Prevalence and Comorbidities Among Individuals With Rheumatoid Arthritis in the Saudi Arabian Context.

BACKGROUND:  Rheumatoid arthritis (RA) in Saudi Arabia (SA) is a significant health concern with a notable impact on individuals and the healthcare system. This study aimed to investigate the prevalence and profile of comorbidities in patients with RA. METHODOLOGY:  This is a retrospective descriptive study involving 150 RA patients from August 2022 to August 2023, which was conducted at Khamis Mushait General Hospital, a major healthcare institution in SA. We examined the medical records to gather pertinent information. Stata Statistical Software: Release 18 (2023; StataCorp LLC, College Station, Texas, United States) was used for data analysis. The examination focused on sociodemographic factors, disease duration, prescribed medications (including methotrexate and biologic therapy), and the presence of comorbidities. Approval for the study was obtained from the Institutional Review Board of the Aseer Ministry of Health (approval number: H-06-B-091). RESULTS:  The study found a high prevalence of comorbidities in patients with RA. Around 96.7% of the patients had at least one documented comorbidity, highlighting this population's burden of additional health conditions. The most common comorbidity observed was anemia, affecting 48.7% of the patients. Other frequently observed comorbidities include hypertension, hyperlipidemia, diabetes mellitus, osteoporosis, interstitial lung disease, chronic renal disease, stroke, and coronary artery disease. The factors influencing comorbidities included an odds ratio of 1.086 (p=0.025), while being male was associated with lower odds (odds ratio=0.529, p=0.017). Additionally, disease duration (odds ratio=1.164, p=0.007), methotrexate use (odds ratio=2.553, p=0.001), and receiving biologic therapy (odds ratio=3.488, p<0.001) were significant contributors to comorbidities. CONCLUSION:  These findings highlight the need for comprehensive approaches to address RA and its associated comorbidities. Research and awareness initiatives are essential to understand better the specific nuances of RA in SA, leading to improved diagnostic and treatment strategies for the needs of the local population.

Adult-Onset Still's Disease with Dermatopathic Lymphadenitis Clinicopathologic Features: A Rare Case Report and Review of the Literature.

Adult-onset Still's disease (AOSD) is an inflammatory disorder characterized by fever, arthritis, and a transient skin rash. It is a rare condition characterized by inflammatory multisystem changes of unknown cause. A 35-year-old woman was admitted to rheumatology department of tertiary care hospital complaining of painful wrist and skin rash as well as fever, generalized lymphadenopathy, weight loss, and fatigue. The early diagnosis of AOSD was confirmed by clinical history, examination, and laboratory tests, as well as a confirmatory skin biopsy with typical histopathological features, namely, upper epidermal dyskeratosis and dermal inflammatory neutrophilic infiltration. The patient's condition was treated with steroids and NSAIDs, to which she responded well, and on follow-up, her symptoms regressed along with improvement in biochemical parameters. The authors suggest that skin biopsy and confirmation of histopathological diagnosis of AOSD are useful in the diagnosis and proper management of AOSD patients in cases with clinical suspicion of AOSD.

The Association Between Physical Activity Level and Severity of Knee Osteoarthritis: A Single Centre Study in Saudi Arabia.

Background and aim Knee osteoarthritis (OA) is a disabling joint disease that results in degeneration of the joint cartilage. Many studies demonstrate the risk factors and complications of knee osteoarthritis, but how physical activity impacts the osteoarthritis severity needs to be studied. The study aimed to assess the impact and association of physical activity level with the severity of knee osteoarthritis among patients attending a single center in the Aseer region, southwest Saudi Arabia. Methods An analytical cross-sectional study was conducted targeting all patients clinically diagnosed with knee osteoarthritis in the Aseer region from June 2021 to September 2021. Data was collected using a pre-structured online questionnaire. The questionnaire included patients' socio-demographic data and clinical data on knee osteoarthritis. The level of physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). The severity of knee osteoarthritis was assessed using the index of severity for osteoarthritis of the knee. Results Out of 473 patients clinically diagnosed with knee OA, only 145 patients met our inclusion criteria. Patients' ages ranged from 35 years to 71 years, with a mean age of 44.3 (±12.9) years. A total of 122 (84.1%) patients were females. Sixty-five (44.8%) patients complained of knee OA for less than two years, 46 (31.7%) for two to five years, and 34 (23.4%) were diagnosed for more than five years. A total of 96 (66.2%) had a low level of physical activity, 32 (22.1%) had a moderate level of physical activity, while 17 (11.7%) had a high level of physical activity. Thirty-eight (26.2%) cases complained of extremely severe knee OA, 37 (25.5%) had very severe knee OA, 28 (19.3%) complained of severe knee OA, 36 (24.9%) had mild to moderate knee OA, while six (4.1%) had minimal knee OA. There was a significant beneficial effect of physical activity on the severity of knee OA. Conclusion The study revealed that physical activity, especially at high levels, was associated with lower knee OA severity which means a beneficial effect. Most of the patients included in the study had severe to extremely severe knee OA with low physical activity levels.

The Assessment of the Prevalence and Disability Severity of Musculoskeletal Pain in Patients With Multiple Sclerosis in Saudi Arabia.

Background Multiple sclerosis (MS) is an autoimmune disease of the nervous system that causes chronic demyelination over time and may lead to physical disability. MS-related pain may be musculoskeletal, paroxysmal, or persistently neurogenic in nature. The most common type of pain is musculoskeletal discomfort, which is typically brought on by muscle weakening, stiffness, and generalized imbalance as the condition progresses. Pain often manifests after prolonged immobilization of muscles, tendons, and ligaments. Aim We aimed to evaluate the prevalence and severity of musculoskeletal pain (MSP) among MS patients in Saudi Arabia. Methodology A quantitative cross-sectional study was conducted. Patients with confirmed MS in Saudi Arabia were invited to participate in the study during the duration from April 2022 to May 2022. Data were collected using an electronic collection tool. The study tool was checked to ensure the content validity and clarity of the Arabic and English versions. Results A total of 360 MS patients were included. Patients' ages ranged from 18 to 65 years with a mean age of 34.9±13.2 years old. Exactly 229 (63.6%) patients were females. A total of 104 (28.9%) patients complained of relapsing-remitting MS, 34 (9.4%) complained of primary progressive MS, and 16 (4.4%) complained of secondary progressive MS. A total of 138 (38.3%) patients had the disease for less than five years, and 14 (3.9%) had the disease for more than 21 years. Exactly 124 (34.4%) MS patients complained of high disability due to MSP, while 236 (65.6%) had low disability. Conclusions This study demonstrates that one out of each three patients with MS complained of pain with high disability associated with pain. Old age, comorbidities, long disease duration, and a family history of MS were significant determinants of associated disability severity.

Massive hemoptysis secondary to Behçet's aneurysm controlled with endobronchial balloon lung isolation: Case report and review of literature.

Behçet's disease (BD) is a multisystem disorder with various clinical presentations. Herein, we present a lethal complication associated with pulmonary artery aneurysm due to BD, resulting in massive hemoptysis that was controlled using endobronchial balloon lung isolation.

Behçet's disease presentations and care outcomes in a tertiary hospital in south-western Saudi Arabia.

AIM: To study the clinical presentations of Behçet's disease in patients visiting a tertiary hospital in south-western Saudi Arabia. PATIENTS AND METHODS: Forty-seven patients with Behçet's disease attending the Rheumatology Department at Asser Central Hospital, Saudi Arabia were recruited into the study. The study was conducted over a period of 5 years from January 2012 to July 2017. Medical records of the patients were reviewed to analyze the frequency of different clinical manifestations. RESULTS: The study had 26 men and 21 women. The mean age of the patients was 37.11 ± 11.9 years (range <30-60 years). Frequency of main clinical manifestations in these patients included 89.4% (42/47) oral ulcers, 80.9% (38) genital ulcers, 55.3% (26/47) ocular complications, 55.3% arthralgia (26/47), 31.9% arthritis (15/47), 36% neurological complications (17/47), 34% gastrointestinal involvement (16), 17% pulmonary complication (8/47), cutaneous lesions in the form of skin pustules were found in 31.9% of cases and erythema only in 4.3% of patients. Deep venous thrombosis was observed in 66.6% of patients. About 96% of patients showed improvement with drugs. Only 2 patients died during the study period. CONCLUSION: Behçet's disease showed higher male predominance in south-western Saudi Arabia, similar to other Middle-Eastern countries. The clinical characteristics are comparable to different studies reported from other countries. Regarding the care outcome, the majority of patients were cured using oral corticosteroids and other immunosuppressive drugs.

Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review.

OBJECTIVE: Research on psoriatic arthritis mutilans (PAM), the most severe form of psoriatic arthritis, is impeded by the lack of an accepted classification criteria. We performed a systematic review of the literature to identify and synthesize clinical and radiographic features associated with the definition of PAM. METHODS: A systematic literature search limited to human studies was conducted without language restriction. Abstracts were independently screened by 2 investigators and studies that reported information on patients with PAM were included. A standardized form was used to independently collect clinical and radiographic items defining PAM, patient's demographics, disease characteristics, and outcomes. RESULTS: There were 8570 citations searched to identify 112 articles for full review and 58 articles for data abstraction. We identified 8 definitions of PAM that were used in 283 subjects with a mean age ± SD at diagnosis of PsA of 33.9 ± 8.2 years. Disease manifestations (prevalence) included dactylitis (29-64%), enthesitis (29-32%), axial disease (14-27%), and nail lesions (47%). PAM definitions include 1 (n = 2 studies) or more (n = 14 studies) joints involving interphalangeal, metacarpophalangeal, or metatarsophalangeal joints. The most prevalent PAM clinical features were digital telescoping (34%), digital shortening (33%), and flail joints (22%). The most prevalent PAM radiographic items were bone resorption (41%), pencil-in-cup change (16%), total joint erosions (14%), ankylosis (21%), and subluxation (7%). CONCLUSION: We have identified 8 definitions of PAM, and synthesized the clinical and radiographic items that are important for the classification of PAM. We have established the groundwork for future development classification criteria for PAM.

DEVELOPING AN IPAD® APPLICATION FOR DATA COLLECTION IN A RHEUMATOLOGY RESEARCH CLINIC.

OBJECTIVES: Clinical research data are often collected on paper and later inputted onto an electronic database. This method is time consuming and potentially introduces errors. Therefore, to make primary data collection more efficient and less error prone we aimed to develop a touch-screen application for data collection in a psoriatic arthritis research clinic and compared it with the pre-existing paper-based system. METHODS: We developed a Web application using Java and optimized it for the iPad®. It highlights missing fields for physicians in real time, and only permits submission of data collection form after corrections are made. For its evaluation, seven physicians participated, and before each patient visit they were randomly assigned paper or iPad® data entry. Number of errors, length of visit, and time between clinic visit and completion of data entry were measured. RESULTS: A total of 106 patients seen in the clinic who agreed to participate were randomly assigned to be evaluated by clinic physicians using the iPad® (fifty-three patients) or a paper protocol (fifty-three patients). On average, 3.34 omissions were found per paper form, of which 2.24 would have been detected on the iPad®. The iPad® increased the mean patient encounter time from 37.2 minutes to 46.5 minutes, but eliminated delay between a clinic visit and its data entry. CONCLUSIONS: Entering data using the iPad® application makes the patient encounter slightly longer, but reduces "missing fields." It also eliminates the delay between clinic visit and data entry thus improving the efficiency of clinical data capture in a research setting.