TITLE:
Epidemiological, Diagnostic, Therapeutic, and Outcome Profile of Pediatric Systemic Diseases in Chad
AUTHORS:
Harine Abdel Aziz Garba, Adama Bah, Ramadhane Bouchrane, Sadou Yamoga Lam, Rakseunbe Ignazianki, Harine Abdel Aziz Hamid, Moustapha Niasse, Saïdou Diallo
KEYWORDS:
Juvenile Idiopathic Arthritis, Pediatric Systemic Diseases, Acute Rheumatic Fever, Outcomes, Methotrexate, Sub-Saharan Africa, Chad
JOURNAL NAME:
Open Access Library Journal,
Vol.12 No.11,
November
20,
2025
ABSTRACT: Background: Pediatric systemic diseases are heterogeneous, potentially disabling, and under-reported in Sub-Saharan Africa. We aimed to describe their epidemiological, diagnostic, therapeutic, and outcome profile in a hospital setting in Chad. Methods: We conducted a retrospective descriptive study with a prospective component in the Rheumatology Unit between January 2020 and September 2024. Cases were identified using standard clinical and paraclinical criteria (ACR/EULAR where applicable). Demographic, clinical, laboratory, treatment, and outcome data (CHAQ, JADAS when available) were analyzed with SPSS 21.0. Results: Among 5000 patients seen during the study period, 111 fulfilled criteria for pediatric-onset systemic diseases (frequency 2.34%): juvenile idiopathic arthritis (JIA) 85 (76.6%) and connective tissue diseases 26 (23.4%) including acute rheumatic fever 7, juvenile Sjögren’s syndrome (primary/secondary) 15, dermatomyositis 2, systemic sclerosis 1, and systemic lupus erythematosus 1. Females accounted for 78/111 (70.3%). Mean age at disease onset was 11.21 years (range 2 - 16); mean diagnostic delay was 4.2 years (3 months - 32 years). JIA subtypes were: systemic 5 (including 1 MAS), RF-negative polyarticular 26, RF-positive polyarticular 14, oligoarticular 6, enthesitis-related arthritis 26, and undifferentiated 5. Acute anterior uveitis occurred in 13 cases. Management relied mainly on NSAIDs, corticosteroids, hydroxychloroquine, and methotrexate; biologics (etanercept) were used in 3 patients. Outcomes were generally favorable; three deaths were recorded (1 MAS, 1 infectious syndrome with dyspnea, 1 bedridden state). Conclusions: In this Chadian cohort, JIA predominated, whereas acute rheumatic fever was less frequent than historically reported. Conventional DMARDs remain the mainstay of therapy; access to biologics is limited. Diagnostic delays and severe complications underscore the need for earlier recognition, systematic follow-up, and improved access to advanced therapies.