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Osteoarthritis (OA) is a common degenerative condition leading to significant pain, functional limitation, and economic loss. Generalized OA (GOA) is associated with greater morbidity and accounts for 5-25% of total OA cases depending on definition used. This paper aims to determine the frequency and pattern of GOA, compare clinical and laboratory parameters of GOA and non-GOA subjects, then identify independent associations of GOA among Nigerians with knee OA.A cross-sectional study of 180 knee OA patients with knee and generalized OA defined using ACR criteria. Questionnaire administration was followed by physical examination and appropriate radiographs. Data was summarized using tables and figures. Multivariate regression was done to identify independent GOA associations with statistical significance p0.05. Ethical approval was obtained for the study.There were 180 participants with mean age 59.7±9.1 years. Twenty-eight patients (15.6%) had GOA of which 26 were female. The hip/knee/spine pattern was the commonest while hand OA was rare. Comparisons showed that GOA patients were significantly older with longer pain duration, higher pain score, more Heberden's nodes, and greater fatigue. There were no significant differences between both groups in levels of inflammatory markers and other laboratory parameters. Further analysis identified joint stiffness as the only independent association of GOA (OR 3.34, p=0.01).A 15.6% frequency of GOA was identified among knee OA sufferers with the hip/knee/spine pattern most frequent. Nigerians with GOA are predominantly females with a large joint phenotype. Joint stiffness was the only independent association of GOA observed. Key Points • Generalized osteoarthritis occurs in 15.6% of Nigerian patients with knee osteoarthritis. • Females are predominantly affected with a large joint phenotype involving the hip/knee/spine. • Joint stiffness is an independent association of generalized osteoarthritis.

Interstitial lung disease (ILD) occurs in 15% of connective tissue disease (CTD) patients causing considerable morbidity and mortality. Data is scarce regarding its clinical characteristics and outcomes in Africa. We aim to study the frequency, clinico-radiological characteristics, and treatment outcomes of African CTD-ILD patients. A retrospective cross-sectional study of ILD among 318 CTD patients diagnosed using relevant ACR criteria at the rheumatology unit of Lagos State University Teaching Hospital (LASUTH), Lagos from 2012 to 2019. Socio-demographics, clinical features, radiological findings, and treatment outcomes were documented. Data was analyzed using SPSS version 21 with p < 0.05. The LASUTH ethics committee approved the study. Interstitial lung disease occurred in 31 (9.7%) of 318 CTD cases. Their mean age was 38.8 ± 13.3 years, range 19-68 years with 28 (90.3%) females. Proportions of CTD-ILD were Sjogren's syndrome (50%), UCTD (50%), systemic sclerosis (46.7%), MCTD (33.3%), PM/DM (25%), SLE (6.5%), and RA (2.6%). Commonest presentations were cough (93.5%) and bibasal inspiratory crackles (83.9%) with a restrictive pattern in 83.9%. Antinuclear antibody occurred in 100% and anti-ENA in 67.7%. Traction bronchiectasis (89.7%) and ground glass opacities (96.6%) were frequent HRCT findings. Treatments included pulse-dose prednisolone, cyclophosphamide, mycophenolate mofetil, pirfenidone, and rituximab. Outcomes were ambulatory oxygen therapy (12.9%) and mortality (16.1%) with 9.7% lost to follow-up. CTD-ILD is a female predominant disease occurring in 9.7% of CTD patients mostly those with Sjogren's syndrome and systemic sclerosis. Due to significant morbidity and mortality, we advocate routine ILD screening for all CTD patients including those with undifferentiated disease. Key Points: • Interstitial lung disease occurs in 9.7% of patients with underlying connective tissue disease. • Females are predominantly affected especially those with Sjogren's syndrome and systemic sclerosis. • Mortality occurs in roughly 1 in every 6 patients with CTD-ILD.

To determine the prevalence of depression and its determinants among Nigerian patients with knee osteoarthritis (OA). Two hundred and fifty patients satisfying the American College of Rheumatology classification criteria for knee OA were recruited from five centers. Pain was assessed using Western Ontario and McMaster Universities Index (WOMAC) pain subscale, functional status was determined by Steinbrokers criteria, radiographic knee OA was graded using Kellgren–Lawrence criteria, depression was determined using the Patient Health Questionnaire (PHQ-9), sleep quality by the Pittsburgh Sleep Quality Index (PSQI), and family functioning by Family APGAR (Adaptation, Partnership, Growth, Affection, and Resolve). Factors associated with depression in KOA following bivariate analyses were adopted as independent variables in logistic regression analysis to determine the predictors of depression in KOA. The study was approved by the Ethical Review Committee of each of the study centers. The mean age of patients was 59.90 ± 10.62 years and 209 (83.6%) were females. Their mean PHQ-9 score was 4.68 ± 4.19 with 105 (42%) having depression (PHQ-9 ≥ 5). Eighty-four (80%) of patients with depression had poor sleep quality (PSQI≥ 5.0). Depression was significantly associated with poor sleep, WOMAC pain scores, medial compartment KOA, lateral compartment KOA, and patellofemoral OA. Poor sleep quality was the best predictor of depression (OR 4.555, CI (2.241–9.257), p

ObjectivesTo develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic.MethodA task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-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.ResultsA total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting.ConclusionsThe 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.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 the African rheumatologists.• Hydroxychloroquine shortage has become rampart across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of 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.