s12969-023-00889-6
pmc: PMC10496368
doi:
Substances chimiques
Methotrexate
YL5FZ2Y5U1
Hydroxychloroquine
4QWG6N8QKH
Prednisone
VB0R961HZT
Rheumatoid Factor
9009-79-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
98Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Littlejohn EA, Monrad SU. Early diagnosis and treatment of rheumatoid arthritis. Prim Care Clin off Pract. 2018;45(2):237–55.
doi: 10.1016/j.pop.2018.02.010
Yazici Y, Paget SA. ELDERLY-ONSET RHEUMATOIDARTHRITIS. Rheum Dis Clin N Am. 2000;26(3):517–26.
Mody GM, Meyers OL. Rheumatoid arthritis in blacks in South Africa. Ann Rheum Dis. 1989;48(1):69–72.
Greenwood BM. Polyarthritis in Western Nigeria. I. Rheumatoid arthritis. Ann Rheum Dis. 1969;28(5):488–96.
doi: 10.1136/ard.28.5.488
pubmed: 4186678
pmcid: 1031236
Niasse M, Kane BS, Ndiaye AA, Ndao AC, Djiba B, Fall S, etal. Severity of the Rheumatoid Arthritis in Sub-Saharan Africa: Study of 403 Senegalese Observations. Open J Intern Med. 2017;07(04):151.
van Venrooij WJ, van Beers JJBC, Pruijn GJM. Anti-CCP antibody, a marker for the early detection of rheumatoid arthritis. Ann N Y Acad Sci. 2008;1143(1):268–85.
doi: 10.1196/annals.1443.013
pubmed: 19076355
Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD, Tanasescu R. Extra-articular manifestations in rheumatoid arthritis. Mædica. 2010;5(4):286–91.
pubmed: 21977172
pmcid: 3152850
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–81.
doi: 10.1002/art.27584
pubmed: 20872595
Madenci E, Gursoy S. Hand deformity in rheumatoid arthritis and its impact on the quality of life. Pain Clin. 2003;15(3):255–9.
Prahalad S, Conneely KN, Jiang Y, Sudman M, Wallace CA, Brown MR, et al. Brief Report: Susceptibility to Childhood-Onset Rheumatoid Arthritis: Investigation of a Weighted Genetic Risk Score That Integrates Cumulative Effects of Variants at Five Genetic Loci. Arthritis Rheum. 2013;65(6):1663–7.
Hinks A, Marion MC, Cobb J, Comeau ME, Sudman M, Ainsworth HC, et al. Brief Report: The Genetic Profile of Rheumatoid Factor–Positive Polyarticular Juvenile Idiopathic Arthritis Resembles That of Adult Rheumatoid Arthritis. Arthritis Rheumatol. 2018;70(6):957–62.
Ndongo S, Lekpa FK, Ka MM, Ndiaye N, Diop TM. Presentation and severity of rheumatoid arthritis at diagnosis in Senegal. Rheumatology. 2009;48(9):1111–3.
Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, Cuttica R, et al. Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus. J Rheumatol. 2019;46(2):190–7.
Weakley K, Esser M, Scott C. Juvenile idiopathic arthritis in two tertiary centres in the Western Cape, South Africa. Pediatr Rheumatol. 2012;10(1):35.
Chipeta J, Njobvu P, Wa-Somwe S, Chintu C, McGill PE, Bucala R. Clinical patterns of juvenile idiopathic arthritis in Zambia. Pediatr Rheumatol. 2013;11(1):33.
Correia ML, Carvalho S, Fortuna J, Pereira MH. Comparison of Three Anti-CCP Antibody Tests and Rheumatoid Factor in RA and Control Patients. Clin Rev Allergy Immunol. 2008;34(1):21–5.
Aggarwal R, Liao K, Nair R, Ringold S, Costenbader KH. Anti-Citrullinated Peptide Antibody (ACPA) Assays and their Role in the Diagnosis of Rheumatoid Arthritis. Arthritis Rheum. 2009;61(11):1472–83.
McCurdy D, Parsa MF. Updates in Juvenile Idiopathic Arthritis. Adv Pediatr. 2021;68:143–70.
doi: 10.1016/j.yapd.2021.05.014
pubmed: 34243850
Kunjir V, Venugopalan A, Chopra A. Profile of indian patients with Juvenile Onset Chronic Inflammatory Joint Disease using the ILAR classification Criteria for JIA: A Community-based Cohort Study. J Rheumatol. 2010;37(8):1756–62.
doi: 10.3899/jrheum.090937
pubmed: 20516021
Martini A, Lovell DJ, Albani S, Brunner HI, Hyrich KL, Thompson SD, et al. Juvenile idiopathic arthritis. Nat Rev Dis Primer. 2022;8(1):1–18.
Condé K, Barry MC, Guelngar CO, Kadidjatou I, Hady M, Diawara K, et al. Profile of Juvenile Idiopathic Arthritis in Guinea. Open J Rheumatol Autoimmune Dis. 2021;11(01):1.
Dieye A, Diallo S, Diatta M, et al. Identification of HLA-DR alleles for susceptibility to rheumatoid polyarthritis in Senegal. Dakar Med. 1997;42:111–13.
pubmed: 9827131
Diallo S, Diallo R, Niasse M, Diaw CB, Diouf C, Ndongo S, et al. Familial forms of rheumatoid arthritis: a study of 17 multiplex families in Senegal. Rhumatol Afr Francoph. 2018;1(2):28–35.
Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A. Rheumatoid arthritis: Extra-articular manifestations and comorbidities. Autoimmun Rev. 2021;20(4):102776.
Dai Y, Wang W, Yu Y, Hu S. Rheumatoid arthritis-associated interstitial lung disease: an overview of epidemiology, pathogenesis and management. Clin Rheumatol. 2021;40(4):1211–20.
Yunt ZX, Solomon JJ. Lung Disease in Rheumatoid Arthritis. Rheum Dis Clin. 2015;41(2):225–36.
Dawson K, Fewins HE, Desmond J, Lynch MP ,Graham DR. Fibrosing alveolitis in patients with rheumatoid arthritis as assessed by high resolution computed tomography, chest radiography, and pulmonary function tests. Thorax. 2001;56(8):622–7.
Vander Cruyssen B, Peene I, Cantaert T, Hoffman IEA, De Rycke L, Veys EM, et al. Anti-citrullinated protein/peptide antibodies (ACPA) in rheumatoid arthritis: specificity and relation with rheumatoid factor. Autoimmun Rev. 2005;4(7):468–74.
doi: 10.1016/j.autrev.2005.04.018
pubmed: 16137613
Shin JI, Kim KH, Chun JK, Lee TJ, Kim KJ, Kim HS, et al. Prevalence and patterns of anti-nuclear antibodies in Korean children with juvenile idiopathic arthritis according to ILAR criteria. Scand J Rheumatol. 2008;37(5):348–51.
Yilmaz M, Kendirli SG, Altıntas DU, Karakoc GB, Inal A, Kılıc M. Juvenile idiopathic arthritis profile in Turkish children. Pediatr Int. 2008;50(2):154–8.
Ramsey SE, Bolaria RK, Cabral DA, Malleson PN, Petty RE. Comparison of criteria for the classification of childhood arthritis. J Rheumatol. 2000;27(5):1283–6.
pubmed: 10813302
Nishimura S, Nishiya K, Hisakawa N, Chikazawa H, Ookubo S, Nakatani K, et al. Positivity for antinuclear antibody in patients with advanced rheumatoid arthritis. Acta Med Okayama. 1996;50(5):261–5.