Medication adherence, depression and disease activity among patients with systemic lupus erythematosus.

Introduction Medication non-adherence is an important cause of treatment failure among patients with systemic lupus erythematosus (SLE). Depression is a common neuropsychiatric disorder associated with SLE. The aims of this study are to assess the prevalence of both medication non-adherence and depressed mood among Saudi patients with SLE by using validated tools and to explore the impact of both depressive symptoms and disease activity on medication non-adherence. Methods A cross-sectional study was conducted in outpatients with SLE. Medication non-adherence was assessed by using the Morisky Medication Adherence Scale, and the severity of depressed mood was evaluated with the Beck's Depression Inventory. Disease activity was measured using the SLE Disease Activity Index (SLEDAI). Multiple logistic regression models were used to identify the multivariate predictors of medication non-adherence. Results Out of 140 patients, 134 (95.7%) were females with a mean (±SD) age of 35.6 (±11.3) years and a disease duration of 8.8 (±6.7) years. Medication non-adherence and depressed mood were detected in 62.1% and 35% of the patients, respectively. A moderate or severe depressed mood was significantly associated with medication non-adherence ( p = 0.04). There was a significant correlation between disease activity and the severity of depressed mood ( r = 0.31, p = 0.003). Disease activity did not correlate with medication non-adherence. Logistic regression demonstrated that moderate-to-severe depressed mood increased the probability of medication non-adherence (OR 2.62; 1.02-6.71). Conclusion Medication non-adherence and depressive symptoms are highly prevalent among Saudi SLE patients. Routine screening could facilitate the early detection and management of depression and medication adherence.

Bone disease in systemic sclerosis: outcomes and associations.

OBJECTIVES: The relationship between systemic sclerosis (SSc) and low bone mineral density (BMD) is poorly understood. The aim of this study is to improve our understanding of low bone density in SSc and its potential consequences. METHODS: Fifty consecutive unselected SSc patients were approached. Demographics, disease manifestations, BMD (lumbar spine and femoral neck) were collected at baseline and occurrence of fracture and death were collected over 2 years. The 10-year risk of osteoporotic fracture was estimated using the fracture risk assessment tool (FRAX) v2.0 with the Canadian population reference. Fisher's Exact and Student's t-tests were used to evaluate differences between patients with and without low BMD. Logistic regression was used for multivariate analysis. RESULTS: Forty-five patients had complete BMD data. Twenty-eight patients (62%) had low BMD, of those 10 (36%) had osteoporosis. There was no difference in age, sex, or disease duration between both groups. Low BMD was associated with non-Caucasian race (57% vs. 18%, p=0.01), postmenopausal status (83% vs. 47%, p<0.01), low body mass index (24.5 vs. 26.2, p=0.05). The mean 10-year risk of developing a major osteoporotic fracture and a femoral neck fracture was higher in the low BMD group (10.2% vs. 4.8%, p=0.12) and (4.1% vs. 0.5%, p = 0.16) respectively. Fourteen percent (4/28) of SSc patients with low BMD had a fracture, compared to 6% (1/17) SSc patients without low BMD. Fracture-related mortality did not occur in any patients. CONCLUSIONS: Low BMD and fracture are frequently seen in SSc patients. A number of clinically relevant factors are associated with low BMD. Further research is needed to evaluate these factors and the role of bone-specific treatments in SSc.

Effectiveness and adverse effects of anakinra in treatment of rheumatoid arthritis: a systematic review.

OBJECTIVE: Rheumatoid arthritis (RA) can be described as a chronic, inflammatory, progressive, autoimmune disorder characterized by generalized inflammation of the synovial joints, which hereby triggers the progressive erosion of both cartilage and bone. Anakinra is a recombinant form of human IL-1 receptor antagonist which targets the type I IL-1 receptor. In the present systematic review, we intend to evaluate the effectiveness and adverse effects of interleukin-1 antagonists in the treatment of rheumatoid arthritis. MATERIALS AND METHODS: The database search was carried out using PubMed (Medline), Web of Science (Clarivate), Embase, Scopus, and Cochrane Library for the existing studies. A total of 3912 relevant articles were identified as per the search strategy. Out of them, 854 duplicate records and further 3024 records were excluded after going through their titles and abstracts. Further, out of 42 articles left, we excluded 32 more articles matching our inclusion criteria and excluding the reviews and case studies. Finally, we included 10 relevant studies that focused on both the effectiveness and adverse effects of interleukin-1 antagonists during the treatment of adult patients with rheumatoid arthritis in the present analysis. Nine out of 10 included studies are randomized trials (RCT) except for 1 study, which was an extension study. RESULTS: The results showed an ACR20 response at week 12 and were the most common primary outcome measure in the present review. Various secondary outcome measures studied were changed from baseline at week 24 in individual ACR components. ACR50 and ACR70 responses at subsequent weeks (12 and 24), ESR components, HAQ score, CRP levels, and ESR. Notably, more improvement was observed with anakinra in comparison to placebo for achieving ACR50 and ACR70 responses at 24 weeks. Premature withdrawal of participants was observed in almost all the studies. Adverse drug reactions were attributed to be the most common reason followed by loss of efficacy for withdrawal of patients from the treatment. The infectious episode was another common adverse effect observed in both anakinra and placebo groups. Some malignancies were also documented in the included researches of this systematic analysis. We observed a lower overall incidence of malignancies for the studies screened compared with that of the general population. CONCLUSIONS: This review demonstrated that anakinra is safe, effective, and well-tolerated, with no significant difference in adverse effects compared to placebo in rheumatoid arthritis patients.

A cross-sectional study on clinical characteristics of Saudi axial spondylarthritis: preliminary results.

OBJECTIVE: To describe Spondyloarthritis (SpA) patients in a single center (preliminary phase), Build connections to establish local cohorts, Saudi Registry, and publication in Gulf and Arab database. PATIENTS AND METHODS: This prospective observational cohort consists of patients with spondylarthritis (SpA) diagnosed by a rheumatologist. Patients with AS were defined as those who met the modified New York criteria for Ankylosing Spondylitis (AS) 1984. All other patients with axial SpA who did not meet the radiology criteria of modified New York criteria for Ankylosing Spondylitis were classified as having non-radiographic axial SpA based on Assessment of SpondyloArthritis International Society (ASAS) diagnostic criteria for axial spondyloarthropathy. RESULTS: The study group comprised 106 patients with SpA (49 patients with AS and 57 patients with non-radiographic axial SpA). Patients with non-radiographic axial SpA and patients with AS who had previously been treated with biologic disease-modifying drugs (DMARDs) were 66.67 percent and 83.67 percent, respectively. In patients with AS, CRP and age significantly impact disease activities (p<0.05). The overall mean ASDAS score was 2.3 ± 0.7. CONCLUSIONS: This study has shown a more detailed description of the largest Saudi cohort reported yet. Interestingly, both disease groups, Ankylosing spondylitis and non-radiographic spondyloarthritis showed a lower prevalence of HLA-B27 is lower in the general Saudi population compared to other nations including Caucasians, thus, limiting its use as a diagnostic tool. The majority of both groups, nearly three-quarters of all patients (74.53%) in biologic DMARD treatment, and only (22.64%) used csDMARD treatment, which may help control disease activity and showing easier access and availability of these therapies to the patient. Patients with non-radiographic axial SpA showed slightly higher Extra-articular Manifestations comparing with AS patients.

Removal of heavy metals via adsorption on activated carbon synthesized from solid wastes.

The huge quantity of date pits as solid waste byproduct in Saudi Arabia pose a problem as they are difficult to biodegrade. The potential of using date pits as a cheap precursor to prepare activated carbons was investigated. Steam as well as zinc chloride activated carbons were prepared from dates pit. The textural properties, including surface area, mean pore radius and total pore volume, were determined from the adsorption of nitrogen at 77 K. FT-IR spectroscopy and base neutralization capacity were used to determine the surface groups. The adsorption of Cu2+, Pb2+ and Cd2+ was studied in equilibrium method. FT-IR investigation of un-activated carbons identified phenolic, lactonic, -O-H, quinonic and carboxylate groups. For steam and zinc chloride activated carbons, some of the adsorption bands either disappeared or become less predominant, depending on the acidic or basic nature of the surface. The measurements of BNC indicated that steam activated carbons were predominately basic, while zinc chloride activated carbons exhibited acidic nature. Physical and chemical activation increase the porosity and thereby develop a higher surface area. The adsorption of Cu2+, Pb2+ and Cd2+ followed the order Pb2+ > Cu2+ > Cd2+. Zinc chloride activated carbons had a higher adsorption power compared with steam activated carbons. The adsorption behavior was affected by the textural and chemistry of the surface.

Protective effect of α-lipoic acid against α-cypermethrin-induced changes in rat cerebellum.

Alfa cypermethrin is a pyrethroids extensively used as ectoparasiticide in domestic animals, insecticidal spray on cotton, vegetables and other crops and to kill cockroaches, fleas and termites in house and other buildings. Previous studies have shown the adverse effect of α -cypermethrin on brain. This study was planned to evaluate the possible role of α-lipoic acid in α -cypermethrin induced toxicity in brain of male albino rats. Rats were divided into four groups. The control, α-cypermethrin, α-lipoic acid and α -cypermethrin plus α-lipoic acid treated groups. The duration of the experiment was four weeks. Our results showed that the administration of α-cypermethrin caused a significant decreased in γ- aminobutyric acid level, acetylcholinesterase, catalase, superoxide dismutase activities and increase in lipid peroxidation in cerebellum. Furthermore, the co-administration of α-lipoic acid mitigates the toxicity of α-cypermethrin by partially normalizing the biochemical parameters. The biochemical observations were supported by histopathological examinations. The findings of this investigation suggest that α-lipoic acid may play a protective role against α-cypermethrin induced toxicity in cerebellum of treated rats.

Incidence of tuberculosis in people living with the human immunodeficiency virus in Saudi Arabia.

OBJECTIVE: To identify the incidence of tuberculosis (TB) in people living with the human immunodeficiency virus (HIV) (PLWH) followed at an HIV referral and care facility. DESIGN: Observational longitudinal cohort. METHODS: Data were collected longitudinally as patients were admitted to the HIV programme and included demographics, TB diagnosis and treatment, CD4+ T lymphocyte count and TB treatment outcomes. The TB-free follow-up period of all patients was used to calculate TB incidence rates. RESULTS: Between 1997 and 2007, 217 new adult patients joined the HIV programme. TB was diagnosed in 16 patients (7.4%), all of whom had acquired immune-deficiency syndrome at the time of TB diagnosis. Seven developed extra-pulmonary disease (44%), six had pulmonary TB (37%), while three had both (19%). The TB incidence rate was 1354 per 100,000 person-years (py) among the HIV-infected cohort. The incidence rate of pulmonary TB was 762/100,000 py and for extra-pulmonary TB it was 592/100,000 py. Seven patients (44%) died despite early diagnosis and treatment for TB. CONCLUSION: Among PLWH in Saudi Arabia, TB incidence is 30 times higher than in the general population, with significant mortality despite early diagnosis, treatment and tertiary care support.