Occupational impacts of early inflammatory arthritis: results from the National Early Inflammatory Arthritis Audit.

OBJECTIVES: Inflammatory arthritis (IA) causes significant work disability. Studies frequently fail to report important contextual information such as employment type. Our objective was to explore work participation, by gender and occupation type in early IA. METHODS: Data are from the National Early Inflammatory Arthritis Audit between 2018 and 2020. At diagnosis, clinicians collected information on demographics, IA disease activity and working status. Participants completed patient-reported outcomes at baseline, 3- and 12-months, including occupation and Work Productivity Activity Impairment (WPAI). Descriptive analyses of work participation and WPAI scores by occupational class at all timepoints were performed. Regression models examined associations between WPAI score and occupation. FINDINGS: 12 473 people received a diagnosis of IA and reported employment status, amongst whom 5,999 (47%) were in paid-work at least 20-h/week. At diagnosis, the working cohort had statistically significant lower measures of disease activity (p< 0.001). Occupation data were available for 3,694 individuals. At diagnosis, 2,793 completed a WPAI; 200 (7.2%) had stopped work and 344 (12.3%) changed jobs because of IA symptoms. There was a high burden of absenteeism (30%) and presenteeism (40%). Compared with managerial or professional workers, the burden of work disability was greater amongst those in routine (manual) occupations. During follow-up, 9.4% of WPAI completers had stopped work and 14.6% had changed roles. Work dropout occurred almost entirely amongst people doing routine jobs. CONCLUSION: IA associates with work disability within 12 months of diagnosis. It is easier to retain work in certain employment sectors. Participation in routine jobs is more affected, which may widen health inequalities.

Efficacy and Safety of Temporary in situ Stenting of Ahmed Glaucoma Valve in Eyes with High Risk of Hypotony.

Introduction and Objective: To describe a novel technique for providing external ligation of the Ahmed glaucoma valve (AGV) to prevent hypotony in eyes at high risk with a 4/0 nylon stent suture and report outcomes compared to ligation with an absorbable vicryl suture and no ligation in terms of efficacy and safety. Methods: This was a retrospective cohort study investigating the efficacy and safety of in situ stenting compared to an absorbable ligature and the standard care, in high risk eyes, of hypotony. It included 116 patients; 34 in Group A (ligation + stent), 27 in Group B (ligation - stent), and 55 in Group C (no ligation). Results: The mean age (in years) of the participants was 53.94±19.01 in Group A, 44.85±29.92 in Group B and 52.62±24.47 in Group C, 59% (n = 20), 63% (n = 17) and 60% (n = 33) were males, respectively. The follow-up period was at least 6 months (Group A: 9.1±4.2 months, Group B: 9.6±3.4 months and Group C: 10.2±6.4 months). The mean baseline Snellen VA (LogMAR) was 1.82±1.34, 1.30±0.98 and 1.34±1.07 and the mean baseline IOP was 32.50±9.48, 28.22±7.12 and 28.33±10.63 mmHg, in Groups A, B and C, respectively. The failure rates, by the Kaplan Meier Survival curve, were higher 27.3% in Group C (no ligation) compared to 20.6% in Group A (ligation + stent) and 18.5% in Group B (ligation - stent) yet not found to be statistically significant (p = 0.4; log rank test). There was lower hypotony 2.9% in Group A and lower complications 25.9% in Group B but no statistical significance was found amongst the groups. Conclusion: In conclusion, temporary nylon in situ stenting of AGV had lower rates of hypotony. Furthermore, lower failure and complication rates were observed in vicryl only ligated AGV, then nylon in situ stented AGV and lastly in standard AGV controls.

Barriers and adherence to glaucoma medication in a paediatric glaucoma population: A cross-sectional survey in central Saudi Arabia.

PURPOSE: To examine barriers and adherence to topical glaucoma medication in a pediatric glaucoma population in Saudi Arabia. METHODS: This cross-sectional study was undertaken at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia during 2016-2017. Parents (father or mother) of children aged 6 months to 15 years with a history of glaucoma were interviewed. Rasch analysis was performed to assess the psychometric properties of the developed 12-item barriers-to-adherence tool (BAT-12) and to identify barriers deemed highly important. The 12-items were adapted from previous studies examining different barriers to adherence in different populations. Medication adherence was assessed by asking parents a series of closed-ended questions about the frequency of missed medications. Determinants of missed medications on at least 1 out of the last 3 days were examined using Poisson regression. RESULTS: One hundred and six parents were interviewed. The 12-item scale had acceptable psychometric properties. Barriers deemed important were forgetfulness (logit -0.59), complex dosing regimen (logit 0.09), and being too busy with other work/activities (logit 0.14). When asked how often, on average, their child missed the prescribed medication, 26 (24.5%) reported daily, 17(16.0%) reported few times per week, and 32 (30.2%) reported once per week. A third of parents (n = 37, 34.9%) reported having missed giving all drops on at least one day in the last 3 days. Poisson regression with robust variance revealed that increase in age of the child (prevalence ratio, 1.08 [95% CI, 1.03-1.14]; p = 0.003) and increase in parents' barriers score (prevalence ratio, 2.13 [95% CI, 1.49, 3.03]; p < 0.001) were significantly associated with having missed medications on at least one out of the last three days while adjusting for the effect of father's current employment status and area of residence. CONCLUSIONS: The tool we used to examine barriers to glaucoma medication had acceptable psychometric properties and could be used and strengthened in future studies. Our study highlights poor adherence to glaucoma medications among children with glaucoma.

Magnitude of diabetes and hypertension among patients with Dry Eye Syndrome at a tertiary hospital of Riyadh, Saudi Arabia - A case series.

PURPOSE: To study the magnitude of chronic diseases among patients suffering from Dry Eye Syndrome (DES) and compare them with published findings in the literature. METHODS: Patients diagnosed in 2016 suffering from DES based on presenting symptoms and findings of ocular examination were included in this study. The demographic information included age and gender. Chronic diseases among them were identified through case records, assessment and ongoing medications. RESULTS: This case series had 62 patients (58% males) of DES. The mean age was 60.2 ± 16.6 years. The prevalence of hypertension, dyslipidemia and diabetes among them was 48.5% (95% confidence interval (CI) 31.5-65.5), 55.9% (95% CI 40.1-71.7) and 47.1% (95% CI 29.8-64.4) respectively. The rate of thyroid diseases (16.2%), renal diseases (6.5%), and liver diseases (6.7%) was not significant in this series. CONCLUSIONS: This series in central Saudi Arabia suggests that the magnitude of chronic diseases such as diabetes, hypertension, obesity and dyslipidemia seems to be higher in patients with DES compared to the population.

Chronic diseases among vitiligo patients. A case control study.

OBJECTIVES: To identify the proportion and risk of chronic diseases in vitiligo patients in a tertiary hospital in Riyadh, Kingdom of Saudi Arabia (KSA). Methods: A retrospective case-control study included 61 vitiligo patients and 61 normal non-dermatology controls in King Abdulaziz Medical City, Riyadh, KSA between January and September 2016. Age, gender and  co-morbid diseases including hypertension, diabetes, dyslipidemia, obesity and hypothyroidism were retrieved from participants' charts and medical records. Proportion and mean were used to describe the variables, and odds ratio (OR) was used to test the data. Results: A total of 122 participants (34 males, 88 females) equally divided in cases and controls. The mean age was 45±19 years for the case and 40±17 years for the control group. The proportion of diabetes (51%) was higher in the case group than the control (33%) (OR: 0.47; 95% confidence interval [CI]: 0.23-0.98; p=0.04). Dyslipidemia was significantly associated with vitiligo (67%) compared with the control group (48%) (OR: 0.44; 95% CI: 0.21-0.92; p=0.03). Vitiligo participants had a significantly increased risk of having hypothyroidism (26%) compared with the control group (10%) (OR: 0.31; 95% CI: 0.11-0.85; p=0.02). Conclusion: There is an increased risk of chronic diseases among vitiligo patients including diabetes, dyslipidemia, hypothyroidism, renal injuries, and obesity.