背景:风湿性疾病会严重影响儿童的整体健康,发展,和增长。然而,由于缺乏资源,在许多非洲国家,小儿风湿病在很大程度上是不发达的专业。患有风湿性疾病的儿童在获得专门医疗护理方面面临障碍,包括缺乏专家,护理中心,药物接入,以及有限的研究和教育,以增加医疗保健从业者对小儿风湿性疾病的理解。这项研究描述了疾病的特点,患病率,以及在阿克拉的教学医院接受护理的小儿风湿性疾病患者所面临的挑战,加纳。
方法:对2011年1月至2021年12月在KorleBu教学医院风湿病诊所就诊的所有儿科病例进行了一项基于记录的回顾性研究。收集的数据包括临床特征,疾病表现的实验室发现,根据标准指南和经验规定的治疗方案。
结果:截至2021年,共确定121例,点患病率为0.0011%。大多数(73%)是女性,平均年龄为13.4±3.2岁。患者在成功转诊至风湿病学家之前经历的平均症状持续时间为18个月。转诊诊断和确诊诊断之间存在显着差异,特别是在涉及混合性结缔组织疾病(MCTD)的病例中,系统性红斑狼疮(SLE),和青少年皮肌炎(JDM),这表明这些条件可能被低估了。关节痛和关节炎是最常见的症状。研究的病例中有四分之三以上(86.8%)接受了类固醇(口服或静脉注射)治疗。在需要免疫抑制治疗的病例中,在33.9%的病例中,甲氨蝶呤是最常用的处方。死亡率为8.3%,大多数涉及SLE病例。大多数(95.7%)的主要护理人员对成人风湿病诊所接受的护理表示了积极的经验。
结论:小儿风湿性疾病(PRD)患者的诊断和诊断准确性明显延迟。这凸显了加强非洲儿科风湿病服务的迫切需要,包括提高公众和医疗保健提供者对这些疾病的认识,以改善患有这些疾病的儿童的早期诊断和生活质量。
BACKGROUND: Rheumatic diseases can seriously impact children\'s general health, development, and growth. However, due to a lack of resources, paediatric rheumatology is a largely underdeveloped speciality in many African nations. Children with rheumatic disorders face obstacles in accessing specialized medical care, including lack of specialists, care centres, medication access, and limited research and education to increase understanding of paediatric rheumatic disease among healthcare practitioners. This study described the disease characteristics, prevalence, and challenges faced by paediatric rheumatic disease patients receiving care at a teaching hospital in Accra, Ghana.
METHODS: A retrospective record-based study was conducted among all paediatric cases presenting to the rheumatology clinic of the Korle Bu Teaching Hospital (KBTH) from January 2011 to December 2021. Data collected include clinical features, laboratory findings at disease presentation, andtherapeutic regimens prescribed per standard guidelines and experiences.
RESULTS: A total of 121 cases were identified as of 2021, indicating a point prevalence of 0.0011%. The majority (73%) were females with a mean age of 13.4 ± 3.2 years. The mean duration of symptoms in months experienced by patients before being successfully referred to a rheumatologist was 18 months. There were significant differences between referred and confirmed diagnoses, especially in cases involving mixed connective tissue diseases (MCTD), systemic lupus erythematosus (SLE), and juvenile dermatomyositis (JDM), suggesting that these conditions may be under-recognised. Arthralgia and arthritis were the most common presenting symptoms. More than three-quarters (86.8%) of the cases studied were treated with steroids (oral or intravenous). In cases requiring immunosuppressive therapy, methotrexate was the most commonly prescribed in 33.9% of instances. Mortality was recorded at 8.3%, with the majority involving SLE cases. Most (95.7%) of the primary caregivers expressed positive experiences regarding care received at the adult rheumatology clinic.
CONCLUSIONS: There were significant delays in diagnosis and diagnostic accuracy for patients with paediatric rheumatic disease (PRD). This highlights the pressing need for strengthening paediatric rheumatology services in Africa, including increasing awareness about these conditions among the public and healthcare providers to improve early diagnosis and quality of life for children with these conditions.