Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with manifestations ranging from mild to life-threatening organ dysfunction. There is wide variability in the reported incidence and prevalence rate globally, particularly in low and middle-income countries. Nigeria had very few isolated reports of SLE from private and public hospitals Therefore, we conducted this large multi-center descriptive study to determine the sociodemographic, clinical profile, laboratory patterns, and treatment among Nigerian lupus patients. A retrospective hospital-based study of all SLE patients seen over 4 years (January 2017 to December 2020) was conducted at 20 rheumatology clinics spread across the 6 geopolitical zones of Nigeria. All patients 18 years and above satisfying the American College of Rheumatology (ACR) 1997 and/or the Systemic Lupus International Collaboration Clinics (SLICC) 2012 classification criteria for SLE were enrolled. Patients with other Rheumatic and Musculoskeletal Diseases (RMDs) not in keeping with SLE and Patients with incomplete data were excluded. Data was analysed using SPSS version 23.0 software. A total of 896 patients with SLE were included in the final analysis with a mean age ± SD of 34.47 ± 11 and a female to male ratio of 8.1:1. Synovitis was reported by 61.6

Osteoarthritis is the most prevalent articular disease in older adults. Disease markers that will detect early disease and allow early intervention with pharmacologic agents are presently unavailable. This was a hospital based observational prospective study carried out over a period of six months from April 2016 to October 2016. Patients were interviewed and data were recorded on a standardized predesigned and a pretested questionnaire. Measurements of height, weight and body mass index (BMI) were recorded. Patients in the age group 60-80 years who fulfilled the American College of Rheumatology (ACR) clinical criteria were included. Patients below the age of 60 years, patients with inflammatory arthritis, trauma induced pain, systemic illness and mentally impaired were excluded. Two hundred and fifty four patients were seen during the study period. Eighty six patients that met the ACR clinical criteria were studied. Patients in the age group 60 to 70 (67.4%) years dominated the study group. The mean age was 68 ± 7.5 and female to male ratio was 2.6 to 1. The duration of knee pain before presentation was 3 to 16 years with a mean of 9 ± 3 years. Knee osteoarthritis was positively associated with body mass index (p <0.05). Obesity was more common amongst women (67.8%) compared to men (58.3%).. Knee pain and joint crepitus were the leading clinical presentations. The period prevalence of knee osteoarthritis was 33.9%. The prevalence among men was 9.4% while the prevalence among women was 24.4%. Osteoarthritis was common among the elderly people and women were more affected. There was a positive correlate between knee osteoarthritis and the body mass index.

Tel.: +2348035534449 Background: To assess the distribution and prevalence of rheumatic diseases in a tertiary hospital rheumatology outpatient practice. Methods: This was a prospective study of rheumatological diagnoses of 472 consecutive new and follow up patients over a period of three years (Jan 2011Dec 2013). All patients with age 14 years and above whom presented with rheumatology diagnosis were included in the study. Detailed history and physical examination were carried out on all the patients. The disease prevalence was calculated for each group of rheumatological disorders. Results: There were 3124 patients seen at the medical outpatient department of the hospital during the studied period. Four hundred and seventy two rheumatological cases comprising of 162 new cases and 310 follow up cases were seen. Two hundred and nineteen (46.4%) were female. Degenerative arthritis was the leading case (45.8%) while connective tissue disease was the least cases seen (4.9%). Osteoarthritis was the leading case in both new and follow-up cases while rheumatoid arthritis was second among the follow up cases. Osteoarthritis had the highest prevalence (4.35%) among the articular diseases, while non-specific low back pain had the highest prevalence (1.79%) among the soft tissue rheumatic diseases. Conclusion: Degenerative conditions (osteoarthritis and spondylosis) and soft tissue rheumatism were the most common rheumatology diagnoses in new patients, while osteoarthritis and rheumatoid arthritis were most prevalent in followup patients. The predominance of auto-immune diseases in females was as earlier reported in the literatures.

BACKGROUND:Neck pain is a common pain syndrome in the clinical practice. It may or may not be associated with the radiculopathy or myelopathy. Load carrying on the head is believed to be associated with an increased incidence of cervical spondylosis. Radiographic spondylosis is noticeable in 25-50% of people of 50 years of age and in 75-90% by the age of 65 years.MATERIALS AND METHODS:Plain cervical radiograph were obtained in all farmers and female traders above 45 years of age who complained of neck pain. Those who met the radiological diagnostic criteria were enlisted in the study. The study was carried out over a 3 year period (July 2009-June 2012) in a private rheumatology clinic.RESULTS:Thirty six cases of cervical spondylosis were seen, representing 10.7% of a total rheumatology cases seen over the study period. There were 23 males (63.9%) and 13 females (36.1%), giving a male : female ratio of 1.8:1. There were 18 male farmers, 5 female farmers, and 5 female traders. Eight males and 6 females showed severe degenerative changes in the cervical spine. Mostly affected were C4-C7 cervical spine levels.CONCLUSION:Load carrying, as earlier documented in literature may be a significant contributory factor to the degenerative process of the cervical spine.

Plantar fasciitis is a common pathological condition of the foot. It causes heel pain in active as well as sedentary adults of all ages. It is a disorder of degenerative changes in the fascia. The condition is more likely to occur in persons who are obese or in those who are on their feet most of the day. The study populations were those who presented at the rheumatology clinic with heel pain. The study was carried out over three and a half years. 20 patients were seen over three and a half years spanning between July 2009 and December 2012. There were 7 (35 %) men and 13 (65 %) women with a male to female ratio of 1: 1.9. 6 (30 %) patients were obese, 4 (20 %) overweight, and 10 (50 %) were of normal weight. 18 (90%) had one foot affected and 2 (10 %) had both feet affected. Most of our patients benefited from conservative management. Plantar fasciitis is relatively common in the society. Women were more affected in this study, and conservative method of treatment achieved a good result.This result however may not be a good representation of what obtains in the society because it was a hospital based study.

Objective: The study assessed the risk of developing type 2 diabetes Mellitus in Ogun State, Nigeria. Materials and Methods: Finnish Medical Association diabetes risk score was administered across 25 communities facilitated by non-communicable disease clinics established under a World Diabetes Foundation project. Subjects in the high risk group had blood glucose estimated. Results: 58,567 respondents included 34,990 (59.6%) females and 23,667 (40.3%) males. Majority (61.2%) were between 25 years and 54 years. Considering waist circumference, 34,990 (38.1%) females and 23,667 (5.3%) males had values above 88 cm and 102 cm respectively. Overall, 11,266 (19.2%) were obese and 28.9% overweight using body mass index (BMI). More females had elevated BMI than males. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of all subjects were 129.54 mm Hg ± 23.5 mm Hg and 76.21 mm Hg ± 15.5 mm Hg respectively. Prevalence of hypertension (Joint National Committee VII classification) was 27.7%. More subjects had normal DBP than SBP (68.2% vs. 42.5% P < 0.05). Mean fasting blood glucose (FBG) of all subjects was 5.5 mmol/L ± 0.67 mmol/L. Using a casual blood glucose >11.1 mmol/L and/or FBG >7 mmol/L, the total yield of subjects adjudged as having diabetes was 2,956 (5.05%). Mean total risk score was 5.60 ± 3.90; this was significantly higher in females (6.34 ± 4.16 vs. 4.24 ± 3.71, P < 0.05). A total of 2,956 (5.05%) had high risk of developing DM within 10 years. Conclusion: The risk of developing DM is high in the community studied with females having a higher risk score. There is urgent need to implement diabetes prevention strategies.

Background: Medical school is a time of significant psychological distress for physicians-in-training. The objective of this study was to assess factors affecting the well-being of medical students undergoing clinical training at Olabisi Onabanjo University. Methods: One hundred and forty seven 500 level medical students of Olabisi Onabanjo University were administered questionnaires to assess the socio-demographic characteristics, levels of stress and well-being, psychological distress, anxiety and depression. Results: One hundred and thirty seven students completed their questionnaire out of a total of 147 students. Three quarters of the respondents were within ages 24 – 28 years with a mean of 26.3 +- 2.3 years. Seventy seven (56.2%) of the respondents were females. Close to half (48.9%) of the respondents had spent 8 years in school. About 30 % of the respondents were psychologically distressed while 21.9% and 14.6% had anxiety and depression respectively. Respondents who had spent more years in the school had a positive correlations with psychological distress (r = 0.249, p = 0.003) and anxiety (r =0.274, p = 0.001). Having no one to talk to when respondents had a problem was significantly associated with psychological distress (P = 0.00), anxiety (p = 0.00) and depression (p = 0.00). Academic stress at school was strongly associated with psychological distress (p = 0.00) and depression (p = 0.03). Conclusion: The study observed areas of possible stressful events (academics and non-academics) in medical education during the clinical periods. It is recommended that increased attention should be paid to building up the coping reserve of students.

BACKGROUNDAvascular Necrosis (AVN) or osteonecrosis has been frequently reported among Nigerians with sickle cell disease. Other known aetiologies include connective tissue diseases, alcohol, fat embolism, juvenile arthritis and pregnancy. Connective tissue disease (CTD) are uncommonly reported among Nigerians.OBJECTIVETo report the cases of three Nigerian female patients with radiological evidence of AVN associated with connective tissue diseases and inflammatory arthritis who presented to a rheumatology hospital in Lagos, Nigeria.METHODSThe first patient was a 36-year-old woman who was initially diagnosed as systemic lupus erythematosus (SLE). After four years of treatment, she presented with intense pain in the left hip, which on radiograph showed AVN. She was initially treated with NSAIDS and narcotic analgesics. She eventually had a left hip replacement. The second patient was a 44-year-old female, who had presented seven years earlier with features of SLE. She had attended the clinic irregularly. She later developed pain in both hips and shortening of left lower limb over the preceding three years. Radiographs confirmed AVN. She was treated with analgesics. The third patient was an 18-year-old female undergraduate who had rheumatoid arthritis (RA) and later developed bilateral hip pain which on radiograph showed bilateral AVN. She was placed on analgesics and then referred for orthopaedic surgery.CONCLUSIONOsteonecrosis may be associated with connective tissue diseases. A high index of suspicion is needed for the diagnosis, especially in SLE and RA patients with prolonged hip pain not responding to immunosuppressive.

BACKGROUNDTakayusu's disease is a rare disease affecting women predominantly during the child- bearing age. It is a primary vasculitis condition of large-vessels that responds well to steroid therapy. Immunosuppressives and vascular reconstruction may be needed as necessary.PROCEDUREReference was made to the case note of this young boy who was being co-managed by cardiology and vascular clinics. The diagnosis of Takayasu's disease was confirmed by the rheumatology unit and appropriate literature search was done.RESULTTakayusu's disease responds well to steroid therapy as exemplified by this patient. There was no relapse of the active inflammation after six months of steroid therapy.CONCLUSIONA high index of suspicion must be exercise in diagnosing Takayasu's disease. It could be difficult to have a clue early in the disease process because of non-specific presentations. Appropriate referral should however be made to Rheumatologist when the diagnosis is suspected. This will go a long way in delaying the morbidity that is associated with this rare disease.

Systemic lupus erythematosus (SLE) has rarely being reported among African Blacks, in contrast with African-Americans. Such reports have been mostly case reports. Our encounter with new cases shows that this disease may not be rare after all. The objective of this study was to study the clinical presentations, laboratory and serological characteristics of Nigerians presenting with SLE. This is part of a retrospective study of patients presenting with rheumatic complaints to a private practice rheumatology clinic, Arthrimed Specialist Clinic located in Lagos, Nigeria. This is a retrospective study of consecutive SLE patients seen in a rheumatology clinic over a 6-year period and diagnosed using the ACR Criteria for SLE. Laboratory tests and serology were carried out when possible. Treatment was initiated with immunosuppressives, steroids, anti epileptics, aspirin and anti hypertensives as indicated. SLE accounted for 5.28% of all the 1,250 rheumatology cases seen over the study period of 6 years. Female constituted 95.5% of the 66 cases seen. The subjects were aged 17-55 with a mean of 33 years at presentation and had the symptoms for a mean of 2.6 years. Polyarthralgia, fever and hair loss were the most common presentation. Neuropsychiatric presentations were common. Erythrocyte sedimentation rate was markedly elevated in most cases. Anti-nuclear antibody titres were markedly high and were mostly speckled staining pattern. Treatment was with conventional immunosuppressives. SLE may not be uncommon among African blacks, contrary to previous reports. A high index of suspicion is needed for this otherwise severe disease in blacks. Early aggressive treatment with immunosuppressives is indicated.

OBJECTIVES:To identify aetiological causes of shoulder pain syndrome among patients attending a rheumatology clinic, and to highlight the therapeutic options.DESIGN:Retrospective study.SETTING:A private rheumatology clinic in Lagos, Nigeria fromJanuary 2002 to December 2006.SUBJECTS:Forty female adult patients and 26 male adult patients aged 24-79 years.MAIN OUTCOME MEASURES:Patient reported outcome in terms of pain relief and increased mobility.RESULTS:Sixty six subjects were seen during the study period. Females were more commonly affected and were mostly middle aged. Adhesive capsulitis was the most common condition while septic arthritis and avascular necrosis were least diagnosed 22.7% of the subjects could not, however, be categorised.CONCLUSION:Shoulder pain syndrome is common among Nigerians. Diagnosis and management are mostly based on the clinical presentations, especially considering the lack of sensitivity of plain radiographs and the high cost of more sensitive MRI. The treatment of these conditions are standard.

Scleroderma and other connective tissue diseases have rarely been reported among Africans. The objective of this paper is to have a retrospective study of the clinical and investigative characteristics of scleroderma patients seen in a rheumatology clinic. This was done in a private practice rheumatology clinic in Lagos, Nigeria. Patients were identified using the American College of Rheumatology criteria for diagnosis of scleroderma. A total of 14 cases of scleroderma are reported. Most of the patients were females and diffuse scleroderma was more frequently seen. Arthritis and reflux esophagitis were the most common nondermatological presentation while Raynaud's phenomenon and dysphagia were the least seen. Restrictive pattern of lung function tests were seen in most of those tested and pulmonary fibrosis was seen in some cases. Antinuclear antibodies were the commonest serological findings with the speckled staining pattern in most cases. Treatments were with standard medications. Scleroderma among Nigerians is rare as elsewhere and there are certain common characteristics as seen elsewhere as well as certain differences.

Systemic Lupus Erythematosus (SLE) and concomitant complication of Neuropsychiatric lupus (NPSLE) are rarely reported among Africans. This retrospective study has the objectives of highlighting the clinical and laboratory characteristics of SLE subjects with neuropsychiatric manifestations seen in a private practice rheumatology clinic and comparing these with studies elsewhere. Such subjects were diagnosed using the American College of Rheumatology (ACR) criteria for SLE as well as the ACR Case definition for Neuropsychiatric SLE (NPSLE). A total of thirty three subjects (51.6%) out of the sixty four diagnosed SLE had features of NPSLE. Females were more commonly affected and the mean age was 32.8 years. Most of the subjects had either one or two concomitant syndromes. Headache was the commonest presentation (66.6%) while other common presentations were seizures (42.4), psychosis (30.3%) were also seen. Dementia was the least seen. The mean erythrocyte sedimentation rate was 95.5 mm/hr. Serology tests showed high frequencies of Anti Nuclear Antibody (ANA) and Anti ds DNA. Treatment was with standard immunosuppressives, and epileptics where indicated. The outcome was generally good with 54.5% better after six months while 7 subjects (21%) were lost to follow up and three were known to have died. NPSLE is a common presentation among Nigerian SLE patients and the pattern is as seen in other reports, though the frequencies of the syndromes vary widely. Early recognition and management with immunosuppressives are required.

BACKGROUND:Juvenile chronic arthritis (JCA) is a chronic arthritis affecting children below age of 16 years. The systemic onset subgroup is also known as Still's disease. There are several distinct subgroups. There is paucity of literature of this disease entity in our environment due to under diagnosis of the disease.METHOD:The case note of this patient was retrieved. He was managed for 2 years in the adult rheumatology clinic after being transferred from the Paediatric unit. Relevant literature was reviewed.RESULT:There was a good response to immunosuppressive agents and low dose prednisolone. He was back at School and able to play with his mates after long withdrawal from School.CONCLUSION:Prompt referral of such cases to specialist centers will go a long way in determining the outcome of such patients. Prognosis is better with early presentation and appropriate management.