RESUMO
The objective of this study was to examine the characteristics of cutaneous lupus erythematosus, excluding systemic lupus erythematosus (SLE), in patients of African descent. Indeed, since the description of subacute cutaneous lupus erythematosus (SCLE), which had been included in chronic cutaneous lupus erythematosus (CCLE), there has been no description of the disease in black patients. In 2000, we performed a retrospective epidemiological study by querying multiple sources to identify all patients with lupus in French Guiana--a part of France in South America having western living conditions, free healthcare and 157,000 inhabitants, most of whom are of African origin. We found 45 patients with pure cutaneous lupus, which included CCLE (mostly discoid), SCLE and bullous lupus. The disease characteristics of these patients exhibited few differences compared with those of the Caucasian patients cited in the literature. However, the age of onset for our patients of African descent was younger than that of Caucasian patients. In contrast to the race-related differences reported for SLE, we found no major differences in terms of demographic, clinical and biological presentation between this cohort of pure cutaneous lupus erythematosus patients of African origin and Caucasian patients with similar forms of lupus.
Assuntos
População Negra , Lúpus Eritematoso Cutâneo/etnologia , Adolescente , Adulto , Idade de Início , Anticorpos Antinucleares/sangue , Biomarcadores/sangue , Criança , Feminino , Guiana Francesa/epidemiologia , Humanos , Lúpus Eritematoso Cutâneo/sangue , Lúpus Eritematoso Cutâneo/diagnóstico , Lúpus Eritematoso Cutâneo/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele/patologia , População Branca , Adulto JovemRESUMO
Risk factors for peripartum cardiomyopathy (PPCM) are controversial. PPCM seems to be more prevalent in women of African descent, the highest observed incidence is in Haiti (1 per 300 live births). Our retrospective study conducted in Martinique showed an incidence of 1 per 5500 live births. This incidence is significantly lower than in Haiti. Women from Martinique and Haiti do not differ for most classical risk factors: African descent, age, pregnancy-associated hypertension, multiple pregnancy and pre-eclampsia. However, the parity rate and the socioeconomic level are different. Thus, African descent could be confounded by high parity rate and socioeconomic status.
Assuntos
População Negra/etnologia , Cardiomiopatias/etnologia , Transtornos Puerperais/etnologia , Adolescente , Adulto , População Negra/genética , Cardiomiopatias/economia , Cardiomiopatias/genética , Estudos de Coortes , Feminino , Haiti/etnologia , Humanos , Martinica/etnologia , Pessoa de Meia-Idade , Gravidez , Complicações Cardiovasculares na Gravidez/economia , Complicações Cardiovasculares na Gravidez/etnologia , Complicações Cardiovasculares na Gravidez/genética , Transtornos Puerperais/economia , Transtornos Puerperais/genética , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
PURPOSE: To review epidemiological and clinical aspects of systemic lupus erythematosus (SLE) in Martinique, French West Indies. METHODS: Cases of SLE were identified by attending physicians. Patients who presented with at least four of the criteria defined by the American College of Rheumatology were included. Determination of incidence and prevalence included the new cases arising during the 1990-1999 period and 1999 population census results. Probability of survival was based on the use of the Kaplan-Meier estimator. RESULTS: Two hundred and eighty-six patients were studied, including 265 females (92.7%). The average annual incidence was 4.7 cases per 100,000 inhabitants (95% confidence interval [CI]: 2.5-6.9). The prevalence for 1999 was 64.2 cases per 100,000 inhabitants (CI: 56.2-72.2). The mean age at onset was 30 years. Eleven percent of all patients had at least one parent with SLE. Renal disease was present in 139 patients (48.6%), and neurological disorders were diagnosed in 70 patients (24.5%). Patients tested positive for the following antibodies: anti-Sm (37.1%), anti-RNP (58.7%), anti-SSA (47.2%). Mean survival time was: 96.4% (CI: 94.1-98.7) at 5 years, 91.8% (CI: 87.9-95.7) at 10 years. Survival was significantly reduced in patients with end-stage renal disease (n = 40, chi 2 = 6.96, P < 0.01). CONCLUSION: The high incidence of SLE in Martinique and the immunological characteristics of patients were found to be similar to those described in other populations of African descent. The frequency of renal disease and survival rates were identical to those reported in Caucasians.
Assuntos
Falência Renal Crônica/etiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/patologia , Adolescente , Adulto , Idade de Início , Idoso , Anticorpos/análise , Criança , Feminino , Humanos , Incidência , Lúpus Eritematoso Sistêmico/complicações , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Prevalência , Prognóstico , Análise de SobrevidaRESUMO
OBJECTIVE: Calcification of the ligamentum flavum at the cervical spine is an uncommon condition reported mainly in Japanese patients. We describe the clinical manifestations, imaging study findings, and outcomes in six cases seen in the French West Indies. MATERIAL AND METHODS: We retrospectively reviewed the medical charts of six patients admitted to an orthopedics department for spinal cord compression shown upon computed tomography to be caused by calcification of the ligamentu flavum. There were five women and one man, mean age at admission was 71.7 years (range, 64-79 years) and all six patients were Black. RESULTS: Five patients had cervical myelopathy and one was asymptomatic. All five symptomatic patients had cervical spinal stenosis, explaining the rapid symptom onset (within six and a half months) and severe motor loss. Computed tomography reconstruction in the sagittal plane ruled out ossification of the ligamentum flavum. Magnetic resonance imaging of the neck failed to demonstrate the calcifications but was useful in evaluating the severity of the spinal cord compression. One patient had articular chondrocalcinosis in both knees and another had calcifications in the basal ganglia. Surgical decompression by the posterior route was performed in two patients and was effective in both, whereas two of the three symptomatic patients who did not have surgery experienced worsening neurological loss. Analysis of the operative specimens from the two surgically treated patients showed a mixture of calcium pyrophosphate dihydrate crystals and apatite microcrystals. CONCLUSION: Calcification of the ligamentum flavum is probably underrecognized in blacks. This condition causes severe neurological loss. Imaging studies provide the diagnosis. The pathogenesis remains unclear.
Assuntos
Calcinose/etnologia , Calcinose/patologia , Ligamento Amarelo/patologia , Idoso , População Negra , Vértebras Cervicais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Estudos Retrospectivos , Compressão da Medula Espinal/etnologia , Compressão da Medula Espinal/patologia , Índias OcidentaisRESUMO
STUDY DESIGN: A case of acute disseminated encephalomyelitis (ADEM) preceding the features of cutaneous lupus is reported. OBJECTIVES: To suggest that ADEM and cutaneous lupus are pathophysiologically related. SUMMARY OF THE BACKGROUND DATA: Neurological complications of systemic lupus erythematosus are common. However, demyelinative central nervous system manifestations are rare, and restricted to neuromyelitis optica (NMO). NMO is thought to be a partial form of ADEM. METHODS: A clinical, neuroradiological and immunological study was performed in this case. RESULTS: ADEM was diagnosed in a young black female. Three years later, she developed a cutaneous lupus without hypocomplementemia. CONCLUSION: A relationship between ADEM and cutaneous lupus is suggested. The normal serum complement level in our patient might be a predisposing factor for the development of ADEM.
Assuntos
Encefalomielite Aguda Disseminada/etiologia , Lúpus Eritematoso Cutâneo/complicações , Adulto , Anti-Inflamatórios/uso terapêutico , Encefalomielite Aguda Disseminada/diagnóstico , Feminino , Humanos , Lúpus Eritematoso Cutâneo/diagnóstico , Lúpus Eritematoso Cutâneo/tratamento farmacológico , Imageamento por Ressonância Magnética , Prednisolona/uso terapêuticoRESUMO
Myositis linked to HTLV-1 is unfrequent. Over a period of 8 years, 14 patients with inflammatory myopathy were diagnosed in Martinique. Seven were seropositive for HTLV 1 antibody; the clinical and pathological data of whom are presented herein. Five patients presented with polymyositis, two with dermatomyositis. All seven patients had extra-muscular clinical features including neuropathy (4/7) and myelopathy (6/7), resulting in a quite peculiar clinical picture. Muscle biopsy showed a neurogenic process combined with myositic changes in 3/7 patients. Corticotherapy led to dramatic improvement in only one case, but with no sustained effect. HTLV 1 may be considered the etiological agent of this form of dermato-polymyositis, characterized by a clearly distinctive clinico-pathological picture, and a poor response to corticotherapy. As in the case of tropical spastic paraparesis/HTLV 1 associated myelopathy, careful assessment of non-steroidal therapy is now warranted.
Assuntos
Dermatomiosite/diagnóstico , Infecções por HTLV-I/diagnóstico , Paraparesia Espástica Tropical/diagnóstico , Polimiosite/diagnóstico , Adulto , Idoso , Biópsia , Criança , Dermatomiosite/tratamento farmacológico , Dermatomiosite/patologia , Feminino , Seguimentos , Infecções por HTLV-I/tratamento farmacológico , Infecções por HTLV-I/patologia , Humanos , Masculino , Martinica , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Exame Neurológico/efeitos dos fármacos , Paraparesia Espástica Tropical/tratamento farmacológico , Paraparesia Espástica Tropical/patologia , Polimiosite/tratamento farmacológico , Polimiosite/patologia , Prednisona/uso terapêutico , Falha de TratamentoRESUMO
A retrospective study was conducted in Martinique to identify patients with polyarthritis and positive serologic tests for the human T-cell lymphotropic virus Type I (HTLV-1). Patients with metabolic or bacterial causes of polyarthritis were excluded. We found 17 cases of HTLV-1-positive polyarthritis (6.7% of the total of polyarthritis patients followed in our department); there were 14 females and three males, and all the patients were West-Indian blacks. Mean age at diagnosis was 50 years. Five patients also had tropical spastic paraparesis. The polyarthritis was the inaugural manifestation of T-cell leukemia in one patient. Four patients had received blood transfusions. Fever, myalgia, and/or skin lesions were present at onset of the polyarthritis in seven cases. All 17 patients had peripheral, bilateral, symmetric polyarthritis; the most commonly involved sites were the hands (17/17) and knees (14/17). Three patients had rheumatoid factor and five had antinuclear antibody. Ten patients met at least four American Rheumatism Association criteria for rheumatoid arthritis; they accounted for 6.7% (10/150) of all polyarthritis patients managed in the same hospital department during the same period. We compared these ten patients with 20 HTLV-1-negative rheumatoid arthritis patients matched on gender, ethnic origin, and disease duration. There were no significant differences between the two groups for any of the parameters studied.
Assuntos
Artrite/virologia , Infecções por Deltaretrovirus , Vírus Linfotrópico T Tipo 1 Humano , Adulto , Idoso , Reações Antígeno-Anticorpo , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/imunologia , Artrite Reumatoide/virologia , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
As incidence of SLE is high in Blacks, we studied HLA and SLE associations in the French West Indies, whose population is racially mixed. Forty-seven coloured SLE patients have been typed in HLA A,B,C and DR. We observed B8 association in nearly all of the studies. B15 association, more frequent in Caucasians, was found, also B53 association, a Black variant of B5 more frequent in Blacks. We did not find any class II association.
Assuntos
Antígenos HLA/análise , Antígenos HLA-D/análise , Antígenos HLA-DR/análise , Lúpus Eritematoso Sistêmico/genética , Antígenos HLA/genética , Antígenos HLA-DR/genética , Humanos , Lúpus Eritematoso Sistêmico/imunologia , Índias OcidentaisRESUMO
Blount's disease is associated with agenesis of the medial tibial plateau leading to tibia vara. It appears to be more frequent in Scandinavian countries and in black populations. Twenty-six cases had been seen in Martinique (Antilles) of whom twenty were children. A classification into six stages was described. Stage IV is a critical one. Before it, corrective osteotomy will often lead to complete healing. After stage IV, lateral epiphysiodesis must be added to avoid recurrence of deformity. The technique of osteotomy was variable according to the age of the child and the obliquity of the joint line. In young children, a subtraction closing wedge osteotomy is suitable. In older children a "V" shaped osteotomy is recommended to lessen the amount of shortening. At the end of the growth period, a medial opening wedge osteotomy is advisable. In adults (six cases) whose deformity can reach as much as 50 degrees with considerable ligamentous laxity, reefing of the ligament must be added to the osteotomy. The problem of the opposite knee is discussed. Even when the disease is not bilateral, it can tend to develop towards arthrosis.