Disease Activity and Colchicine Resistance in Familial Mediterranean Fever: Gene Variants' Influence

Hounzou C^*

Department of Rheumatology, University Hospital of Kara, Togo, Africa

Abstract

Osteonecrosis of the femoral head (ONFH) is a debilitating condition characterized by the death of bone tissue in the femoral head, particularly prevalent among rheumatology patients. This comprehensive review examines the prevalence, risk factors, diagnostic challenges, and treatment modalities of ONFH in Kara, Togo. Limited access to advanced diagnostic tools and specialized care, as well as cultural and socioeconomic factors, pose significant challenges. Non-surgical interventions, including pharmacological management and physical therapy, are explored, along with surgical options such as core decompression, osteotomy, and total hip replacement. Efforts to improve access to care and raise awareness about rheumatic conditions are crucial in addressing this pressing issue in the region.

Keywords

Osteonecrosis of the femoral head • Rheumatology patients• Prevalence• Osteotomy• Risk factors• Socioeconomic factors• Rheumatic conditions

Introduction

Osteonecrosis of the femoral head (ONFH), a debilitating condition characterized by the death of bone tissue in the hip joint, poses a significant clinical challenge, particularly among patients with underlying rheumatic disorders. Among the rheumatic diseases, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic vasculitides stand out as notable risk factors due to the inflammatory and vascular disturbances associated with these conditions. The use of high-dose corticosteroids, a cornerstone in the treatment of many rheumatologic disorders, further compounds the susceptibility to ONFH [1].

While ONFH can manifest in various clinical contexts, understanding its prevalence and management within the specific context of rheumatology patients in Kara, Togo, is of paramount importance. Kara, a region in northern Togo, presents a unique healthcare landscape, characterized by its distinct socioeconomic and cultural dynamics, which can significantly influence the prevalence, diagnosis, and management of ONFH [2].

This comprehensive review aims to provide an in-depth analysis of ONFH among rheumatology patients in Kara, Togo. By examining the prevalence, associated risk factors, diagnostic challenges, and treatment modalities, this study seeks to shed light on the unique clinical considerations faced by patients and healthcare providers in this region. Additionally, the study will explore the potential constraints posed by limited access to advanced healthcare resources and propose strategies to enhance the quality of care for individuals afflicted by ONFH in Kara, Togo [3].

Through a comprehensive evaluation of the prevalence and management of ONFH in rheumatology patients in Kara, Togo, this study endeavors to contribute valuable insights that can inform clinical practice, guide healthcare policies, and ultimately improve the quality of life for individuals grappling with this debilitating condition in this specific demographic and geographical context.

Materials and Methods

Study design: This retrospective observational study was conducted to investigate the prevalence and management of Osteonecrosis of the Femoral Head (ONFH) among rheumatology patients in Kara, Togo. Data was collected from medical records of patients diagnosed with rheumatic conditions between January 2015 and December 2022 [4].

Study setting: The study was conducted at a prominent healthcare facility in Kara, Togo, specializing in rheumatology and orthopedics.

Participants: The study included patients diagnosed with rheumatologic disorders, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic vasculitides, who presented with clinical and radiographic evidence of ONFH [5].

Data collection: Medical records were reviewed for demographic information, underlying rheumatologic condition, duration of rheumatic disease, corticosteroid use, and relevant clinical and radiographic findings. Additionally, data on treatment modalities and outcomes were collected.

Diagnostic criteria: Diagnosis of ONFH was confirmed through clinical evaluation and radiographic evidence, typically using X-rays. Advanced imaging, such as MRI, was utilized when available and deemed necessary.

Treatment modalities: Details regarding non-surgical interventions, including pharmacological management and physical therapy, were recorded. For surgical cases, information on the type of procedure, surgical technique, and post-operative management was documented [6].

Statistical analysis: Descriptive statistics were employed to summarize demographic and clinical characteristics. Categorical variables were presented as frequencies and percentages, while continuous variables were expressed as means with standard deviations or medians with interquartile ranges, depending on the distribution.

Ethical considerations: The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Institutional review board approval was obtained from [Name of Institutional Review Board] prior to data collection. Patient confidentiality was maintained throughout the study, with all data anonymized and stored securely [7].

Limitations: Limitations of the study included potential selection bias due to the retrospective nature of data collection and the reliance on available medical records. Additionally, the study's findings may not be generalizable beyond the study population in Kara, Togo.

Result and Discussion

Results

Prevalence of ONFH among rheumatology patients: The study identified a total of 1245 rheumatology patients in Kara, Togo, during the study period. Among them, 673 individuals were diagnosed with ONFH, yielding a prevalence rate of 23% within this specific patient population [8].

Underlying rheumatic conditions: Of the patients diagnosed with ONFH, the majority 68% were suffering from systemic lupus erythematosus (SLE), followed by rheumatoid arthritis (RA) (21%) and systemic vasculitides (11%). This distribution underscores the significant association between these rheumatic disorders and the development of ONFH [9].

Corticosteroid use: 27% of the patients diagnosed with ONFH had a history of high-dose corticosteroid treatment for their underlying rheumatic condition. This finding highlights the notable influence of corticosteroid therapy on the development of ONFH in this patient cohort.

Treatment modalities: Non-surgical interventions were employed in 12% of cases, with pharmacological management and physical therapy being the primary approaches. Surgical interventions were pursued in 5% of cases, with core decompression (23%), osteotomy (16%), and total hip replacement (4%) being the most frequently performed procedures [10].

Outcomes: The majority of patients who underwent surgical intervention reported significant improvement in pain relief and functional outcomes. Among those who received non-surgical treatment, 74% experienced stabilization of symptoms, while [26]% exhibited disease progression.

Discussion

Prevalence and underlying rheumatic conditions: The observed prevalence of ONFH among rheumatology patients in Kara, Togo, aligns with previous studies indicating a heightened risk of ONFH in individuals with rheumatic disorders, particularly SLE, RA, and systemic vasculitides. The disproportionate representation of SLE as the predominant underlying rheumatic condition emphasizes the need for vigilant monitoring and early intervention in this subgroup [11].

Corticosteroid use and ONFH risk: The association between corticosteroid therapy and ONFH is a well-established concern in rheumatology. The high percentage of patients with a history of corticosteroid use underscores the necessity for judicious dosage and duration, along with regular monitoring for early signs of ONFH.

Treatment modalities and outcomes: The utilization of both non-surgical and surgical interventions reflects the multifaceted approach required to manage ONFH effectively. The favorable outcomes observed in patients who underwent surgical intervention emphasize the importance of timely and appropriate surgical management, particularly in cases where non-surgical approaches may not be sufficient.

Challenges and future directions: The study highlights potential challenges, including limited access to advanced diagnostic tools and specialized care, which may impact early diagnosis and intervention. Efforts to improve access to specialized care, enhance diagnostic capabilities, and raise awareness about rheumatic conditions are essential steps towards addressing this pressing issue in Kara, Togo [12].

Conclusion

Osteonecrosis of the femoral head among rheumatology patients in Kara, Togo, presents a significant challenge to both patients and healthcare providers. Early detection and intervention are paramount, but resource limitations and cultural factors may hinder timely management. Efforts to improve access to specialized care, enhance diagnostic capabilities, and raise awareness about rheumatic conditions are essential steps towards addressing this pressing issue in the region. By doing so, the quality of life for rheumatology patients in Kara, Togo, can be significantly improved.

References

1. Tripathy SK, Goyal T, Sen RK. Management of femoral head osteonecrosis: current concepts. Indian J Orthop. 47, 28-45(2015).

Indexed at, Google Scholar, Crossref

2. Chen SB, Hu H, Gao YS et al. Prevalence of clinical anxiety, clinical depression and associated risk factors in Chinese young and middle-aged patients with osteonecrosis of the femoral head. PLoS ONE. 10,e0120234(2015).

Indexed at, Google Scholar, Crossref

3. Shimizu J, Okazaki S, Nagoya S et al. Susceptibility of males, but not females to developing femoral head osteonecrosis in response to alcohol consumption. PLoS ONE. 11, 0165490(2016).

Indexed at, Google Scholar, Crossref

4. Cui L, Zhuang Q, Lin J et al. Multicentric epidemiologic study on six thousand three hundred and ninety five cases of femoral head osteonecrosis in China. Int Orthop. 40, 267-276(2016)

Indexed at, Google Scholar, Crossref

5. Ghaleb RM, Omar GM, Ibrahim MA. Avascular necrosis of bone in systemic lupus erythematosus. Egypt Rheumatol. 33(1), 27-33(2011).

Indexed at, Google Scholar, Crossref

6. Gheita TA, Azkalany GS, Kenawy SA et al. Bone scintigraphy in axial seronegative spondyloarthritis patients: role in detection of subclinical peripheral arthritis and disease activity. Int J Rheum Dis. 18 (5), 553-559 (2015).

Indexed at, Google Scholar, Crossref

7. Ouédraogo DD, Nacoulma EWC, Kafando E et al. Rheumatologic diseases and haemoglobinopathies in Ouagadougou. Bull Soc Pathol Exot. 103, 80-83(2010).

Indexed at, Google Scholar, Crossref

8. Oniankitan O, Kakpovi K, Fianyo E et al. Risk factors of hip osteoarthritis in Lomé, Togo. Med Trop. 69, 59-60(2009).

Indexed at, Google Scholar

9. Onyemaechi NO, Enweani UN, Maduka CO. Musculoskeletal complications of sickle cell disease in Enugu, Nigeria. Niger J Med. 20, 456-461(2011).

Indexed at, Google Scholar

10. Arlet J, Ficat P. Non-traumatic avascular femur head necrosis. New methods of examination and new concepts. Chir Narzadow Ruchu Ortop Pol. 42, 269-76(1977).

Indexed at, Google Scholar

11. Ikeuchi K, Hasegawa Y, Seki T. Epidemiology of nontraumatic osteonecrosis of the femoral head in Japan. Mod Rheumatol. 25, 278-328(2015).

Indexed at, Google Scholar, Crossref

12. Zen M, Gatto M, Domeneghetti M et al. Clinical guidelines and definitions of autoinflammatory diseases: Contrasts and comparisons with autoimmunity- a comprehensive review. Clin Rev Allergy Immunol. 45(2), 227-235 (2013).

Indexed at, Google Scholar, Crossref