Background

Pediatric Rheumatology (PR) is a young specialty that has not yet gained momentum in Algeria. The aim of this study is the assessment of the perception of PR by pediatric residents in Algeria and the current practice of this young sub-specialty in our country.

Methods

Descriptive cross-sectional study evaluating the perception of PR by pediatric residents was created on Google forms and distributed via email and Facebook to be taken as a self-administered online survey.

The survey is composed of three parts: socio-demographic characteristics of the participant, current practice of PR and perspectives of PR training.

Results

Seventy-seven residents responded to the online questionnaire, with an average age of 30.40 ± 3.13 years and 65% of participants being female. Participation included different regions of Algeria (Batna, Annaba, Setif, Constantine, Algiers and Oran) and different levels of training (from the first year to the fifth year of residency)

Ninety-two percent (92%) of participants had managed PR consultations, with a frequency of once a week in 75.3% of cases and twice a week in 15.6% of cases. In 81% of cases, it was not the initial presentation. The patients were mainly referred by a general practitioner or a general pediatrician. The Management of these patients was provided by a general pediatrician in 69.4% of cases and only in 37.7% by a specialized pediatrician. In 71.4% of cases, there was no pediatric rheumatologist in the establishment where the resident was being trained.

The level of knowledge in PR was admitted to be poor by 59.7% of the respondents. Seventy-five percent of the residents wanted to have rotations dedicated to this sub-specialty during their training. Seventy percent thought that PR is equally as important to know as the other subspecialties in pediatrics (pediatric endocrinology, pediatric pneumology ...). Interest in further PR training was expressed by 80.5% of participants, given the chance.

Conclusion

This survey reinforces the perception that PR training needs to be improved in Algeria, especially as the number of PR consultations is on the rise.

The creation of specialized training in PR is becoming a necessity.

Background

Gourgerot-Sjögren syndrome (GSS) is a systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands leading to dryness of the mucous membranes. It may also involve other organs and organ systems. GSS can be primary (pGSS) or secondary due to other autoimmune diseases. pSGS mainly affects women over 40 years old, but can occur at any age. GSS is rare in children and is often secondary to other diseases. We report the case of a 12-year-old girl with primary Gougerot-Sjögren Syndrome

Methods and results

A 12-year-old girl from Batna (Algeria) presented to her pediatrician in 2016 for a rash with arthralgia. She had no relevant past medical history and is the child of a non-consanguineous marriage. Clinical examination found a well-nourished child with a purpuric rash on her lower limbs. She complained of arthralgia without clinical signs of arthritis. The child also complained of a sensation of a foreign body and burning in both eyes. The eye exam was normal except for a positive Schirmer's test. There were no signs of parotitis. Laboratory tests showed an erythrocyte sedimentation rate (ESR) of 84 mm the first h and a negative C-reactive protein (CRP). She was also Leukopenic. Serological testing resulted in a positive Anti SS-A and Anti SS-B. The abdominal pelvic ultrasound was normal.

The patient was diagnosed with primary Gougerot-Sjögren Syndrome. Artificial tears and hydroxychloroquine were started as initial therapy. One year later we added an immunosuppressant (Methotrexate) due to the persistence of clinical signs.

Conclusion

Our case is particular in that primary Gougerot-Sjögren Syndrome is rare in children. Routine follow- up with this patient is important to determine whether it is indeed pGSS with pediatric onset or GSS secondary to another autoimmune disease.

Background

Pediatric Rheumatology is an orphan specialty in Africa which is gradually gaining importance across the continent.

Main body

This commentary discusses the current state of affairs in the sphere of Pediatric Rheumatology across Africa and offers practical strategies to navigate the challenges encountered in research, models of care, education and training. We outline the establishment, opportunities of growth and achievements of the Pediatric Society of the African League Against Rheumatism (PAFLAR).

Conclusion

This commentary lays the foundation for establishment of a formidable framework and development of partnerships for the prosperity of Pediatric Rheumatology in Africa and beyond.

Juvenile Idiopathic Arthritis (JIA) is a group of chronic heterogenous disorders that manifests as joint inflammation in patients aged <16 years. Globally, approximately 3 million children and young adults are suffering from JIA with prevalence rates consistently higher in girls. The region of Africa and Middle East constitute a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of JIA. There are only a few studies published on epidemiology of JIA in the region. There is an evident paucity of adequate and latest data from the region. This review summarizes the available data on the prevalence of JIA and its subtypes in Africa and Middle East and discusses unmet needs for patients in this region. A total of 8 journal publications were identified concerning epidemiology and 42 articles describing JIA subtypes from Africa and Middle East were included. The prevalence of JIA in Africa and Middle East was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in the region was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be lower as compared to the incidence from other regions. There is a huge unmet medical need in the region for reliable epidemiological data, disease awareness, having regional and local treatment guidelines and timely diagnosis. Paucity of the pediatric rheumatologists and economic disparities also contribute to the challenges regarding the management of JIA.

Contrairement à l'abstention-surveillance, la surveillance active est une modalité de prise en charge curative. Elle vise à retarder le traitement d'une tumeur peu agressive jusqu’au moment où elle le deviendra tout en restant dans la fenêtre de curabilité de la maladie. À travers une lecture de littératures, nous allons essayer de maitre la lumière sur la place et les modalités de la surveillance active, dans les groupes favorables des cancers de la prostate et de répondre aux questions suivantes : Pourquoi la surveillance active ? Pour qui ? Comment l’instauré ? et quand doit-on l’arrêter ? La majorité des essais, cliniques publiés s’accordent à dire, que la surveillance active est une attitude parfaitement adaptée aux patients du groupe favorable d’AMICO, voire même une partie du groupe intermédiaire bas risque. Les résultats en matière de survie globale et d’évènement métastatiques, sont similaires à ceux des patients traités d’emblée par chirurgie et ou radiothérapie, avec en plus moins de toxicité. La surveillance est basée essentiellement sur le dosage périodique du PSA, rebiopsie selon des protocoles propres à chaque équipe. La décision du passage aux traitements invasifs, sera conditionnée par la progression du score Gleason, selon des algorithmes dont certains, sont déjà validés à l’international. La surveillance active, doit faire partie intégrante des décisions de prise en charge des adénocarcinomes prostatiques localisés favorables. Cette attitude nous permet, d’éviter de surtraiter un grand nombre, de petites lésions non évolutives, tout en ayant la possibilité et les moyens, de rattraper les lésions qui progressent.