ABSTRACT
Background: Juvenile idiopathic arthritis is the most common rheumatic disease in children. Compared to Western countries, very few studies have been devoted to this disease in black sub-Saharan Africa. The aim is to describe the epidemiological, clinical, paraclinical and therapeutic features of juvenile idiopathic arthritis observed in Abidjan and identify the clinical forms. Methodology: This descriptive retrospective study covered 17 children (11 girls and 6 boys, age range: 3-15 years) suffering from juvenile idiopathic arthritis which met the Durban criteria of 1997 revised in Edmonton in 2001. The children have been selected in the rheumatology department of University Hospital Center of Cocody in Abidjan from January 2005 to December 2013. We were interested to sociodemographic, clinical, biological, radiological and therapeutic parameters. Results: The frequency of juvenile idiopathic arthritis was 0.03% that was 17 children among the 4608 rheumatic diseases identified during the study period. The number of patients was dominated by females (64.7%) and the average age at the time of diagnosis was 11 years. The average delay at the time of diagnosis was 15 months. The main complaints of patients were fever, joint involvement and impaired general condition observed each in 12 cases. It was noted the presence of radiographic erosions in 4 cases and 1 case of coxitis on Computer tomography scan. The clinical forms identified were systemic form (12 cases), oligoarticular form (1 case), polyarticular form with positive rheumatoid factors (3 cases), enthesitis-related arthritis (1 case). The vast majority of our patients (15 of 17) was treated with the combination therapy corticosteroid and methotrexate. Conclusion: Juvenile idiopathic arthritis appears very uncommon and affects female children. It is expressed by febrile arthritis with an impaired general condition and is dominated by the systemic form.
ABSTRACT
Background: The research of soft tissue abscesses in spinal tuberculosis is important and can help in the diagnosis of certainty. These abscesses also have a prognostic and therapeutic interest. The aim of this study is to determine the frequency, topography and the therapeutic means of the abscesses of soft tissue in spinal tuberculosis. Methodology: This descriptive retrospective study covered 311 cases of patients (167 men and 144 women, age range 4-88 years) with soft tissue abscesses on spinal tuberculosis, detected by imaging. The patients have been selected in the rheumatology department of the University Hospital Center of Cocody in Abidjan from January 2003 to December 2013. We were interested to epidemiological, topographical and therapeutic data. Fishers exact test was used to test the significance of association between different variables. Level of significance was set at 0.05. Results: The prevalence of abscesses was 72.8% that was 311 cases among these 427 records of spinal tuberculosis collected during the study period. The total number of patients was dominated by men (53.6%) and the average age was 43.1 years. Computed tomography scan was the main diagnostic imaging (97.7%). The topography of soft tissue abscesses was: subcutaneous area (1.2%), paraspinal muscles (95.1%), retro-pharyngeal area (10.6%) and epidural area (19.6%). Osteoarticular lesions associated with abscesses were: Spondylodiscitis (96.1%), spondylitis (2.8%) and zygapophyseal arthritis and osteitis (4.5%). The majority of patients had tuberculosis treatment lasting 12 months: 2 months of the combination Rifampicin-Isoniazid-Pyrazinamide-Ethambutol following by 10 months of Rifampicin-isoniazid. The outcome was favorable marked by the resorption of abscesses and the healing of patients. Conclusion: The soft tissue abscesses are common in spinal tuberculosis in Abidjan. They mostly sit at the paraspinal muscles. Their treatment involves corticosteroid-associated with tuberculosis treatment.