Comparison of Remotely Applied and Face-to-Face Disease Activity Scores in Saudi Arabian Patients With Rheumatoid Arthritis: A Prospective Cohort Study.

OBJECTIVES:  This study aimed to assess the disease activity indices (DAI) of rheumatoid arthritis (RA) by telephone-based tele-visits compared to face-to-face clinic encounters. METHODS: Patients with RA attending outpatient clinics between December 2021 and May 2022 were prospectively recruited. Disease activity assessments were initially performed in the clinic using the disease activity score 28-C-reactive protein (DAS28-CRP) and disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR). Within two weeks of the clinic visit, a telephone-based assessment gathered information on demographics, Routine Assessment of Patient Index Data 3 (RAPID3) score, and satisfaction. Disease activity scores were dichotomized into remission or low disease activity and moderate to high disease activity. RESULTS:  A total of 78 patients completed the two-point interview. Of those, 62 (79.49%) were women, with a mean age of 54.73±13.71 years. Seropositivity for rheumatoid factor and/or anti-citrullinated peptide was observed in 51 (83.61%) participants. Twenty-seven percent of the patients were classified as in remission or low disease activity by RAPID3. This was 71% for DAS28-CRP and 33% for DAS28-ESR. Based on the dichotomized disease activity classification, the agreement percentage between RAPID3 and DAS28-ESR was 78.08%, while it was 47.22% between RAPID3 and DAS28-CRP, which resulted in kappa statistic values of 0.48 (moderate agreement) and 0.14 (low agreement), respectively. Satisfaction rates were low. CONCLUSION:  Telephone-based RAPID3 showed a low-moderate agreeability compared to DAS28 and had low satisfaction rates. This suggests that tele-rheumatology care by this means was not feasible for following up with patients with RA and warrants further development.

Correlation of Disease Activity Scores and Routine Assessment of Patient Index Data (RAPID3) on a Multidimensional Health Assessment Questionnaire in Patients With Rheumatoid Arthritis: A Saudi Experience.

Introduction This study aimed to analyze the correlation between Routine Assessment of Patient Index Data (RAPID3) and disease activity scores using the Disease Activity Score 28 (DAS28 erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP)), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI) in patients with rheumatoid arthritis (RA) attending a single rheumatology center in Jeddah. Methods A cross-sectional study of patients with RA who fulfilled the 2010 American College of Rheumatology criteria for the diagnosis of RA between June 2018 and November 2019 was conducted. The validated Arabic version of the multidimensional health assessment questionnaire (MDHAQ) was used. The data collected included demographic information, comorbid illnesses, concomitant medications, laboratory results, and disease activity measured using the DAS 28 ESR/CRP, CDAI, SDAI, and RAPID3. Results A total of 137 patients with RA were included in the analysis; the mean age was 53.1 (± 12) years, there were 122 (89%) females, and the mean disease duration was 8 (± 4) years. Forty-nine (44.5%) patients were treated with anti-tumor necrosis factor (anti-TNF), 53 (48.2%) with non-anti-TNF, 8 (7.3%) with Janus kinase (JAK) inhibitors, and 27 (20%) with synthetic disease-modifying drugs (sDMARD). The mean RAPID3 (0-10) score was 3.6 (± 2) for low disease activity. The mean DAS28 ESR was 4.16 (± 4) for moderate disease activity. The mean DAS CRP was 3.39 (± 1.2) for moderate disease activity. The mean CDAI was 13.4 (± 10.7) for moderate disease activity. The mean SDAI was 15.34 (± 11.8) for moderate disease activity. Pearson's correlations showed a strong correlation with DAS28 CRP (r=0.773, p < 0.001), SDAI (r=0.764,p < 0.001), CDAI (r=0.710, p < 0.001), and DAS28 ESR (r=0.283, p < 0.002). Conclusion RAPID3 significantly correlated with DAS28-CRP, SDAI, and CDAI scores in our patients. It is a simple, inexpensive, and patient-centered practical tool for assessing disease activity that can reflect the health-related quality of life and be easily implemented in clinical practice.

Behçet's Disease in Saudi Arabia: Clinical and Demographic Characteristics.

Objective This study aimed to analyze and determine the clinical features and characteristics of patients diagnosed with Behçet's disease (BD) in Saudi Arabia. Methods This single-center study was conducted in a tertiary care center in the western region of Saudi Arabia. Electronic medical records of patients with BD aged 14 years and older were reviewed and their demographic and clinical data were collected by trained rheumatologists. Between comparisons, Fisher's exact test, independent t-test, or Mann-Whitney U test was applied. The normality of variables was tested using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Results The mean age of symptom onset was 29.6 ± 11.4 years, and mean age at the time of diagnosis was 31.1 ± 11.9 years. Most patients were overweight (mean body mass index 26.7 ± 5.60 kg/m2). The most associated medical comorbidities were diabetes mellitus and hypertension. The most common clinical manifestations were oral ulcers (91.2%), genital ulcers (81.3%), arthritis (41.8%), and pseudofolliculitis (34.1%). Colchicine was the most prescribed treatment (95.6%), followed by prednisolone (72.5%), and azathioprine (36.3%). Male patients were significantly more likely to have pseudofolliculitis (p=0.011) and take a tumor necrosis factor alpha (TNF-α) inhibitor (p=0.045). Female patients were more likely to have neurological involvement (p=0.029). Conclusion Awareness of BD symptoms and early recognition can help provide timely and effective treatment to avoid disease complications.

A Case of Systemic Lupus Erythematosus in a Patient Presenting with Libman-Sacks Endocarditis.

BACKGROUND: Libman-Sacks endocarditis (LSE) is a rare cardiovascular manifestation of systemic lupus erythematosus/antiphospholipid syndrome that is described as a sterile verrucous nonbacterial vegetative lesion. These lesions can cause progressive damage to the heart valves leading to valve surgery. The most common valves to be affected are the aortic and mitral valves. Libman-Sacks endocarditis is associated with malignancies, other systemic diseases like systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS). The majority of LSE patients are usually asymptomatic. Case Summary. We describe a 39-year-old male patient who presented with increasing shortness of breath and pulmonary congestion. He was found to have severe mitral valve regurgitation and mitral stenosis. Transesophageal echocardiogram confirmed the diagnosis of Libman-Sacks endocarditis with thickened mitral valve leaflets with symmetrical mass-like structure causing a restriction in the valve function during both cardiac phases later diagnosed with systemic lupus erythematosus by immunology. The patient was started on diuretics, anticoagulants, angiotensin inhibitors, beta-blockers, and hydroxychloroquine. He underwent successful mechanical mitral valve replacement with a 27 mm St. Jude valve. The mitral valve was found to be grossly thickened with friable tissue and complete amalgamation of the leaflets with subvalvular apparatus. The patient suffered some warfarin adverse effects a year later but did well otherwise. CONCLUSION: This case demonstrates that Libman-Sacks endocarditis can be the first manifestation of systemic lupus erythematosus. Early and prompt diagnosis of LSE can prevent and lessen the many side effects associated with thromboembolism. Additionally, addressing the underlying disease is key to successful treatment.

Clinical characteristics and outcome of COVID-19 in patients with rheumatic diseases.

This study aimed to assess the baseline characteristics and clinical outcomes of coronavirus disease 2019 (COVID-19) in patients with rheumatic diseases and identify the risk factors associated with severe COVID-19 pneumonia. This was a retrospective study in a tertiary care center conducted through the period between March 2020 and November 2020 and included all adult patients with rheumatic diseases who tested positive on the COVID-19 polymerase chain reaction (PCR) test. We assessed the patients' demographic data, history of rheumatic disease, COVID-19 symptoms and experimental treatment, if any, their disease course, and outcome. In all, 47 patients were included, and most were females. The commonest rheumatic diseases were rheumatoid arthritis (53.2%), followed by systemic lupus erythematosus (21.3%), and psoriatic arthritis (10.6%). Methotrexate and hydroxychloroquine were the most commonly used disease-modifying anti-rheumatic drugs in 36.1% and 25.5%, respectively. Out of 47 patients, 48.9% required hospitalization with a median hospital stay of 7 days. Severe COVID-19 pneumonia, defined as clinical signs of pneumonia plus one of the following: respiratory rate > 30 bpm, severe respiratory distress, or oxygen saturation < 90% in room air was observed in 19.1% of the patients, and one patient died. We found that elderly patients with a mean age of 65.3 years were more likely to develop severe COVID-19 pneumonia and that was statistically significant. Our study showed that elderly patients with a mean age of 65 years and having rheumatic diseases had an increased risk of hospital admission and development of severe COVID-19 pneumonia.

An Adult Patient With a Tetralogy of Fallot Case.

Tetralogy of Fallot (ToF) is considered the most frequent cyanotic congenital heart abnormality with a low adulthood survival rate if kept untreated. The majority of cases are symptomatic during infancy and mandate early treatment. Few instances of survival to asymptomatic middle-age patients have been reported, and they are decreasing due to early detection. We reported a case of a middle-aged man who was asymptomatic during his life and recently diagnosed with ToF. The patient underwent surgical repair with excellent outcomes. The case represents the possibility of diagnosing such cases in a relatively old patient despite medical development and advances.

Inappropriate Prescribing in Elderly Inpatients at a University Hospital in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Elderly populations usually use more medications than any other age group and are therefore more susceptible to potentially inappropriate prescribing (PIP), drug-drug interactions, and the related health consequences. In this study, we aimed to determine PIP prevalence and explore the most common potentially inappropriate medications (PIMs) prescribed. METHODS: This was a retrospective study involving elderly patients admitted at King Abdulaziz Medical City-Jeddah (KAMC-JD), between November 2014 and January 2015. We included all elderly patients aged 60 years and above admitted to KAMC-JD through the emergency department (ED), clinic, and direct admissions during the study period. Patients admitted to the intensive care unit, oncology department, and/or those who passed way in the ED before admission were excluded from the study. Prescriptions were assessed for PIP using the 2012 Beers Criteria, which categorizes PIMs to three classes: first class are medications to avoid in older adults regardless of their conditions; second class are medications to avoid with certain diseases or syndromes; and third class are medications that should be used with caution. RESULTS: Our study included 135 patients, of which 49.6% were males. The mean age was 71.26 ± 8.1 years. According to the 2012 Beers Criteria, 80% of patients were using at least one listed PIM. For the Criteria's first, second, and third classes, PIM prescription rates were 72.6%, 59.2%, and 37.7%, respectively. Regarding the most prescribed PIM in each class, insulin (sliding scale) was the most reported PIM in the first class, NSAIDs in the second class, and, lastly, vasodilators in the third class. CONCLUSION: PIP is a serious health issue threatening elderly patients. There is a need to develop evidence-based, context-sensitive, and user-friendly tools to assess PIP, as well as supportive training programs.

Use of social media in education among medical students in Saudi Arabia.

PURPOSE: Social media (SM), a virtual place where people can share, exchange, and communicate their ideas and knowledge, has become the new trend in communication and learning. This study aims to explore Saudi Arabian medical students' usage of SM and to discover the most common resources used in medical education. Furthermore, it aims to illustrate students' belief about the influence of SM on their learning. METHODS: This cross-sectional study administered validated questionnaires to medical students from different universities in Saudi Arabia, via emails, Twitter, Facebook, and short message service. A non-probability sampling technique was utilized and a sample size of 381 students was arrived at, using 95% confidence interval and 5% margin of error, since the total number of medical students in Saudi Arabia is approximately 36,000. The total respondents were 657 students from 23 different Saudi Arabian medical schools (females: 60.5%, n=397; males: 39.5%, n=260). RESULTS: The questionnaires of 21% of the students (n=139) were excluded from the analysis since they were incomplete. The most common website used by both genders was YouTube (42.3%, n=185); however, males preferred using Twitter and Wikis (p=0.001). With regard to utilizing SM for learning, 95.8% (n=419) of the students believed that it is beneficial. Females stated that SM helps them link basic and clinical science (p=0.003). CONCLUSION: Medical schools need to improve the utilization of SM by their faculty and students by developing activities and encouraging the usage of SM in education.