Browsing by Department "Division of Rheumatology"

Now showing 1 - 14 of 14
  • Thumbnail Image
    Item
    Open Access
    A Retrospective analysis of Spondyloarthropathies at the Rheumatic Diseases Unit, University of Cape Town, over the period 1988-1994
    (1997) Burch, Vanessa Celeste; Burch, Vanessa Celeste; Dr. A.A Kalla; Kalla, A A
    OBJECTIVES: Given the paucity of epidemiological and clinical data representing the South African experience with the spondyloarthropathies, a study was designed to achieve a description of the spectrum of spondyloarthropathy in patients of different ethnic origin attending the Rheumatic Diseases Unit (RDU), University of Cape Town (UCT), in respect of differences in: clinical and/or radiographic expression of disease; gender HLA-B27 status, and choice of therapy and requirements for reconstructive orthopaedic surgical procedures. STUDY DESIGN: The study comprised a retrospective descriptive review of all new cases of spondyloarthropathy seen at the RDU, UCT Medical School, from 1 January 1988 to 31 December 1994, who were consecutively identified from an analysis of the clinical records. The RDU (UCT) is one of two principal referral centres for rheumatic-related diseases in the Western Cape region, and provides clinical services at Groote Schuur Hospital (GSH, Observatory) and Princess Alice Orthopaedic Hospital (PAOH, Retreat) in Cape Town for an estimated population of 3. 4 million (Western Cape), 55% (1.9 million) of whom are resident in the Cape Peninsula region (81). A minority of patients from further afield (Northern Cape and Eastern Cape) also attend the unit. Approximately 12 500 patients attend PAOH outpatient Department (OPD) annually, of which 35% are seen by the RDU staff each year (average values calculated from attendance registers for the period 1 January 1988 to 31 December 1994). New patients constitute about 6% of all patients seen by the RDU per annum (Table 2). Statistical data were not available from the OPD Arthritis Clinic (AC) at GSH, but similar proportions would be expected, since both clinics are staffed by the same complement of doctors and operate under similar circumstances at both venues.
  • Thumbnail Image
    Item
    Open Access
    CANDLE SYNDROME: Orodfacial manifestations and dental implications
    (BioMed Central, 2015-12-28) Roberts, T; Stephen, L; Scott, C; di Pasquale, T; Naser-eldin, A; Chetty, M; Shaik, S; Lewandowski, L; Beighton, P
    A South African girl with CANDLE Syndrome is reported with emphasis on the orodental features and dental management. Clinical manifestations included short stature, wasting of the soft tissue of the arms and legs, erythematous skin eruptions and a prominent abdomen due to hepatosplenomegaly. Generalized microdontia, confirmed by tooth measurement and osteopenia of her jaws, confirmed by digitalized radiography, were previously undescribed syndromic components. Intellectual impairment posed problems during dental intervention. The carious dental lesions and poor oral hygiene were treated conservatively under local anaesthetic. Prophylactic antibiotics were administered an hour before all procedures. Due to the nature of her general condition, invasive dental procedures were minimal. Regular follow-ups were scheduled at six monthly intervals. During this period, her overall oral health status had improved markedly. The CANDLE syndrome is a rare condition with grave complications including immunosuppression and diabetes mellitus. As with many genetic disorders, the dental manifestations are often overshadowed by other more conspicuous and complex syndromic features. Recognition of both the clinical and oral changes that occur in the CANDLE syndrome facilitates accurate diagnosis and appropriate dental management of this potentially lethal condition.
  • Thumbnail Image
    Item
    Open Access
    Consultation outcomes for musculoskeletal conditions at two community health centres in Cape Town
    (South African Academy of Family Physicians, 2013) Namane, M K; Kalla, A A; Young, T N
    Objectives: To compare the proportion of patients with documented diagnoses and management plans when they presented with musculoskeletal complaints at two community health centres (CHCs) using two models of care: one with a rheumatology outreach service and the other with none. Secondly, to describe the profile of patients with rheumatoid arthritis (RA) who attended the CHC with the outreach service. Design: Cross-sectional. Setting: Heidelberg Community Health Centre and Vanguard Community Health Centre, Cape Town. Subjects: A group of 59 patients at each CHC were compared regarding engagement of their musculoskeletal complaints by doctors and clinical nurse practitioners (CNPs). Secondly, 24 RA patients who attended Heideveld CHC were profiled. Results: A comparison of the “overall engagement” between the two CHCs [risk difference (RD) -0.06, 95% confidence interval (CI): -0.17–0.05, odds ratio (OR) 0.79, 95% CI: 0.51–1.24, chi-square 0.82, p-value 0.36] was not significantly different. Comparison between doctors (RD -0.05, 95% CI: -0.05–0.08, OR 0.80, 95% CI: 0.46–1.40, chi-square 0.41, p-value 0.52) was also not significantly different. The comparison between the CNPs at the two CHCs was statistically significant (RD 0.30, 95% CI: 0.14–0.45, OR 8.37, 95% CI: 1.05–66.60, Fisher's exact test 0.01), but the CI around OR was large. Patients with RA had a mean age of 60 years, an average of two co-morbidities and an average of three annual clinic visits. Eighty- three per cent resided in the drainage area of the clinic. Conclusion: There was no significant difference in engagement between the CHCs. The potential that CNPs seemed to show of being positively influenced by the outreach service should be further researched. Patients with RA had co- morbidities that required management at primary healthcare level.
  • Thumbnail Image
    Item
    Open Access
    Demographic and clinical characteristics of children with juvenile dermatomyositis in Cape Town
    (2015) Okong'o, Lawrence Owino; Scott, Christiaan
    Study rationale: Juvenile dermatomyositis (JDM) is a rare idiopathic inflammatory myopathy of childhood with an incidence of 1.9-3.2 per million. The aetiology of JDM is uncertain but may result from immune dysregulation triggered by environmental factors in genetically susceptible children. The demographic and clinical characteristics of JDM may thus differ by race and geographic regions. Few studies have described the characteristics of JDM patients from Africa. There is need for further studies for better understanding of the epidemiology, clinical characteristics and outcome of patients with JDM from the continent. Methods: We conducted a retrospective observational study to determine clinical characteristics and outcomes of patients satisfying the Bohan and Peter criteria for probable JDM seen between 2004-2013 in Red Cross, Groote Schuur and Tygerberg hospitals in Cape Town. Data was analyzed using R version 3.1.0 (2014-04-10). Results: Twenty-five cases were identified: 16 female and 9 male. Thirteen (52%) of the cases were of indigenous African, eleven (44%) mixed and one (4%) European ancestry. The median ages at disease onset and diagnosis were 6.75 (range 2.0-9.7) and 7.9 (range 3.4-9.75) years respectively. Muscle weakness and characteristic cutaneous manifestations occurred in all the 25 patients while 24 had elevated muscle enzymes. All the patients received corticosteroids, seventeen (73.9%) received methotrexate and four received rituximab. Eleven patients had calcinosis during the disease course [median follow up period of 50 (range 0.5-159) months]. The mortality was 2/25 (8%) while only 40% of the patients had clinically inactive disease by PRINTO criteria. There was no difference in racial distribution (p-value = 1), age at disease onset (p-value = 0.87) and disease duration prior to treatment initiation (p -value = 0.75) between patients who had clinically active and inactive disease. Discussion: The demographic characteristics of children with JDM were similar to that from most other regions of the world with female predominance and similar age at onset. The median delay in diagnosis (4 months) was not longer than that reported in most other studies. However, some children had prolonged delay of up to 7 years due to misdiagnosis that denied them appropriate treatment in a timely manner. Majority (60%) of the patients also remained with clinically active disease, which put them at risk of further disease complications including calcinosis. Even though the mortality rate was low (8%) this was still more than double that reported in most recent large studies especially from the resource rich countries. Conclusions: Long-term follow up of JDM patients is advisable since majority of patients seem to have clinically active disease many years after disease onset despite treatment. Formulation and use of appropriate treatment guidelines and protocols may aid in the early diagnosis and appropriate management for optimum outcomes.
  • Thumbnail Image
    Item
    Open Access
    Form and function of the rheumatoid foot
    (1986) Du Toit, Leon Lourens
  • Thumbnail Image
    Item
    Open Access
    Juvenile idiopathic arthritis in two tertiary centres in the Western Cape, South Africa
    (BioMed Central Ltd, 2012) Weakley, Kate; Esser, Monika; Scott, Christiaan
    BACKGROUND:Juvenile idiopathic arthritis (JIA) is a disease that shows wide variations between differing populations. Since the recent international consensus on classification criteria, JIA has been widely described in many countries and population groups. There has been almost no data that describes JIA in an African, specifically Sub-Saharan African, setting. Therefore, the aim of this study is to describe disease characteristics, disease course, and functional disability in two tertiary centres in the Western Cape, South Africa and compare the findings to other JIA populations. METHODS: Eighty-six children were recruited during random clinic visits to rheumatology clinics at Tygerberg and Groote Schuur Hospital between April 2010 and April 2011. Children were diagnosed using International League of Associations for Rheumatology (ILAR) 2001 classification criteria. Consent was obtained and medical records examined. The Childhood Health Assessment Questionnaires (CHAQ) and visual analogue scales (VAS) for pain and general well-being were completed and all children were examined by a researcher in conjunction with a paediatric rheumatologist. HIV status as well as tuberculosis disease and treatment were investigated. RESULTS: A total of 86 children were enrolled. Eight children were excluded (2 HIV arthropathy, 1 TB arthritis, 1 SLE, 4 with insufficient data), leaving a total of 78 patients. There was an equal female to male ratio-39 males and 39 females. There were 6 systemic JIA patients (7.69%), 17 persistent oligoarthritis (21.79%), 4 extended oligoarthritis (5.12%), 11 polyarthritis rheumatoid factor (RF) positive (14.10%), 21 polyarthritis RF negative (26.9%), 1 psoriatic arthritis (1.28%), and 18 enthesitis-related arthritis (23%). The median CHAQ for the group was 0.5 (IQR 0.1-1.25), the median VAS for pain was 18 mm (IQR 4-42) and median VAS for general well-being was 25 mm (IQR 3-49). Enthesitis-related arthritis and polyarthritis disease subtypes in this South African population may be more common than seen in JIA populations described in northern Europe, India, United Kingdom, and Turkey. CONCLUSION: This Western Cape South African JIA population appears to have a different profile of JIA than what has been described elsewhere. Enthesitis-related arthritis and polyarthritis disease subtypes appear to be more prevalent. There are also significant challenges in this setting such as later presentation to pediatric rheumatologists, different disease characteristics, and variable disease courses.
  • Thumbnail Image
    Item
    Open Access
    MyastheniaGravis(MG) in a patient with Juvenile Idiopathic Arthritis
    (BioMed Central Ltd, 2011) Scott, Christiaan; Kalla, Asgar
    Introduction; Myasthenia Gravis associated with Juvenile Idiopathic Arthritis has been reported in 5children with various subtypes of JIA [1,2]. Methods: We present a 17year old girl known with Rheumatoid Factor Positive Polyarticular Juvenile Idiopathic Arthritis for 4 years who developed Myasthenia Gravis while on therapy with Methotrexate, Prednisone and Ibuprofen. Results: This patient presented to the emergency room with a respiratory infection. She had been feeling weak and had noticed tongue weakness and difficulty swallowing, which had worsened significantly since the respiratory infection. On examination she was found to have clinical signs of Right Middle Lobe pneumonia and was found to be weak, especially in her proximal muscle groups. She had bilateral ptosis as well as facial weakness. She had active arthritis in multiple joints. Despite intravenous antibiotics and full supportive management she deteriorated rapidly, and within 12 hours required intubation and ventilation. The patient was found to have high ACH receptor antibodies and responded dramatically to pyridostygmine therapy, confirming the diagnosis of MG. High prednisone and azathioprine have been added to her regime. Discussion: Myasthenia Gravis is a rare association with JIA. The majority of cases appear to be associated with oligo-articular JIA. This patient presented after an acute infection and a recent worsening in her JIA symptoms.
  • Thumbnail Image
    Item
    Open Access
    Osteoporosis in rheumatoid arthritis
    (1989) Kalla, Asgar Ali; Meyers, O L
    The literature is replete with reports of osteoporosis in rheumatoid arthritis, but the mechanism of bone loss remains obscure. This is probably due to the overlap with bone loss of aging and the menopause, whose exact mechanisms are also poorly understood. Against this background, a study was designed to evaluate generalised bone loss in young, premenopausal (if female), patients with rheumatoid arthritis. The protocol was designed to record demographic data, as well as information pertaining to the disease. Cortical bone mass was measured at the metacarpals and left femur, using an automated, computer-controlled technique. Trabecular bone was evaluated at the left femur (Singh index) as well as at the 3rd lumbar vertebra (Saville index). Bone kinetics were studied by the measurement of urinary excretion of calcium, phosphate and hydroxy-praline (resorption) and serum alkaline phosphatase (formation). Disease activity was measured clinically and with laboratory indices. Physical activity was indirectly measured by quantitating the disability, using the Keitel function test as well as a modified health assessment questionnaire (HAQ). The radiograph of the right wrist was scored by the Larsen index. The carpometacarpal ratio was also calculated from the radiograph. Numerous statistical techniques were applied in the analysis of the data. Healthy volunteers were used as controls. Patients with SLE were also studied, in order to compare the 2 inflammatory diseases. Patients with RA had generalised cortical bone loss (metacarpal and femur) (p < 0.001). Trabecular bone measurements were not significantly different from normals, using the crude radiographic techniques. Duration of disease was the most important clinical determinant of this bone loss. The relative contributions of disease activity and lack of physical activity to the loss of bone could not be adequately separated using conventional statistical techniques. Corticosteroid therapy did not promote metacarpal bone loss in these subjects, but may have contributed to thinning of the femoral cortex. Nonsteroidal anti-inflammatory drugs and disease modifying agents did not seem to influence the extent of the bone loss. Nutritional status and skinfold thickness did not correlate with bone mass. Dietary factors played no role in the genesis of bone loss, but may have had some effect on disease activity. Metacarpal measurements showed a sensitivity of 80% and specificity of 85% in discriminating between osteopaenic and normopaenic groups with RA. Osteopaenia could not be adequately predicted in the absence of metacarpal measurements. Metacarpal bone loss in RA was due to endosteal resorption, while in SLE it was due to periosteal resorption. The semi-automatic technique for measurement of metacarpal bone mass showed good reproducibility among 5 observers and at 2 different centres. The pathogenesis of bone loss in RA was multifactorial, the largest contribution probably coming from a humoral factor in the circulation, closely related to disease activity. Ionised calcium was elevated in 55% of RA patients, but only 5% of SLE patients. Serum PTH levels were normal in 99% of the RA subjects. Elevations in alkaline phosphatase. (25%) probably reflected disease activity rather than increased bone formation. Factor analysis of 27 variables showed that disease activity was central to the development of OP in RA. CS therapy tended to be used in the presence of active disease. Disability was not an important determinant of bone loss in RA, but may be a useful measure of activity of the disease. This study did not evaluate the relationships with sex hormonal status or vitamin D metabolism. Future research should aim at cohort analysis at 2 different periods, in order to improve our understanding of the pathogenesis of bone loss in RA.
  • Thumbnail Image
    Item
    Open Access
  • Thumbnail Image
    Item
    Open Access
    Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country
    (2020-06-16) Solomon, Ahmed; Stanwix, Anne E; Castañeda, Santos; Llorca, Javier; Gonzalez-Juanatey, Carlos; Hodkinson, Bridget; Romela, Benitha; Ally, Mahmood M T M; Maharaj, Ajesh B; Van Duuren, Elsa M; Ziki, Joyce J; Seboka, Mpoti; Mohapi, Makgotso; Jansen Van Rensburg, Barend J; Tarr, Gareth S; Makan, Kavita; Balton, Charlene; Gogakis, Aphrodite; González-Gay, Miguel A; Dessein, Patrick H
    Background It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. Methods Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines. Results Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n = 3), lipid lowering agents (n = 8), antihypertensive drugs (n = 1), low dose aspirin (n = 1) and lifestyle modification (n = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound. Conclusions Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA.
  • Thumbnail Image
    Item
    Open Access
    PReS-FINAL-2253: A case series of HIV arthropathy in Cape Town
    (BioMed Central Ltd, 2013) Webb, K; Scott, C; Brice, N
    HIV arthropathy is well described in adults. Few studies have looked in depth at HIV arthropathy in children, and the characteristics of this entity have not been fully described.
  • Thumbnail Image
    Item
    Open Access
    PReS-FINAL-2268: Sarcoidosis in children seen at the pediatric rheumatology clinics of two referral hospitals in Cape Town, South Africa
    (BioMed Central Ltd, 2013) Okong'o, LO; Scott, C; Webb, K
    Sarcoidosis is a relatively uncommon condition in children. Reports from multiracial societies such as the USA indicate that sarcoidosis is more common in Africans than other racial groups. However, few reports of cases of childhood Sarcoidosis have been published from sub-Saharan Africa to shed light on the burden of sarcoidosis and the demographics and clinical presentation of children diagnosed with sarcoidosis.
  • Thumbnail Image
    Item
    Open Access
    The prevalence of rheumatic disease in a rural Coloured population in Namaqualand
    (1982) Meyers, Orlando Llewellyn
    No epidemiological field studies of the rheumatic diseases have been undertaken in the Coloured population of South Africa. As a group they are genetically heterogenous and in comparative medicine they have tended to occupy an intermediate position between Black and White South Africans. A study of the nature and extent of rheumatic disease in this population group can make an important contribution. (i) The Coloured population is both simple, unsophisticated and rural, and on the other hand unquestionably urbanised. In this sense they provide a unique opportunity to study the prevalence of rheumatoid arthritis under rural and urban conditions. Such a study if it supports the rural/ urban differences which have been shown for Black South Africans will help to focus attention on the urban environment in the pathogenesis of rheumatoid arthritis. The same may be true of other rheumatic diseases such as systemic lupus erythematosus. On the other hand, data which is similar to that of other studies also has importance in reinforcing accepted ideas, and furthermore such a study affords an opportunity to test criteria of disease in different circumstances. This helps to define problems and ultimately aids in the refining of criteria. (ii) The planning of strategies for health services cannot hope to become adequate neither can the effectiveness of such health strategies be measured if the prevalence of an important group of diseases is not known. (iii) The teaching of under and postgraduates must also be influenced by the research conducted by a medical school, and in this way the provision and the planning of health services are aided. This study in a rural Coloured population forms the first of a series of studies in rural/urban living Coloured people. The rural study used as its universe the population of Rietpoort in Namaqualand, where 80 % of the adult population was seen.
  • Thumbnail Image
    Item
    Open Access
    Revising the WHO Essential Medicines List for paediatric rheumatology
    (2021-01-23) Scott, Christiaan; Smith, Nicola; James, Rebecca; Whitehead, Ben; Green, Rochelle; Foster, Helen E