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   Table of Contents - Current issue
Coverpage
September-December 2021
Volume 1 | Issue 1
Page Nos. 1-26

Online since Saturday, November 13, 2021

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EDITORIAL  

Editorial p. 1
Hanan Mohammad Al-Rayes
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ORIGINAL ARTICLES Top

Saudi experience of adherence with quality indicators of health care for childhood systemic lupus erythematosus p. 2
Ghada AlSalmi, Kawthar AlHusieni, Sulaiman M Al-Mayouf
DOI:10.4103/ara.ara_4_21  
Objective: The objective of the study is to report the compliance with childhood-onset systemic lupus erythematosus-quality indicators (cSLE-QIs) in a Saudi Tertiary Childhood Lupus Clinic. Methods: In this cross-sectional, observational study, charts of patients with cSLE followed regularly between January 2010 and December 2019 at King Faisal Specialist Hospital and Research center, Riyadh, were reviewed. Data were collected at the last follow-up visit comprising the compliance with the quality of medical care of patient with cSLE using cSLE-QIs, which capturing diagnostic testing, lupus nephritis, medication, bone health, ophthalmological assessment, vaccination, and transition. Pregnancy domain and smoking cessation were not measured in this study. Results: A total of 66 (58 females) cSLE patients were assessed. The median age at disease onset was 10 (interquartile range [IQR]: 7.0–11.0) years, and the median disease duration was 4 (IQR: 3.0–6.0) years. Most of the patients had nephritis (69.7%), while cardiovascular and neuropsychiatric features were 37.7% and 18.8%, respectively. The adherence with cSLE-QIs differed markedly; performance of diagnostic testing, medication management including corticosteroid weaning, and bone health was high while the compliance with flu vaccine, eye screening, photoprotection, and education about cardiovascular risk was lower. There was a noticeable variability between the international childhood lupus clinics. Conclusion: Providing cSLE patients with a high quality of health care is challenging without the proper guidance. Hopefully, these findings will enhance the adherence to cSLE-QIs and increase the likelihood of the desired outcome.
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Clinical and serological features of patients with systemic lupus erythematosus in the eastern province of Saudi Arabia: A prospective cohort study p. 7
Khawla K Alghanim, Batol G Gasmelseed, Reemaz S Abdulhameed, Hezab A Alrayes, Arulanantham Z Jebakumar, Hanan S Abozaid
DOI:10.4103/ara.ara_1_21  
Context: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that manifests differently across races. Aims: The aim of the study is to summarize the clinical and serological features of patients with SLE in Saudi Arabia and to determine the predictors of morbidity and mortality. Settings and Design: This was single-center prospective cohort study. Patients and Methods: We included SLE patients who met our selection criteria and followed prospectively and regularly between December 2016 and January 2020. We analyzed their symptoms, laboratory results, frequencies of clinical manifestations, causes of admission, and causes of death. We also assessed variables that predicted mortality. Statistical Analysis: Chi-square test was used to find the association between quantitative variables; survival analysis was done using Mantel–Cox method. Results: The mean age of the patients at diagnosis was 33.42 ± 12.9 years. The most common symptoms were arthritis (74.1%), malar rash (66.4%), and photosensitivity (64.7%). Renal involvement was seen in 17.2% of patients, with Class IV lupus nephritis (35%) being the most common. Patients aged ≤45 years had higher antinuclear antibody titers. Patients of African descents displayed higher rates of Class VI lupus nephritis and renal failure (25%). SLE caused deaths in 4.3% of patients, the main cause being infection (46.03%). There were obstetric complications in 27 (23.3%) patients; 28 (24.1%) vascular thrombosis events were noted, the most common being venous thrombosis (n = 21). Conclusions: Most patients were diagnosed at a young age. African patients displayed more severe disease in the form of renal symptoms, especially Class VI lupus nephritis. Infectious complications were the main cause of death.
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A cross-sectional assessment of the knowledge about rheumatoid arthritis among university students in Saudi Arabia p. 13
Fahidah Alenzi, Haifa Al-Sheikh, Khozama Alaraj, Taeef Saeed, Raghad Alfedeah, Reem Al-Anazi, Nawal Alfawari
DOI:10.4103/ara.ara_5_21  
Background: Rheumatoid arthritis (RA) is a chronic multisystem autoimmune inflammatory disorder characterized by inflammatory joint and extra-articular organ involvement including lung, eye, and heart that can lead to physical dysfunction and impaired quality of life. Aim: The aim of the study is to estimate the level of knowledge about RA and determine attitudes among university students and staff of Riyadh and to assess the limitations of this knowledge. Materials and Methods: A cross-sectional study was conducted at universities of Riyadh in Saudi Arabia. The study used a close-ended, interviewer-based questionnaire and includes 500 respondents from health and nonhealth college students and administrative staff. Results and Discussion: There were 404 (80.8%) females and 96 (19.2%) males and 65.5% were in the common age group of 18–24 years. The highest number of the participants (234, 48.6%) was from Princess Nourah University, and 53% of the participants were from nonhealth science colleges. 51.4% of the participants had a family member working or studying in a health-related field, and the level of knowledge of these participants about RA was 81 (31.5%). The age group that had poor knowledge of RA was between 31 and 40 years (including 83.3% of the participants). The participants from Princess Nourah Bint Abdulrahman University had good knowledge (31.7%) compared to participants from other universities. Finally, among gender groups, females had a better level of knowledge about RA (30.2%) compared to (69.8%) of males. Conclusion: Our study found that the level of awareness about RA in Riyadh is slightly lower than that observed in previous studies conducted in Saudi Arabia. This could be due to a lack of educational programs and awareness campaigns.
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The pattern and factors associated with COVID-19 infection among rheumatology patients p. 17
Huda Alfaris, Eiad Alfaris, Fahidah AlEnzi, Farhana Irfan, Lina El Kibbi, Hanan Alrayes
DOI:10.4103/ara.ara_2_21  
Objectives: The global coronavirus pandemic has led to a considerable concern among rheumatologists regarding the possible higher risk of infection and complications among their patients. The severity and outcome of coronavirus disease 2019 (COVID-19) infection among patients with rheumatic disease (RD) need to be studied to help guide physicians choose the best approach for different categories of patients. Therefore, we aimed to estimate the rate of COVID-19 infection among RD patients and to evaluate the risk factors and outcomes. Methodology: This study was a cross-sectional questionnaire-based study. A convenience and nonprobability sample of RD patients filled out the study questionnaire from October to November 2020. They were invited digitally through SurveyMonkey and were recruited from social support group sites of the Saudi Society of Rheumatology and the Charitable Association for Rheumatic Diseases. The Chi-square test, Mann–Whitney test, and Fisher's exact test were used as appropriate. Continuous data are expressed as the mean and standard deviation. A P < 0.05 was considered as statistically significant. Results: The study participants were composed of 530 RD patients. The ages of the participants ranged from 14 to 80 years, and women outnumbered men with a ratio 4.4:1 (329 female and 96 male patients). The rate of COVID-19 infection among the study population was 13.7% (n = 71). Previous comorbidities (liver disease and heart failure) were associated with higher risk of COVID-19 infection (P < 0.01 and 0.012) and worse outcome (P < 0.005). Conclusion: This study indicates a relatively high rate of COVID-19 infection among RD patients. Having comorbidities posed a significantly greater risk for contracting COVID-19 infection and developing worse outcomes. Therefore, close monitoring of patients with comorbidities such as liver and cardiovascular diseases is warranted.
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CASE REPORT Top

A child with immunoglobulin a vasculitis and hemorrhagic shock: An unusual presentation p. 23
Shahad Alansari, Alhanouf Alsaleem
DOI:10.4103/ara.ara_3_21  
Immunoglobulin A (IgA) vasculitis, formerly known as Henoch–Schonlein purpura, is the most common vasculitis in children affecting small-sized vessels. Although IgA vasculitis is a self-limiting disease, a small number of patients can present with severe life-threatening complications. Here, we described a pediatric patient with final diagnosis of IgA vasculitis complicated with massive gastrointestinal bleeding and hemorrhagic shock, who recovered with supportive treatment and combined immunosuppressive drugs.
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