Introduction: Patients with Systemic Lupus Erythematosus (SLE) are seen late in specialized medical consultation in Benin. The objective of this work was to assess general practitioners’ knowledge in Cotonou about SLE. Materials and Methods: This work was a cross-sectional study that was led in the city of Cotonou from July 1 to September 30, 2017. In the study population, we have general practitioners who practice in the city. Data collection was set in response to a self-questionnaire. Result: The survey involved 209 general practitioners. The average age was 27.5 years with a minimum of 22 and a maximum of 34. Most of them practiced in private clinics. Besides, 17 doctors (8.1%) reported that they never heard of lupus. Among the 192 remaining, only one had an average knowledge of lupus, while the others had insufficient knowledge. Conclusion: From this study, we got that SLE is still little known by the general practitioner. Increasing the knowledge of general practitioners’ knowledge of lupus is compulsory to improve the screening rate.
Systemic Lupus Erythematosus is an auto-immune disease from the group of the connective tissue disease [
In the Benin Republic, the published papers about this disease were done in numerous hospitals and patients are seen late by medical specialists, around 5 to 10 years on average after the onset of the first symptoms [
This work is a cross-sectional study conducted in the city of Cotonou from July 1 to September 30, 2017. In the study population, we have general practitioners and student doctors in their final school year who practice in the city. Let’s note that, in our context, general practitioners are doctors. Additionally, student doctors are to become general practitioners. Actually, we did a complex two-stage exhaustive sampling. Firstly, we selected the health institutions (teaching hospitals, local hospitals and polyclinics, clinics and medical offices were represented), then the doctors practicing there who were selected and eligible were included in the study. In addition, data collection was done with a self-questionnaire assisted by the investigation agency. As we know, this study is about knowledge of a specific disease and considering the standard [
Actually, we got 209 doctors in the study. There were 37 student doctors in their final school year in medicine and 172 general practitioners. Most of the doctors were from Benin medical faculty (98.1%) and mainly from the Faculty of Health Sciences (FSS) in Cotonou (80.9%). The average age was 27.5 years with a minimum of 22 and a maximum of 34.
Most of the doctors (91.4%) had limited knowledge about lupus. Doctors’ knowledge scores are in
The knowledge score has constantly increased from 2008 (17.9%) to 2017 (31.1 %) regardless of the peak in 2009 as shown in
· Information sources of Doctors who knew about lupus
The main information source of SLE was the basic medical education (84.4%). In addition,
The main LES teaching during reported basic medical education was internal medicine (48.1%) and dermatology (43.2%).
· Knowledge of clinical manifestations
The knowledge of the existence of clinical manifestations related to LES is described in
Score | Knowledge | Frequency | Percentage (%) |
---|---|---|---|
0% | Don’t know | 17 | 8.1 |
[0%; 50%] | Limited | 191 | 91.4 |
[50%; 65%] | Average | 1 | 0.5 |
[65%; 85%] | Good enough | 0 | 0.0 |
[85%; 100%] | Good | 0 | 0.0 |
Total | 209 | 100.0 |
Cutaneous, general, and rheumatological manifestations were the most frequently mentioned by physicians. Namely, we have erythema vespertilio (63.5%), fever (81.8%), and arthralgia (62.0%) that were, respectively, the most frequent symptoms of the manifestation.
In
Pregnancy, sun exposure, and medication are the most common triggers that the interviewees listed.
Frequency (n = 192) | Percentage (%) | |
---|---|---|
Basic medical training | 162 | 84.4 |
Mass Media | 24 | 12.5 |
Medical Press | 21 | 10.9 |
EPU | 15 | 7.8 |
Others* | 28 | 14.6 |
*Others: LES personal or family history, conference, inter-university diploma.
Known Manifestations | Frequency | Percentage |
---|---|---|
Mucocusal skin manifestations | 173 | 90.1% |
General manifestations | 171 | 89.1% |
Rheumatologic manifestations | 167 | 87.0% |
Renal manifestations | 159 | 82.8% |
Hematologic manifestations | 157 | 81.8% |
Cardiovascular manifestations | 151 | 78.6% |
Neuropsychiatric manifestations | 146 | 76.0% |
Breathing manifestations | 132 | 68.8% |
Digestive manifestations | 121 | 63.0% |
Ophthalmologic manifestations | 104 | 54.2% |
Genital manifestations | 93 | 48.4% |
Ear-nose-throat manifestations | 28 | 14.6% |
Known factors that can contribute to SLE | Frequency | Percentage |
---|---|---|
Pregnancy | 133 | 69.3% |
Exposition to sun | 117 | 60.9% |
Drugs | 112 | 58.3% |
Stress | 110 | 57.3% |
Tobacco | 96 | 50.0% |
Infections | 72 | 37.5% |
Contact with allergen | 48 | 25.0% |
Alcohol | 11 | 5.7% |
Don’t know | 8 | 4.2% |
14 doctors (7.3%) declared that SLE has been regularly noticed with young black women. Respectively, 78.1%, 75.5%, and 81.8% of doctors have confirmed that SLE is also possible with children, old people, and male patients. In addition, most of the surveyed (97.4%) stated that SLE can be diagnosed to female people.
Among the clinical manifestations of SLE, those that are cardiovascular and neuropsychiatric are the most frequently listed to be complicated. The ENT manifestations are the least mentioned in that section.
The majority of doctors (71.3%) said that they did not know the antibodies in SLE. Among the 192 practitioners who heard of LES, 43 (20.6%) cited native anti-DNA antibodies and 27 (12.9%) cited native anti-DNA antibodies as being specific for SLE.
· Criteria of classification
The majority of physicians (154% or 80.2%) reckoned that they did not know the classification criteria for LES. Among the 38 remaining, 17.2% mentioned the ACR classification and 1.6% the SLICC.
· Associated pathologies
Gougerot-Sjögren syndrome is the pathology frequently associated with SLE that is most cited by physicians (44.5%), followed by anti-phospholipid syndrome (18.2%). We also have 66 doctors (31.6%) who did not know any of the pathologies frequently associated with SLE.
· Therapeutic modality
Among the 192 physicians, 10 (5.2%) noted both corticosteroids and synthetic antimalarials as part of the initial background therapy.
Most of the doctors (153% or 79.3%) declared that they did not know the duration of SLE treatment.
· Training request
Most of the surveyed doctors who have heard of SLE (189% or 98.4%) expressed the desire to participate in a training on this disease.
Our study population was general practitioners and final school year students. Their age on average was 27.5 years and their average seniority period was 2.9 years. This population is quite young compared to the one in the studies of Rat et al. concerning the management of rheumatoid arthritis in general practice where the average age was 49 years [
Most of the doctors worked in polyclinics or local hospitals. Actually, these centers rarely offer permanent contracts. Indeed, these health facilities tend to employ a greater number of general practitioners and students to ensure continuity and on-call duty to manage the flow of patients.
Clinics and medical offices generally employ a single doctor who is in charge of ensuring continuity and not on-call.
Teaching hospitals most often offer stable jobs. However, these are the reference teaching hospitals where most of the practicing doctors are specialists or are in the process of being specialists.
The current results of the study revealed a low level of knowledge of general practitioners about SLE. Actually, 17 doctors (8.1%) stated not to have heard about this disease. Among the 192 physicians remaining, 191 had a limited knowledge of SLE. Blaauw et al. in 1995 demonstrated that it was one of the most difficult diagnoses for general practitioners [
Whatever personal efforts he makes or the quality of his initial training, the general practitioner has become, and will remain, the one who knows a little of everything.
In our study, we find that the primary source of information for surveyed doctors about SLE was their initial medical education. Internal medicine was the main teaching discipline which was followed by the dermatology. In the content of the doctors training at the Cotonou FSS, lupus has been taught in the dermatology program for several decades and in internal medicine for a year. This shows the need to strengthen the knowledge of general practitioners through postgraduate teaching. The level of knowledge, and therefore the level of uncertainty, changes with the addressed points in the different majors of medical knowledge. Thus, the factor contributing the most and cited by doctors was pregnancy (69.3% or 133), and it is followed by exposure to the sun and some drugs. This is because they are the most frequently found factors [
The best known manifestations are general, mucosal skin, and rheumatic. They are also the most frequent and common manifestations of systemic lupus [
Among the general manifestations, fever was the most cited; it is also the most common general sign; however it is not always related to SLE itself but rather to infectious complications of the treatment [
The most well-known mucosal skin manifestation by physicians was erythema malaria vespertilio. It is one of the specific lesions of SLE and it gives the disease its etymological origin [
Only 44.8% of physicians who reported the existence of mucosal skin manifestations in SLE mentioned discoid lesions, among them, 27.6% cited skin necrosis, and a quarter of them chose oral erosions. Urticarial lesions, alopecia, livedo, and vasculitis lesions are the least mucosal skin manifestations that were revealed. This is somehow an evidence of the fact that despite the great specificity of these different lesions [
Among physicians, 82.8% are aware of the existence of renal manifestations of SLE, but only 21.5% know about the prognostic importance of these attacks. The determining nature of these manifestations in the prognosis [
The cardiovascular manifestations of SLE have been enumerated [
The neuropsychiatric manifestations of SLE have also been correctly cited among the most serious. They are also poorly understood since hallucinations, delusions, psychosis, and confusional states, although not frequent and not very specific [
The best-known breathing manifestation of SLE by physicians was pleurisy. It was cited by 41.1% of them. It is also one of the most common breathing manifestations [
Only 12.9% of physicians cited native anti-DNA antibodies among the antibodies to be assayed in SLE. However, these are the most specific antibodies to the disease [
General practitioners are relatively young. Their level of knowledge related to lupus disease is generally limited, though the main source is basic medical training. Consequently, it is important to continuously strengthen the capacities of physicians in the area of lupus disease both in postgraduate studies and during initial basic training.
The current work has a main limitation and it is compulsory to output it. Let’s emphasize that all the medical agents that we questioned schooled in the same university and this might influence the variability in the answers about knowledge of SEL.
All authors contributed to the conduct of this work and to the writing of the manuscript.
The authors declare no conflicts of interest regarding the publication of this paper.
Azon-Kouanou, A., Aboué, N.C.A., Missiho, M.S.G., Dansou, E., Sokadjo, Y.M., Agbodande, K.A., Wanvoegbe, A.F., Zannou, D.M. and Houngbé, F. (2020) Knowledge of General Practitioners in Cotonou about Systemic Lupus Erythematosus. Open Journal of Internal Medicine, 10, 311-320. https://doi.org/10.4236/ojim.2020.104032