The diagnosis of RA is delayed in Senegal, and the disease is highly active at diagnosis, although 44 patients have no erosions, and extra-articular manifestations are rare.

Purpose: The unfortunate association between myasthenia gravis and Graves' disease is not widely appreciated. It would be consistent with a genetic predisposition for autoimmune disease. The frequency of this association is variously appreciated in the literature. Case: We report a case of a 20 years old patient with a two years history of Graves' disease, who presented with a myasthenic syndrome leading to an acute respiratory failure. This was found to be reversible with prostigmine, and the diagnosis of myasthenia gravis (MG) was confirmed by EMG and positive immunology. There was a positive response to medical treatment. Discussion: The frequency of this association is variously appreciated in the literature. MG has been reported to be discovered simultaneously with, or prior to, the diagnosis of Graves' disease, but is most commonly subsequent to it. The similarity of symptoms makes diagnosis difficult. Furthermore, an excess of thyroid hormones worsens MG and the existence of MG imposes certain precautions in the management of hyperthyroidism. Conclusion: Research is called for into the surveillance and management of specific manifestations of the co-occurrence of these conditions.

Several studies have suggested that rheumatoid arthritis (RA) is uncommon in rural sub-Saharan Africa. The aim of this study is to determine the potential differences between patients with RA living in rural areas and those living in urban areas. We performed a cross-sectional study from June 2006 to May 2009. We included all patients with RA (1987 ACR criteria) seen at the Rheumatology Unit of the Le Dantec Teaching Hospital, Dakar, Senegal. We compared the main socio-demographic and clinical characteristics of patients living in rural areas to those living in urban areas. We included 180 patients in our study, of whom, 143 (79.4 %) lived in urban areas and 37 (20.6 %) in rural areas. The median age was 44 years [range 34-55] in patients from rural areas vs. 41 years [range 30-53] in patients from urban areas, without any statistical significance (p = 0.24). Patients under the age of 60 mostly lived in urban areas (p = 0.03). The extra-articular manifestations were significantly more frequent in patients living in rural areas (p = 0.02). There was no statistical significance when comparing the delay in diagnosis, number of swollen joints, disease activity, hand deformities, and concentration of autoantibodies (RF and ACPA) in both populations. The percentage of patients seen from the rural areas of Senegal is low (20.6 %) compared to those seen from the urban areas. The number of extra-articular manifestations is the main difference between patients living in rural and urban areas. The role played by environmental factors seems important. Further incidence studies are needed.

Le myélome multiple (MM) ou maladie de Kahler est une prolifération maligne monoclonale plasmocytaire se développant dans la moelle osseuse avec la production d'une immunoglobuline (Ig) monoclonale. L'objectif de cette étude est de décrire la présentation clinique du MM dans un service de médecine interne. Patients et méthode : Il s'agit d'une étude descriptive réali-sée sur une période de huit ans au CHU Aristide-Le-Dantec de Dakar (Sénégal). Était inclus dans l'étude, tout patient présentant des critères biologiques, cytologiques ou histologiques de MM. Résultats : L'âge moyen au moment du diagnostic était de 55,7 ans. Sur le plan clinique, un syndrome osseux était retrouvé dans 69 % des cas, des fractures pathologiques dans 30,9 % des cas. Sur le plan paraclinique, une anémie était observée chez 57,7 % des malades, l'hyperprotidémie était notée chez 48,3 % des malades, une hypercalcémie était observée dans 69 % des cas et une insuffisance rénale était retrouvée dans 28,6 % des cas. L'électrophorèse des protéines sériques avait mis en évidence un pic au niveau des gammaglobulines dans 55 % des cas. Dans les urines, on notait l'existence des chaînes légères de type lambda dans 80 % des cas et de type kappa dans 20 % des cas. Conclusion : Le tableau clinique du myélome dans nos régions est bruyant, avec des complications présentes dès le diagnostic. Cette présentation clinique reflète la lenteur diagnostique et donc de la prise en charge de cette pathologie. Pour citer cette revue : J. Afr. Cancer 3 (2011). Mots clés Myélome multiple · Présentation clinique · SénégalAbstract The multiple myeloma (MM) or Kahler disease is a clonal malignant proliferation of plasmocytes in bone marrow with monoclonal immunoglobulin proliferation. The aim of this study is to describe the clinical presentation of MM in the Department of Internal Medicine of Dakar (Senegal). Patients and method: It is a descriptive study conducted over a period of eight years. Any patient who presented with biological, cytological, or histological criteria of MM was included in the study. Results: The average age at diagnosis was 55.7 years. Clinically, bone syndrome was found in 69% of the cases, and pathological fractures in 30.9% of the cases. Paraclinically, anemia was found in 57.7% of the patients, hyperprotidemy in 48.3%, hypercalcemia in 69%, and kidney disease in 28.6% of the cases. Electrophoresis of serum protein had revealed a high level of gammaglobulins in 55% of the cases. In urine samples, we noted the existence of light chains of lambda type in 80% and kappa type in 20% of cases. Conclusion: Clinical presentation of MM in Dakar showed that complications were present at the diagnosis; it reflects slow diagnosis and thus the management of the disease. To cite this journal: J. Afr. Cancer 3 (2011).