Spectrum of musculo-skeletal disorders in sickle cell disease in Lagos, Nigeria

Abstract

BackgroundSickle cell anemia (SCA) is a common genetic disease in Nigeria. Past studies from West Africa focused on isolated aspects of its medical and surgical presentations. To the best of our knowledge, the musculo-skeletal presentations amongst Nigerians with SCA have not been documented in a single all encompassing study. This work aims to prospectively document the musculo-skeletal disease burden among SCA patients.MethodsIn a prospective study of 318 consecutive patients with genotype-confirmed SCA at the Lagos University Teaching Hospital (LUTH), the musculo-skeletal pathologies, anatomic sites, grade of disease, age at presentation and management outcome were recorded over a one-year period. Data obtained were analyzed using Epi-Info software version 6.0. Data are presented as frequencies (%) and mean values (SD) as appropriate.ResultsThe HbSS genotype occurred in 296 (93.0%), while 22 (7.0%) were HbSC. 100 (31.4%) patients with average presenting haemoglobin concentration of 8.2 g/100 ml in the study group, presented with 131 musculo-skeletal pathologies in 118 anatomic sites. Osteomyelitis 31 (31%) and septic arthritis 19 (19%) were most commonly observed in children less than 10 years. Skin ulcers and avascular necrosis (AVN) occurred predominantly in the older age groups, with frequencies of 13 (13.0%) and 26 (26.0%) respectively. 20 (71.5%) of diagnosed cases of AVN presented with radiological grade 4 disease. The lower limbs were involved in 84 (71.1%) of sites affected. Lesions involving the spine were rare 11 (0.9%). Multiple presentations occurred in 89 (28.0%) of patients; 62 (69.7%) of which were children below 10 years.ConclusionsMusculo-skeletal complications are common features of sickle cell anaemia seen in 31.4%. Infectious aetiologies predominate with long bones and joints of lower limbs more commonly affected by osteomyelitis and septic arthritis. Healthcare providers managing SCA should be aware of the potential morbidity and mortality of these conditions to ensure early diagnosis and adequate management.

Musculoskeletal complications in sickle cell anemia patients: a ten-year retrospective review of hospital-based records (1991-2000) in two Nigerian hospitals

“…This prevalence is similar with the findings of 19 (12.8%) but at variance with the prevalence of (37.5%) and (18%) reported by 20,24 respectively. Salmonella has been thought to be responsible for osteomyelitis in children with SCA in more than 50% of cases 25 and in over 70% of cases.…”

“…13 The prevalence of musculoskeletal disorders in this study is high 54.1%. This prevalence is higher than that reported by Chinawa et al, 19 (32.1%) and Balogun et al, 20 (31.4%) in Nigeria.…”

“…The prevalence of septic arthritis in the current study is similar with previous reported prevalence of 6-15%. 16,17,20,27 The study also reported hand and foot syndrome (dactylitis) and low back pain (11.6%) respectively as one of the leading musculoskeletal disorders seen among these patients. This is in contrast with 20 that reported a lower prevalence of 7.6% among their participants.…”

“…16,17,20,27 The study also reported hand and foot syndrome (dactylitis) and low back pain (11.6%) respectively as one of the leading musculoskeletal disorders seen among these patients. This is in contrast with 20 that reported a lower prevalence of 7.6% among their participants. However the study by 19 did not report any incidence of dactylitis and low back pain in their five year review.…”

Factors Associated with Aseptic Osteonecrosis in Hospital Settings in Yaounde, Cameroon

“…Nevertheless, this pathology is often described in association with sickle cell anemia [3]- [5] and infection by human immunodeficiency virus [6] [7]. Equatorial Africa has a prevalence of sickle cell anemia trait that varies between 10% and 40% [8], and HIV infection is endemic in this region [4]. The latter increases the risk of occurrence of aseptic osteonecrosis by 100 times when compared to a normal healthy general population [6].…”