Introduction: Systemic Autoimmune Diseases (SAID) long considered very rare in Africa are increasingly the subject of publications. The objective of this work is to identify the difficulties in the management of these pathologies in an internal medicine department in northern Senegal by analyzing the epidemiological, clinical-biological, therapeutic and evolutionary aspects of SAID. Methods: This was a descriptive cross-sectional study carried out in the internal medicine department of the Saint-Louis University Hospital Center. Included were all the files of patients followed in outpatient and/or hospitalization for autoimmune diseases according to the criteria of the American College of Rheumatology, during the period from January 2017 to December 2020. The data were analyzed using SPSS software version 21.0. As the study was descriptive, no statistical test was performed. Results: Out of 3800 patients, 70 presented SAID, i.e. a hospital prevalence of 1.8%. Polyarthritis was the first reason for consultation in 97% followed by skin manifestations in 8%. The patients had positive anti-nuclear autoantibodies in 88% of cases. Rheumatoid arthritis was the predominant condition (71%) followed by systemic lupus erythematosus (SLE) (15%) and undifferentiated autoimmune diseases in 10%. Eleven percent (11%) of patients had an associated autoimmune disease. Corticosteroids were used in the treatment of these conditions in 97% of cases and methotrexate was the most prescribed immunosuppressant (54%). Thirty-two percent (32%) of patients are lost to follow-up. Conclusion: SAID are diverse and under diagnosed; they are characterized by diagnostic delay above all linked to access to specialists and sometimes to the high cost of paraclinical examinations, in particular immunology. Treatment remains based primarily on corticosteroid therapy and conventional immunosuppressants in the face of the unavailability of biotherapies.
References
[1]
Konan, M., Binan, Y., Acko, U.V., Bita, D., Ouattara, R. and Toutou, T. (2019) Caractéristiques des maladies auto-immunes: Analyse d’une série de 45 patients. Revue International des Sciences Médicales, 21, 306-311.
[2]
Ka, M.M., Diop, M.M., Lèye, A., Lèye, Y., Touré, P.S., Berthé, A., Dia, D.G., Dioussé, P. and Diop, B.M. (2017) Problématique des maladies auto immunes en Afrique. Revue Africaine de Médecine Interne, 4, 7-8.
[3]
Kane, B.S., Ndongo, S., Ndiaye, A.A., Djiba, B., Niasse, M., Diack, N., Ndao, A.C., Fall, B.C., Gning, S. and Pouye, A. (2016) Maladie systémique en médecine interne contexte africain: Aspects épidémiologiques et classification. La Revue de Médecine Interne, 37, A37. https://doi.org/10.1016/j.revmed.2016.04.237
[4]
Ouedraogo, D.-D., Korsaga-Some, N., Zabsonne Tiendrebeogo, J., Tieno, H., Kabore, H., Niamba, P. and Drabo, J. (2014) Connective Tissue Diseases in Hospital Practice in Ouagadougou (Burkina Faso). Médecine et santé Tropicales, 24, 271-274. https://doi.org/10.1684/mst.2014.0348
[5]
Louzir, B., Othmani, S. and Ben Abdelha dh, N. (2003) Le lupus érythémateux systémique en Tunisie. Etude multicentrique nationale. A propos de 295 observations. La Revue de Médecine Interne, 24, 768-774. https://doi.org/10.1016/S0248-8663(03)00250-9
[6]
Hochberg, M.C. (1997) Updating the American College of Rheumatology Revised Criteria for the Classification of Systemic Lupus Erythematosus. Arthritis & Rheumatology, 40, 1725. https://doi.org/10.1002/art.1780400928
[7]
Sibilia, J. (2007) How to Define and to Classify Inflammatory Systemic Diseases? Revue du Rhumatisme, 74, 714-725. https://doi.org/10.1016/j.rhum.2007.07.003
[8]
Lèye, Y.M., Ndiaye, N., Diack, N.D., Ndour, M.A., Fall, B.C., Ka, W., Devokolot, J.D.G., EL Fajri, S., Bahati, A., Niass, A., Fall, M., Touré, P.S., Diop, M.M., Ka, M.M. and Léye, A. (2017) Aspects épidémiologiques et diagnostiques des connectivites au service de Médecine Interne du CHUN de Pikine: Analyse de 287 observations. RAFMI, 4, 22-25.
[9]
Ouedraogo, D.D., Korsaga-Some, N., Zabsonne Tiendrebeogo, J., et al. (2014) Les connectivites en pratique hospitalière à Ouagadougou (Burkina Faso). Médecine et Santé Tropicales, 24, 271-274.
[10]
Niasse, M., Kane, B.S., Ndiaye, A.A., et al. (2017) Severity of the Rheumatoid Arthritis in Sub-Saharan Africa: Study of 403 Senegalese Observations. Open Journal of Internal Medicine, 7, 151-159.
[11]
Malemba, J.J. and Mbuyi-Muamba, J.M. (2008) Clinical and Epidemiological Features of Rheumatic Diseases in Patients Attending the University Hospital in Kinshasa. Clinical Rheumatology, 27, 47-54. https://doi.org/10.1007/s10067-007-0650-x
[12]
Ntsiba, H., Ngandeu-Singwe, M. and Mbuyi-Muamba, J.M. (2010) Les connectivites en Afrique centrale. Revue du Rhumatisme, 77S, 199.
[13]
Guerne, P.A. (2013) Manifestations ostéo-articulaires dans les connectivites. Revue Médicale Suisse, 9, 542-548.
[14]
Fall, S., Pouye, A., Ndiaye, F.S., Ndongo, S., Leye, Y. and Dioumet, L. (2011) Initial Presentation of Systemic Lupus Erythematosus in Senegal. Medecine d’Afrique Noire, 58, 156-160.
[15]
Niang, S.O., Coumé, M., Ndiaye, M., Diop, A., Diatta, B.A., Diallo, M., et al. (2011) The Scalp Involvements in the Connective Tissue Diseases. JCDSA, 1, 95-98. https://doi.org/10.4236/jcdsa.2011.13014
[16]
Diousse, P., Berthé, A., Done, H., Touré, P.S., Bammo, M., Seck, F., Guèye, N., Diop, M.M., Faye, F.A., Dieng, M.T., Diop, B.M. and Ka, M.M. (2017) Profil épidémio clinique des maladies auto-immunes systémiques dans le service de Dermatologie. Revue Africaine de Médecine Interne, 4, 18-21.
[17]
Gabay, C. and So, A. (2013) Les connectivites, une affaire de spécialistes? Revue Médicale Suisse, 9, 539-540.
[18]
N’Soundhat, N.E.L. and Honoré, N. (2020) Les Maladies Auto Immunes et de Système au Service de Rhumatologie du Centre Hospitalier Universitaire de Brazzaville. Health Sciences and Disease, 21, 138-142. https://www.hsd-fmsb.org
[19]
Ndongo, S., Pouye, A., Lekpa, F.K., Bihéhé, D.M., Tiendrebeogo, J., Ndao, A.C., Ka, M.M. and Moreira Diop, T. (2012) Problématique du traitement de fond des rhumatismes inflammatoires en Afrique subsaharienne: évolution à six mois de 205 patients sénégalais atteints de polyarthrite rhumatoïde. Médecine et Santé Tropicales, 22, 385-389.
