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   Table of Contents - Current issue
May-December 2022
Volume 2 | Issue 2
Page Nos. 35-66

Online since Wednesday, January 25, 2023

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National guidelines for the management of lupus nephritis in Saudi Arabia p. 35
Hanan M Al Rayes, Huda Alfaris, Mohammad Alkhowaiter, Khawla K Alghanim, Roaa Aljohani, Abdulaziz Alkhalaf, Sultana Abdulaziz, Tariq E Aljohani, Abdulkareem Alsuwaida
Context: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that can affect all organs and cause considerable morbidity and mortality. The estimated prevalence of SLE in the central region of Saudi Arabia is 19.28/100,000 individuals. Approximately half of those will eventually develop clinically significant renal disease. Therefore, screening for renal involvement is essential for early diagnosis and optimal disease management. Aims: This study aims to develop a pathway that can facilitate the early diagnosis and management of lupus glomerulonephritis in the Kingdom of Saudi Arabia. Methodology: The Saudi Society of Rheumatology in collaboration with the Saudi Society of Nephrology and Transplantation and under the supervision of the Saudi Commission for Health Specialties formed a committee involving rheumatologists, nephrologists, and a renal pathologist. Multiple workshops were conducted to adapt the 2019 Update of the Joint European League against Rheumatism and European Renal Association–European Dialysis and Transplant Association recommendations for the management of SLE, as well as The Kidney Disease: Improving Global Outcome 2020 using the ADAPTE process. Results: This document includes recommendations related to screening for renal involvement, renal pathology and classification, initial and subsequent therapy for lupus nephritis (LN), the treatment of refractory and relapsing LN, and the management of advanced renal disease. Recommendations concerning pregnancy and postpartum care are also included. Conclusion: We developed a guideline for the management of adults with LN based on recommendations developed elsewhere. This guideline was adapted to the local context of our health-care system.
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The practice of referring patients with rheumatic diseases and respiratory involvement to respirology clinics: A survey study p. 45
Rahmah Abdulhadi Alsilmi
Background: There is a significant association between rheumatic diseases and pulmonary complications, mandating careful assessment for patients. Aim: We aimed to assess the current practice of rheumatologists in referring patients with rheumatic diseases and respiratory involvement to respirology clinics in Saudi Arabia. Materials and Methods: This study is a cross-sectional online survey conducted among rheumatologists and distributed from September 15th, 2021, to December 30, 2021. The first part of the questionnaire aimed to determine the participants' demographic data. The second part assessed the current practice of referring patients with respiratory symptoms to respirology clinics. The third part assessed the participants' awareness of evaluating respiratory diseases in patients with rheumatic conditions. Results: The survey was distributed to 250 rheumatologists using social media and E-mail. We received 61 responses. The majority, 56 (91.8%), did not have a preset respiratory questionnaire and 55 (90.2%) reported ordering pulmonary function tests and high-resolution computerized tomography of the chest before referring patients to a pulmonologist. Forty respondents (65.6%) screen their high-risk patients for respiratory involvement at baseline, and annually, 53 (86.9%) collaborate with a pulmonologist to manage patients who have lung involvement on a long-term basis. The majority of the respondents, 60 (98.4%), did not have an established combined rheumatology-respirology clinic; however, 43 (70.5%) believed that it was feasible to establish such a clinic in their workplace. There is consistency in agreement among the respondents regarding the importance of screening high-risk patients for pulmonary complications. Conclusion: Among the respondents, there was an appreciation of the importance of pulmonary complication screening and collaboration with a pulmonologist to comanage their patients. The concept of the combined rheumatology-respirology clinic is not widely adopted, considering its potential effect on prompt patient evaluation.
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Psoriatic arthritis: Saudi retrospective observational study of manifestations and treatments p. 53
Seham R Alunizi, AlRabbab AlShanqeeti, Khalidah A Alenzi, Ibrahim Abdulrazag Al-Homood
Objectives: Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disease associated with psoriasis. In this study, we aimed to assess clinical features and the response rates to various biological agents among patients with PsA in the Kingdom of Saudi Arabia. Materials and Methods: A retrospective study where 39 patients diagnosed with PsA based on ClASsification criteria for PsA criteria for the period 2015–2019, were recruited from rheumatology outpatient clinics at KFMC, Riyadh, Saudi Arabia. Results: Thirty-nine PsA patients (31 females [79.5%] and eight males [20.5%]) were reviewed. The median age at disease onset was 36 years (ranging from 20 to 61 years). The median disease duration was 3 years. Peripheral arthritis reported in 92% and axial involvement in 28.2% of our patients. Fifteen percent of our patients developed enthesitis, whereas 12.5% had dactylitis. The mean duration for adalimumab (ADA) as a first-line treatment was 104 weeks, whereas etanercept (ETA) was 120 weeks. However, ADA had the longest duration in the second-line therapy (177 weeks), and secukinumab (SEC) had the longest duration (209 weeks) in the third-line therapy. ADA was discontinued in 76.9% of our patients due to inefficacy, whereas the most adverse events were reported with SEC and ETA (7.1%). Conclusion: Our study provided insights on the demographics, characteristics, and responses to various biological treatments of PsA patients in Saudi Arabia.
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Childhood-onset systemic lupus erythematosus presenting with features mimicking Kawasaki disease p. 58
Mohammed Olfat, Asmaa Jokhdar, Banan Al-Rewaithy, Amal Alhejaily
Childhood-onset systemic lupus erythematosus (cSLE) may rarely present initially with features mimicking Kawasaki disease (KD). Here, we report a 10-year-old girl presenting with high-grade fever, generalized skin rash, conjunctivitis, cervical lymphadenopathy, dry fissured lips, strawberry tongue, polyarthritis, abdominal pain, and neck stiffness. She was initially diagnosed and treated as KD, and the diagnosis of cSLE was confirmed 4 weeks later when she presented with a malar rash, nasal ulcer, seizures, and polyarthritis. In addition, her antinuclear antibodies, anti-double-stranded DNA, and direct Coombs test were positive. Therefore, with the difficulties in differential diagnosis and the rarity of such presentation, children with KD who develop new or unexpected features need to be evaluated for the development of cSLE.
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Lupus erythematosus with segmental anhidrosis p. 64
K Geetha
Systemic lupus erythematosus (SLE) is a multisystem connective tissue disorder that also affects all the components of the neurological system, such as autonomic, peripheral, and central nervous systems. There was no link between autonomic dysfunction and lupus activity or the presence of peripheral neuropathy. Anhidrosis and hypohidrosis are most usually caused by local skin injury (e.g., related to trauma, radiation, infection [e.g., leprosy], or inflammation) or gland atrophy caused by connective tissue illness (e.g., systemic sclerosis, systemic lupus erythematosus, and Sjögren syndrome). Drugs, particularly those with anticholinergic effects, can possibly induce it. Diabetic neuropathy, thyroid problems, and other factors might potentially contribute to it. Here is a rare case report of patchy segmental anhidrosis with compensatory hyperhidrosis as the presenting manifestation of SLE treated with topical sunscreen, topical glycopyrrolate, and oral hydroxychloroquine with mild clinical improvement. However, anhidrosis showed no improvement.
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