Spectrum of paediatric rheumatic disorders at a tertiary hospital in Tanzania

Abstract

Background: Paediatric rheumatic disorders are common in children and result in significant impairment in quality of life, morbidity and mortality. There is limited information on the burden of these disorders in lower income countries especially in sub-Saharan Africa. Few case reports have documented presence of paediatric rheumatic disorders in Tanzania. This study was conducted to determine the spectrum of rheumatic disorders among children at Muhimbili National Hospital (MNH). Methods: This was a retrospective study conducted among children who were attended at MNH between January 2012 and August 2019. Paediatric patients seen in the outpatient clinics and those admitted in the wards were eligible. All patients with diagnosis of rheumatic disorders were identified from admission books and outpatient clinic logbooks, and later data were collected from their case notes and were recorded in clinical research forms. Collected information included age, sex, clinical features and laboratory tests results. Results: A total of 52 children with mean age of 9.5 ± 4.3 years, 12 (40.4%) participants were aged above 10 years and 32 (61.5%) were females. Frequently reported clinical presentations were joint pain 44 (84.6%), joint swelling 34 (65.4%), fever 24 (46.2%) and skin rashes 21(40.4%). Juvenile idiopathic arthritis (JIA) was the predominant diagnosis reported in 28 (53.8%) participants followed by juvenile systemic lupus erythematosus 8 (15.4%), mixed connective tissue diseases 4 (7.7%) and juvenile dermatomyositis 4 (7.7%). Antinuclear antibody test was performed in 16 participants it was positive in 9 (56.2%). Nine participants were tested for anti-double stranded DNA test and 5 (55.6%) were positive for this test. C-reactive protein was tested in 46 participants out of which 32 (69.6%) had elevated levels. HIV was tested in 24 (46.2%) participants and results were negative. Thirty-five out of 52 (67.3%) participants had anaemia. Predominant drugs used for treatment of JIA include prednisolone and methotrexate. Conclusions: Paediatric rheumatic disorders are not uncommon in Tanzania-and were noted to affect more female children in this study. Predominant conditions included juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM).

Epidemiology of Idiopathic Inflammatory Myopathies in Africa

“…Juvenile DM was reported in 8 studies 17,22,32,36,39,48,50,51 (Supplementary Table S6, http://links.lww.com/RHU/A286). The frequency of JDM was reported to be 5.8% in the largest series, which was a cross-sectional study involving 104 patients of different age groups with the entire spectrum of IIMs reported in this review, 51 and 9% in a retrospective cross-sectional study from Kenya including 46 patients of wide age range with IIMs 48…”

“…Autoantibodies were recorded in 13 studies 20,25,26,29,30,32,33,36,41,45,48,50,51 (Supplementary Table S11, http://links.lww.com/RHU/A286). The frequency of positive serum anti-Jo1/histidyl-tRNA synthetase antibodies varied between 0 (of 6 patients tested) in the aforementioned study on JDM from South Africa 36 and 100% (of 2 patients tested) in the study from Senegal involving 21 subjects 26 .…”

“…The frequency of joint involvement (defined by the presence of arthralgia with or without synovitis) ranged from 28% in the aforementioned study on JDM from South Africa 36 to 100% in the ASS case series. 41 Autoantibodies were recorded in 13 studies 20,25,26,29,30,32,33,36,41,45,48,50,51 (Supplementary Table S11, http://links.lww.com/ RHU/A286). The frequency of positive serum anti-Jo1/histidyl-tRNA synthetase antibodies varied between 0 (of 6 patients tested) in the aforementioned study on JDM from South Africa 36 and 100% (of 2 patients tested) in the study from Senegal involving 21 subjects.…”

Epidemiology of Sjögren Syndrome in Africa

“…Fourteen studies reported the frequency of SS across autoimmune and other rheumatic conditions (Supplementary Table S7, http://links.lww.com/RHU/A253). 12,15,16,[18][19][20][21][24][25][26][27][29][30][31] The frequency of pSS ranged from 1.8% in a cross-sectional study from Morocco reporting data of 944 subjects with diverse autoimmune diseases recruited between 2010 and 2016, 29 to 47.6% in a cross-sectional study from Senegal reporting data of 27 subjects with systemic vasculitides recruited during 1995-2007. 16 Regarding sSS, the frequency in patients with RA ranged from 4.3% in a cross-sectional study conducted in Morocco during 2007-2011 and including 164 patients, 20 to 100% in the aforementioned study from Senegal, which included only 4 RA patients.…”

Pulmonary Involvement at Connective Tissue Systemic Diseases in Children

“…Вместе с тем в структуре госпитализированных в специализированные ревматологические стационары больные с СЗСТ составляют от 10 до 33%, в первую очередь по причине более агрессивного течения болезни, обусловленного чаще всего поражением жизненно важных органов, в т.ч. и органов дыхания [8][9][10].…”