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ObjectivesTo determine the frequency and predictors of sleep abnormalities among patients with knee osteoarthritis (OA) in Nigeria.Material and methodsA multi-centre, hospital-based, cross-sectional study, involving 250 knee OA patients. Consenting patients 18 years and above, who satisfied the American College of Rheumatology (ACR) criteria for knee OA were recruited from five Nigerian tertiary centres over 3 months. An interviewer-administered questionnaire was used to collect demographic and relevant clinical information. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality with scores ≥ 5 indicating poor sleep. Other variables assessed were pain, depression, functional class and family functioning. Data were summarized using appropriate measures of central tendency and dispersion. Multiple logistic regression analysis was done to identify predictors of poor sleep. Analysis was done using SPSS version 21.0 with p < 0.05 considered significant. Study approval was obtained from the ethical committees of each of the study sites.ResultsParticipants included 209 females (83.6%) with mean age 59.9 ±10.6 years. One hundred and forty-one participants (56.4%) had PSQI scores ≥ 5 (poor sleep). This was significantly associated with depression (p < 0.001), level of education (p = 0.001), higher pain scores (p < 0.001), body mass index (p = 0.040), medial knee OA (p = 0.032) and patello-femoral OA (p = 0.002). Higher level of education, worse depression scores and higher WOMAC pain scores were the best predictors of poor sleep quality.ConclusionSleep quality was poor in over half of our knee OA patients and best predicted by depression, pain and level of education. Regular sleep quality assessment for knee OA patients is recommended.

Objectives To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic. Method A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a huband-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1-3, 4-6 and 7-9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a 'low' level of agreement. Results A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting. Conclusions The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges. Keywords African rheumatology. COVID-19. DMARD. Rheumatic and musculoskeletal diseases. Rheumatology Key Points • AFLAR has developed preliminary recommendations for the management of RMDs in the face of the COVID-19 pandemic. • COVID-19 is an unprecedented experience which has brought new concerns regarding the use of some disease-modifying anti-rheumatic drugs (DMARDs), and these recommendations seek to provide guidelines to African rheumatologists. • Hydroxychloroquine shortage has become rampant across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of the treatment plan for some patients with RMDs. • Breastfeeding should continue for as long as possible if a woman is positive for SARS-CoV-2 as there is currently no evidence that the infection can be transmitted through breast milk. This article is part of the Topical Collection on Rheumatology in Africa

The COVID19 pandemic has caused widespread global devastation with over 11 million infections and 534,000 deaths recorded at the end of June 2020. Measures such as physical distancing and regular hand hygiene are effective in controlling the disease, though compliance varies. This study aimed to determine the frequency of hand hygiene compliance, identify reasons for non-compliance as well as significant associations of hand hygiene performance, type and duration. Visitors to two landmark sites in Uyo—southern Nigeria, (a tertiary hospital and a popular mall) were observed for hand hygiene compliance. The type and duration of hand hygiene was also assessed. A subset of the participants was subsequently invited to participate in an interviewer-administered survey comprising questions on hand hygiene frequency, type, duration and reasons for non-compliance. Ethical approval was obtained for the study. A total of 490 subjects were observed from both sites (280 from the mall and 210 from the hospital), while 155, comprising 52.9% females and 47.1% males, with a mean age of 32.3 ± 11.2 years completed the survey. Although almost all patients (94.2%) considered hand hygiene a necessity, most (65.2%) forgot to wash their hands. Majority of the participants (74.3%) performed hand hygiene, while using soap and running water was the preferred method in majority (80.6%). Age and location were significantly associated with hand hygiene performance, type and duration Over 70% of adult residents in Uyo performed hand-hygiene though infrequently. Forgetfulness was the most common reason for non-compliance. Public education and compulsion at public places are key strategies in improving hand hygiene compliance.

Psoriatic arthritis is rare among Nigerians and predominantly affects males in their fourth decade. Oligoarthritis is common, and extra-articular manifestations are frequent.