Management of systemic disease patients in the service of internal medicine CHU Antananarivo Madagascar “Prise en charge des patients atteints de maladies systémiques dans le service de médecine interne du CHU Antananarivo Madagascar”

Resume : Cette etude a eu pour objectif d’estimer les types de traitement et l’utilisation des differents medicaments chez les patients atteints de maladies systemiques dans le service de Medecine interne du CHU d’Antananarivo a Madagascar. Il s’agissait d’une etude  transversale, realisee a partir de 33 cas de maladies systemiques observes dans le service de medecine interne du CHU d’Antananarivo a Madagascar, durant une periode de 16 mois (Avril 2013- 31 Aout 2014). Etaient inclus, apres observation des dossiers medicaux respectifs, tout  patient presentant des signes cliniques, paracliniques en faveur de: lupus erythemateux systemique, polyarthrite rhumatoide, uveite autoimmune, sclerodermie systemique, purpura thrombopenique immunologique, cytopenies autoimmunes, maladie de (Sharp, Behcet, Takayasu, Still, Crohn), arthrite juvenile idiopathique, pseudo polyarthrite rhizomelique. Les patients dont l’observation medicale ne remplissait pas les parametres a evaluer etaient exclus. Le lupus erythemateux systemique  (27,3%) et la polyarthrite rhumatoide (21,2%) etaient les pathologies les plus frequentes. Quatre classes pharmacologiques ont ete prescrites: corticosteroides (93,33%), cytotoxiques (48,48%), antipaludiques de synthese (24,24%) et immunosuppresseurs (9,09%). Les effets iatrogenes notoires etaient mis en exergue chez les patients sous corticoides (n=12), ciclosporine (n=2), cyclophosphamide(n=6), methotrexate (n=1) et sous antipaludiques de synthese (n=3). Des mesures non medicamenteuses etaient egalement preconisees: regime sans residu (n=1), vaccination antigrippale (n=2). Une chimioprophylaxie par cotrimoxazole forte etait faite lors des traitements par cyclophosphamide (n=2). Dans cette etude, les corticoides etaient les medicaments les plus utilises. Les effets notoires du traitement et l’inobservance therapeutique, ainsi que l’inaccessibilite aux medicaments representaient les causes probables de l’echec therapeutique.  Mots cles: Maladies systemiques, traitement, corticoids  Abstract: The objective of this study was to estimate the types of treatment and use of different drugs in patients with systemic diseases in the Department of Internal Medicine at the University Hospital of Antananarivo in Madagascar.  It was about a transversal study realized from 33 cases observed in the service of internal medicine of the CHU from Antananarivo to Madagascar, during a period of 16 months from April 31st, 2013 till August 31st, 2014. All patients with clinical signs of systemic lupus erythematosus, rheumatoid arthritis, autoimmune uveitis, systemic scleroderma, immunological thrombocytopenic purpura, autoimmune cytopenia, (Sharp, Behcet, Takayasu , Still, Crohn), juvenile idiopathic arthritis, pseudo rhizomelic arthritis.The patients excluded from the study were the patients with whom the medical observation had not filled the parameters to be estimated.  Systemic Lupus erythematous (27,3%) and Rheumatoid Arthritis (21,2%) were the most common pathologies. Four classes of pharmacological drugs were mainly used including corticosteroid (93,33%), cytotoxic (48,48%), antimalarial (24,24%) and immunosuppressive (9,09%). The bad effects have been seen into patients after taking medicines containing corticoid (n=12), methotrexate (n=1), cyclosporine (n=2), cyclophosphamide (n=6), antimalarial (n=3). Non medicinal’s measures were equally recommending: diet without residue (n=1), vaccination against influenza (n=2). A chemoprophylaxis by cotrimoxazole forte was done at the time of treatments by cyclophosphamide (n=2). In this study, corticoids were the most using medicines. The notorious effects of treatement, the therapeutic inobservance, and the inaccessibility to medicine represented the expected causes of therapeutic failure.  Key words : Systemic diseases, treatment, corticoids