Frequency and Pattern of Shoulder Pain Syndrome in a Nigerian Tertiary Hospital.

BACKGROUND: Shoulder pain syndrome (SPS) is a chronic condition affecting the shoulder joint, its periarticular structures, or less commonly, radicular pain typically from the neck. OBJECTIVES: The objectives of this study were to assess the frequency and pattern of shoulder pain syndrome in OAUTHC, Ile-Ife. METHODOLOGY: This was a descriptive study in which 50 patients with shoulder pain were recruited from the medical and general outpatient departments of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife over six months out of 350 patients with various musculoskeletal complaints. Detailed history, physical examinations and laboratory tests were done. Plain radiographs were taken for all the patients. Ethical approval was obtained and data analyzed using SPSS version 20.0. RESULTS: The frequency of shoulder pain was 14.3%. Eighteen were males and 32 were females with a M: F ratio of 1:1.7. The mean age for all the patients was 59.74years (±10.64) with patients in the age range 50-59years accounting for the highest proportion (38%). The most common cause of shoulder pain syndrome was rotator cuff tendinopathy accounting for 72% of cases. Diabetes was the most frequent comorbidity and was found in 50% of patients. CONCLUSION: Shoulder pain predominantly occurs in females with people in the fifth decade mostly affected. The most frequent cause of shoulder pain syndrome in this environment is rotator cuff disorder. Diabetes mellitus is an important comorbidity associated with shoulder pain. Therefore, management of shoulder pain should include assessment for risk factors.

CONTEXTE: Le syndrome douloureux de l'épaule (SPS) est une affection chronique qui touche l'articulation de l'épaule, ses structures périarticulaires ou, plus rarement, une douleur radiculaire provenant généralement du cou. OBJECTIFS: Les objectifs de cette étude étaient d'évaluer la fréquence et les caractéristiques du syndrome douloureux de l'épaule à l'OAUTHC, Ile-Ife. MÉTHODOLOGIES: il s'agit d'une étude descriptive dans laquelle 50 patients souffrant de douleurs à l'épaule ont été recrutés dans les services de consultation médicale et générale du complexe hospitalier universitaire Obafemi Awolowo (OAUTHC), à Ile-Ife, sur une période de six mois, parmi 350 patients souffrant de diverses affections musculo-squelettiques. Des antécédents détaillés, des examens physiques et des tests de laboratoire ont été effectués. Des radiographies simples ont été prises pour tous les patients. L'approbation éthique a été obtenue et les données ont été analysées à l'aide de la version 20.0 de SPSS. RÉSULTATS: La fréquence de la douleur à l'épaule était de 14,3 %. Dix-huit patients étaient des hommes et 32 des femmes, soit un rapport M/F de 1/1,7. L'âge moyen de tous les patients était de 59,74 ans (±10.64), les patients âgés de 50 à 59 ans représentant la proportion la plus élevée (38 %). La cause la plus fréquente du syndrome douloureux de l'épaule était la tendinopathie de la coiffe des rotateurs, qui représentait 72 % des cas. Le diabète est la comorbidité la plus fréquente et concerne 50 % des patients. CONCLUSION: Les douleurs à l'épaule touchent principalement les femmes et les personnes de la cinquième décennie sont les plus touchées. La cause la plus fréquente du syndrome douloureux de l'épaule dans cet environnement est le trouble de la coiffe des rotateurs. Le diabète sucré est une comorbidité importante associée à la douleur à l'épaule. Par conséquent, la prise en charge de la douleur à l'épaule devrait inclure l'évaluation des facteurs de risque. Mots-clés: Modèle, Facteurs de risque, Douleur à l'épaule, Soins de santé tertiaires, Troubles musculo-squelettiques.

Comparative histopathological analyses of non-scarring alopecia in systemic lupus erythematosus patients in Lagos Nigeria.

Background: Systemic lupus erythematosus (SLE) is known to cause non-scarring alopecia. However, histopathological evaluation is uncommon. Aim: The objective of this study was to document the histopathology of non-scarring alopecia and to compare histopathology of alopecic and normal appearing scalp areas in SLE hair loss patients. Patients and Methods: A cross-sectional comparative evaluation of scalp biopsies from 23 SLE patients; 12 with hair loss and 11 without was conducted over a 7-month period in 2020. A total of 58 scalp biopsies stained with H and E (23 vertical and 35 cross-sectional) were evaluated. Mucin deposit evaluation was done using Alcian blue (pH 2.5). Results: There were no significant differences in the sociodemographic data between the patients. The SLE hair loss patients demonstrated mucin deposition (91.7%), reduced size/number of sebaceous glands (58.3%), epidermal atrophy (50.0%), naked arrector pili muscles (50.0%), lymphocytic infiltration (33.3%), pigment incontinence (16.7%), fibrous stellae (16.7%), increased telogen percentage, and increased terminal versus vellus hair ratios. On comparing the histopathology of those who had hair loss to those without hair loss, the only significant difference was in the number and size of sebaceous gland. There were no significant differences between scalp areas with and without hair loss in the SLE hair loss patients. Conclusion: There are differences in size and number of sebaceous glands on histopathology between SLE patients who have hair loss and those who do not. Also, there are no histopathological differences between alopecic and non-alopecic scalp areas of SLE patient.

Takayasu's Arteritis Presenting Atypically in a Female Nigerian.

Takayasu's arteritis (TA) is an idiopathic form of large vessel granulomatous vasculitis that mainly affects the aorta and its major branches, most frequently in young women under 50 years. While traditionally, it is a disease found commonly in Asia continent, it has also been reported from different parts of the world, albeit with a few reports from Sub-Sahara Africa. The clinical presentations are variable and are commonly from systemic inflammation, vascular occlusive diseases and aneurysm. Asymptomatic cases of TA have been documented and are usually discovered incidentally on physical examination. Common vascular symptoms from different series include vascular claudication, reduced or absent pulse, carotid bruit, hypertension and headache. Facial mononeuropathy and retinal ischaemic changes are rare findings in TA. However, occlusive disease of ulnar artery has not been reported in TA despite our extensive literature search. Here, we present a 48-year-old woman, who was admitted via the medical emergency with community acquired pneumonia but was incidentally diagnosed with Takayasu arteritis with lower motor neuron facial nerve palsy, unilateral blindness, and ulnar artery occlusion. Multidisciplinary management was instituted and patient was discharged after resolution of community acquired pneumonia, vascular claudication, and chronic headache. TA often presents asymptomatically and sometimes with atypical features and thus we suggest high index of suspicion and detailed cardio-vascular examination in young individuals with unexplained chronic headache, facial nerve palsy and visual symptoms.

Spectrum of musculoskeletal disorders in Nigerians with types 2 diabetes mellitus: prevalence and predictors.

Musculoskeletal (MSK) conditions are more frequently found among patients with diabetes mellitus (DM) than in the non-diabetics. Despite several reports outside Africa, they have been under-studied among Africans. This study aimed to assess the overall prevalence and predictors of MSK conditions in Nigerian with types 2 diabetes mellitus (T2DM). A total of 268 adult with T2DM and 268 non-diabetic controls were recruited. All study subjects had their socio-demographics and clinical parameters obtained using interviewer-administered questionnaire. Musculoskeletal conditions among study subjects were classified using validated criteria and case definitions. Musculoskeletal disorders (MSKD) were significantly more frequent amongst subjects with DM (56% vs 22%, OR=4.5 p=0.001). Osteoarthritis (9.3% vs 4.1%, p=0.016), lumbosacral spondylosis (5.6% vs 2.2%, p=0.045), limited joint mobility (13.8% vs 5.6%, p-0.001), adhesive capsulitis (4.5% vs 1.5%, p-0.042) and rotator cuff tendinitis (3.7% vs 0.4%, p=0.006) were more frequent in DM subjects than in controls. Logistic regression showed that age (OR=2.1, CI=1.5-2.6) and waist circumference (OR=3.0, CI=2.6- 3.4) are independent predictors of MSKD among patients with diabetes. This study found higher prevalence of MSKD among diabetic subjects. It also identified certain factors associated with MSKD among patients with diabetes mellitus.

Nephritis as an initial diagnosis of lupus in Nigerian patients.

BACKGROUND: Systemic Lupus Erythematosus (SLE) is a multi-systemic autoimmune disease. Renal involvement is a common complication, causing considerable mortality and morbidity. SLE is rarely reported among black Africans, though recent reports from Nigeria indicate otherwise. Nephritis, though a common complication of SLE has rarely been reported as the initial diagnosis of lupus among black Africans. AIMS: The aim of our study is to highlight the clinical, laboratory and histological features in Nigerian patients presenting with features of nephritis and subsequent diagnosis of SLE. METHODS: This is a three year prospective study of patients with renal diseases, who were admitted to the rheumatology and nephrology units of the Lagos State University Teaching Hospital (LASUTH) Ikeja. Serology, biochemical, haematologic tests, kidney biopsy were done. RESULTS: Twelve patients were studied (F11; M1); mean age 30.4 years (SD ± 9.8); mean illness 8 weeks (SD ± 6.6). Six patients had a nephritic condition. Nine of the patients had baseline hypertension while 3 had a rapidly progressive nephritis. Two patients had baseline End Stage Renal Disease (ESRD). All had dipstick proteinuria 2+/3+, mean protein creatinine ratio 2.2 (SD ± 0.6), mean 24hr protein 2.8 gm (SD ± 2.7); more than 10 red blood cells/hpf haematuria (n-6), hyaline casts (n-5), granular casts (n-2), mean GFR 31.4 ml/ min (SD ± 21.3.), mean serum creatinine 6.9 mg/dl (SD ± 5.3); mean urea 138.8 mg/dl (SD ± 56.2). For the serology, Anti Nuclear Antibody (ANA) was positive in all the 12 subjects; positive anti dsDNA -10 patients; ENA - 10. Renal biopsy showed mostly WHO/ISSN classes III, IV and V. Treatment was with Euro Lupus regimen and rituximab/ cyclophosphamide. Four patients had dialysis. In terms of the outcome, there were 3 deaths while 9 patients were discharged. CONCLUSION: A high index of suspicion is needed to diagnose Lupus Nephritis in black Africans especially when their presentations do not fulfil the America College of Rheumatology (ACR) diagnostic criteria for SLE.

Inflammatory myopathies in Nigerians: case series and literature review.

BACKGROUND: Idiopathic Inflammatory myopathies (IIM) are rare connective tissue diseases and have been rarely reported among Nigerians: OBJECTIVE: To study the clinical, laboratory and electromyographic characteristics of Nigerian patients with polymyositis and dermatomyositis. METHOD: In a retrospective study, patients attending a private practice rheumatology clinic in Lagos and fulfilling the Bohan and Peter's criteria for polymyositis and dermatomyositis were examined and common causes of proximal muscle weakness were excluded. Haematological, biochemical, serological and electromyographic studies were carried out. Patients were treated with standard drugs. RESULTS: Fourteen patients (F-13, M-1) were diagnosed with Polymyositis (PM) and Dermatomyositis (DM). Seven had probable PM, 4 with possible PM and 3 with probable DM. Mean age was 35 years (range 22-54) ESR was markedly raised mean 105/min (26-150). Muscle and liver enzymes were raised in all patients. Creatinine kinase median 1134 (29-10,166); lactic dehydrogenase median 477 (209-787); ALT 43 (19-233); AST 136 (25-725). Serology for ANF was positive in eight patients; Anti Jo1 in 1 out of 9 while Anti Mi2 was negative in all tested. EMG in 6 tested showed myopathic pattern. CONCLUSION: Inflammatory myopathies are rare among Nigerians but a heightened awareness is needed for diagnosis and management.