Early and late effects of therapeutic plasma exchange in patients with systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis: A single-center experience.

Therapeutic plasma exchanges (TPE) is considered as one of the treatment modalities that is used in systemic autoimmune diseases. This study aimed to describe the early and late effect of TPE in patients with systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) presented with acute kidney injury (AKI). Retrospective study comprised patients with SLE and AAV with AKI seen between January 2000 and June 2014 at King Faisal Specialist Hospital and Research Center in Riyadh. All patients underwent TPE. Retrospectively, all patients were assessed for early and late renal outcome at 12- month and 24-month intervals. Renal outcome was assessed according to serum creatinine level, glomerular filtration rate, active urine sediment, and proteinuria. P <0.05 was considered significant. A total of 68 patients were included, 58 patients (51 females) had SLE and 10 patients (7 females) had AAV completed TPE. All patients had active disease and had AKI. At the first 12 months, 18 patients (17 SLE and 1 AAV) showed complete response and 14 patients had partial response while 22 patients did not show therapeutic benefit. The nonresponders (22 patients) entered the late assessment interval (24 months) without any therapeutic response. Statistically, there was no significant difference between the patient's response to TPE at the first and second assessment intervals and the baseline serum creatinine level. TPE might be an alternative rescue treatment in lupus nephritis with AKI.

Outcome of adult Saudi patients with childhood-onset systemic lupus erythematosus.

OBJECTIVES: We aimed to describe the social, educational, employment and long-term clinical outcomes of adults with childhood-onset systemic lupus erythematosus (SLE) in a Saudi cohort. METHODS: All adult patients with childhood-onset SLE who were treated and had regular follow-up between 1990 and 2013 at King Faisal Specialist Hospital and Research Centre (KFSH-RC), Riyadh were included. The long-term outcome measures comprised SLE Disease Activity and Damage Indices at the last follow-up visit and death related to SLE. Social, educational and employment history were obtained via personal or phone interviews. RESULTS: Forty-eight patients (45 female) were included, whose mean age was 23.6±4 years and mean disease duration 15±4 years. At the last follow-up visit, 24 (50%) patients were found to have active disease with mean of accrual damage index of 2 (0-7). Forty patients (83%) had renal involvement, 7 (15%) of them progressed to end stage renal disease, 5 patients underwent renal transplant, 2 failed the transplant and are currently on haemodialysis. Sixteen patients had central nervous system involvement in the form of seizure disorder (6 patients), chorea (3 patients) and cerebrovascular accident (3 patients). Forty-three patients completed high school and 21 joined a college. Six patients were in employment. Eight patients got married and 5 of them had children. There were 3 deaths related to SLE (6.25%), mainly due to infection. CONCLUSIONS: Our cohort indicates that the outcome of adult Saudi patients with childhood-onset SLE was satisfactory and comparable to earlier reports.

Updated recommendations for the diagnosis and management of osteoporosis: a local perspective.

Postmenopausal osteoporosis and osteoporosis in elderly men are major health problems, with a significant medical and economic burden. Although osteopenia and osteoporosis are more common locally than in the West, fracture rates are generally less than in Western countries. Vitamin D deficiency is common in the region and contributes adversely to bone health. Vitamin D deficiency should be suspected and treated in all subjects with ostopenia or osteoporosis. The use of risk factors to determine fracture risk has been adopted by the World Health Organization and many international societies. Absolute fracture risk methodology improves the use of resources by targeting subjects at higher risk of fractures for screening and management. The King Faisal Specialist Hospital Osteoporosis Working Group recommends screening for women 65 years and older and for men 70 years and older. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines provide recommendations for treatment for postmenopausal women and men older than 50 years presenting with osteoporotic fractures for persons having osteoporosis-after excluding secondary causes-or for persons having low bone mass and a high risk for fracture. The Working Group has suggested an algorithm to use at King Faisal Specialist Hospital that is based on the availability, cost, and level of evidence of various therapeutic modalities. Adequate calcium and vitamin D supplement are recommended for all. Weekly alendronate (in the absence of contraindications) is recommended as first-line therapy. Alternatives to alendronate are raloxifene or strontium ranelate. Second-line therapies are zoledronic acid intravenously once yearly, when oral therapy is not feasible or complicated by side effects, or teriparatide in established osteoporosis with fractures.