Guidelines for fracture risk assessment and management of osteoporosis in postmenopausal women and men above the age of 50 in Qatar.

We present comprehensive guidelines for osteoporosis management in Qatar. Formulated by the Qatar Osteoporosis Association, the guidelines recommend the age-dependent Qatar fracture risk assessment tool for screening, emphasizing risk-based treatment strategies and discouraging routine dual-energy X-ray scans. They offer a vital resource for physicians managing osteoporosis and fragility fractures nationwide. PURPOSE: Osteoporosis and related fragility fractures are a growing public health issue with an impact on individuals and the healthcare system. We aimed to present guidelines providing unified guidance to all healthcare professionals in Qatar regarding the management of osteoporosis. METHODS: The Qatar Osteoporosis Association formulated guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men above the age of 50. A panel of six local rheumatologists who are experts in the field of osteoporosis met together and conducted an extensive review of published articles and local and international guidelines to formulate guidance for the screening and management of postmenopausal women and men older than 50 years in Qatar. RESULTS: The guidelines emphasize the use of the age-dependent hybrid model of the Qatar fracture risk assessment tool for screening osteoporosis and risk categorization. The guidelines include screening, risk stratification, investigations, treatment, and monitoring of patients with osteoporosis. The use of a dual-energy X-ray absorptiometry scan without any risk factors is discouraged. Treatment options are recommended based on risk stratification. CONCLUSION: Guidance is provided to all physicians across the country who are involved in the care of patients with osteoporosis and fragility fractures.

New-onset severe eosinophilic granulomatosis with polyangiitis following the third dose of mRNA COVID-19 vaccine: A case report.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a complex multifactorial disease that results in multisystemic inflammation of the small- and medium-sized arteries. The exact pathogenesis of this syndrome is poorly understood, but it is postulated to result from a combination of eosinophilic dysfunction, genetic predisposition, and the development of autoantibodies after exposure to an unknown stimulus. We describe a case of new-onset EGPA following the third dose of the Pfizer-BioNTech mRNA vaccine in an infection-naive middle-aged man with a background history of allergic respiratory symptoms. The patient developed acute onset of mononeuritis multiplex, pauci-immune glomerulonephritis, and leucocytoclastic vasculitis 10 days after receiving the booster dose. His laboratory markers including eosinophil count, antineutrophil cytoplasmic antibodies, and renal function tests improved markedly after the initiation of pulse steroid therapy and rituximab infusion. However, his peripheral muscle weakness and neuropathic pain did not respond to the initial therapy but improved later with intravenous cyclophosphamide and intravenous immunoglobulin. To the best of our knowledge, this is the fourth case report of post-coronavirus disease 2019 vaccination precipitation of EGPA. All reported cases including our report were in patients with previous allergic manifestations who received mRNA-based coronavirus disease 2019 vaccines, and all the patients developed mononeuritis multiplex at presentation. Despite the few reported cases of post-vaccination autoimmune phenomena, the temporal association between vaccination administration and disease onset does not indicate causality, given the mass vaccination programmes employed. However, the novel use of the mRNA platform in vaccine delivery necessitates vigilant monitoring by the scientific committee.

Epidemiology of hip fracture in Qatar and development of a country specific FRAX model.

Hip fracture data were retrieved from electronical medical records for the years 2017-2019 in the State of Qatar and used to create a FRAX® model to facilitate fracture risk assessment. Hip fracture rates were comparable with estimates from Saudi Arabia, Abu Dhabi, and Kuwait but fracture probabilities varied due to differences in mortality. OBJECTIVE: This paper describes the epidemiology of osteoporotic fractures in the State of Qatar that was used to develop the country-specific fracture prediction FRAX® tool. METHODS: Hip fracture data were retrieved from electronic medical records for the years 2017-2019 in the State of Qatar. The age and sex specific incidence of hip fracture in Qatari residents and national mortality rates were used to create a FRAX® model. Fracture probabilities were compared with those from neighboring countries having FRAX models. RESULTS: Hip fracture rates were comparable with estimates from Saudi Arabia, Abu Dhabi and Kuwait. In contrast, probabilities of a major osteoporotic fracture or hip fracture were lower in Qatar than in Kuwait but higher than those in Abu Dhabi and Saudi Arabia due to differences in mortality. CONCLUSION: The FRAX model should enhance accuracy of determining fracture probability among the Qatari population and help guide decisions about treatment.

Leukocyte chemotactic factor 2-related amyloidosis presenting with severe jaundice and hepatic encephalopathy.

Amyloidosis is a well-known disease with various types and subtypes. One of the most recently identified types is leukocyte chemotactic factor 2 amyloidosis (LECT 2), which was found to be common in certain ethnic backgrounds. It is suggested that the diagnosis of this type is vital to prevent any therapy-related complications when it is erroneously diagnosed as AL amyloidosis. The clinical presentation is usually slowly progressive kidney disease and mild hepatic impairment. We report a case of LECT2 amyloidosis, which presented with severe painless cholestasis and hepatic encephalopathy alongside progressive kidney disease.

Incidence rate of osteoporotic hip fracture in Qatar.

The incidence rate of osteoporotic hip fracture is essential to formulate a national fracture risk assessment tool (FRAX). In this epidemiological study, the incidence rate of osteoporotic hip fracture in Qatar was comparable to that in regional countries, and lower than that in North America and European countries. PURPOSE: Estimate the annual incidence rate (IR) of osteoporotic hip fractures (OHF) in Qatar from January 2017 to December 2019. METHODS: Hamad Medical Corporation is a government-based tertiary medical institute. Hip fractures were captured by using the International Classification of Diseases-10 hip fracture codes. The patient records were reviewed retrospectively to identify fracture mechanisms. The observed census in 2017 and the estimated censuses of 2018 and 2019 were used to calculate the age-sex-specific annual IR of OHF in the population aged ≥ 40 years. The world population in 2010 was used to calculate the age-adjusted standardized IR in the population aged ≥ 50 years. RESULTS: In total, 458 hip fractures were identified; 75 (16.4%) were due to high-energy trauma, and 9 (2%) were pathological hip fractures. The total number of OHF was 374 (81.7%). OHF was slightly higher in men (215, 57.5%). The median age (IQR) of the patients was 69 years (56-78 years). In 2017, 2018, and 2019, the age-adjusted standardized IR of OHF per 100,000 with the corresponding 95% CI was 141.7 (141.1-142.2), 140.8 (140.2-141.3), and 162.7 (162.0-163.2) for the whole Qatar population; 154.2 (153.6-154.7), 105.2 (104.7-105.7), and 176.6 (175.9-177.1) for Qataris; and 134.8 (134.3-135.4), 183.9 (183.3-184.6), and 160.4 (159.8-161.0) for non-Qataris, respectively. CONCLUSION: The annual age-adjusted standardized IR of OHF per 100,000 inhabitants aged ≥ 50 years in Qatar was comparable to that in regional countries, and lower than that in North America and European countries.

Potential Predictors and Prevalence of Helicobacter pylori Infection Among Adult Patients With Dyspepsia: A Retrospective Study From Qatar.

Aim To study the prevalence of Helicobacter pylori (H. pylori) infection among dyspeptic patients of various ethnic origins in Qatar and determine the association between H. pylori infection and various demographic factors and endoscopic findings. Methods A retrospective data review was carried at Alkhor Hospital, Hamad Medical Corporation, Qatar. Adult patients who underwent endoscopy for the evaluation of dyspepsia between January 2011 to December 2017 were included. Patients who underwent endoscopy for reasons other than dyspepsia and those with incomplete data were excluded. Results Of the 638 subjects included, 58.9% were males, and the mean age of the subjects was 42.2 years (range 18-79 years). Epigastric pain (80.6%) was the most common symptom, followed by heartburn (26.2%). Forty point nine percent (40.9%) had a positive Campylobacter-like organism (CLO) test for H. pylori. A higher prevalence of H. pylori infection was observed among subjects between 31-50 years of age (43.6%) and 18-30 years (40.5%), and in Asian (42.2%) and Middle East and North African nationals (MENA) nationals (40%). Among the endoscopic findings, esophagitis (P=0.002) and gastritis (P=0.001) showed a statistically significant correlation with H. pylori positivity. Univariate regression analysis revealed an increased risk for H. pylori infection among all age groups except above 65 years, with an odds ratio (OR) of more than 2 in all the three age groups. Among various ethnicities, patients from Asia and MENA countries showed an increased risk of getting H. pylori infection (OR 1.16, 95% CI; 0.77,1.75 and OR 1.06, 95% CI 0.70,-1.61 respectively). The multivariable logistic regression analysis showed that subjects with endoscopic findings of esophagitis (adjusted OR 1.67, 95%CI 1.19, 2.34; P=0.003), gastritis (adjusted OR 1.79, 95%CI 1.27, 2.57; P=0.001), and duodenal ulcer (adjusted OR 2.41, 95%CI 1.24, 4.70; P=0.010) remained significantly associated with an increased risk of having H. pylori infection. Conclusion The burden of H. pylori infection in patients with dyspepsia undergoing endoscopy is not low in Qatar. Less than 65 years of age, Asian nationals, and being from the MENA region were the demographic predictors for H. pylori infection. The finding of esophagitis, gastritis, and duodenal ulcer on endoscopy were independent endoscopic predictors for having H. pylori infection.

Epidemiology of musculoskeletal complaints and diseases in Qatar: A cross-sectional study.

BACKGROUND: Musculoskeletal (MSK) conditions are considered a significant public health problem on account of their high prevalence in communities worldwide and their pervasive impact. Knowledge of the epidemiology of MSK symptoms and diseases is lacking in Qatar. Obtaining this information will guide local health policymakers in the future strategic planning of the health budget. OBJECTIVE: To estimate the prevalence rate of MSK disorders in the Qatari population above 15 years of age using the Community Oriented Program for the Control of Rheumatic Disease (COPCORD) survey. METHODS: This cross-sectional study targeted 1000 Qatari participants, including 500 males and 500 females. A door-to-door survey was conducted using the Arabic version of the COPCORD questionnaire with the help of research assistants. Participants with positive surveys were asked to visit Hamad General Hospital Rheumatology outpatient clinics for clinical evaluation by a rheumatologist. When necessary, laboratory testing and X-rays were conducted to confirm any MSK diagnosis. RESULTS: A total of 1239 (males, 50.8%) Qatari individuals randomly selected from the different municipalities of Qatar completed the COPCORD survey. Among the participants, 563 (45.4%) screened positive for MSK pain. Knee pain (24.5%) and back pain (23.3%) were the most common sites of pain, and both conditions showed no gender predominance (p = 0.073 and 0.108, respectively). Shoulder, wrist, hand, hip, and neck pain were significantly predominant in females (p < 0.001 for all). A total of 237 MSK disorders were diagnosed in 196 (15.8%) participants, including 181 degenerative joint diseases, 52 soft-tissue rheumatism conditions, and 4 autoimmune inflammatory disorders. Among degenerative joint diseases, knee osteoarthritis (6.4%) was the most common. Among soft-tissue rheumatic conditions, muscular lower back pain (1.9%), myofascial neck pain (0.64%), generalized body pain (0.32%), and shoulder tendinitis (0.7%) were the most common diseases. The autoimmune inflammatory disorders identified included rheumatoid arthritis (n = 2), connective tissue disease (n = 1), and inflammatory bowel disease-associated arthritis (n = 1). CONCLUSION: The overall prevalence rate of MSK disorders in this small cross-sectional cohort of Qatari individuals was 15.8%. Knee pain (24.5%) and knee osteoarthritis (6.4%) were the most common MSK complaints and diagnosis in the studied Qatari population. This study guides future efforts directed toward the prevention and management of MSK diseases. Further studies with a larger sample size are needed to verify the findings.

Endoscopic Findings in Patients With Uninvestigated Dyspepsia: A Retrospective Study From Qatar.

Background and objective Dyspepsia is a common complaint encountered in general clinical practice. The prevalence of clinically significant endoscopy findings in dyspeptic subjects of various age groups and ethnicities in Qatar is not well studied. This study aimed to evaluate the prevalence of endoscopic findings in previously uninvestigated patients with dyspepsia. Patients and methods We retrospectively studied subjects older than 18 years of age who underwent endoscopy for dyspeptic complaints from January 2011 to December 2017. Subjects who already had peptic ulcer disease (PUD), those who underwent endoscopy for reasons other than dyspepsia, and those with incomplete data were excluded. Results A total of 824 subjects were reviewed for eligibility and 733 were included for analysis. The mean ±SD age of the study subjects was 42.7 ±13.5 years, and 59.5% of the subjects were male. Epigastric pain was the predominant symptom (79.2%) followed by heartburn (26.1%). Abnormal endoscopic findings were noted in 91.8% of subjects. Gastritis (65.5%) and oesophagitis (33.1%) were the most common findings observed. The overall prevalence of gastric ulcers was 4.6%, and it was higher in subjects who were more than 60 years of age (14.1%, p=0.001). Gastric carcinoma was seen in only four (0.54%) subjects. Conclusion Gastritis was the most common endoscopic finding observed followed by oesophagitis. The most common presenting symptoms were epigastric pain and heartburn. The prevalence of gastric ulcers was significantly high in patients above 60 years of age, and the incidence of gastric carcinoma was low in the study population.

Characteristics of patients with rheumatoid arthritis in Qatar: a cross-sectional study.

OBJECTIVE: To describe the clinical characteristics, serologic, radiological and clinical disease activity, and modality of therapy in patients with rheumatoid arthritis (RA) at tertiary outpatient care in Qatar. METHODS: The study design was cross-sectional where 100 consecutive cases who met 1987 American College of Rheumatology criteria for diagnosis of RA were enrolled in this study. Demographic data (sex, nationality and age) numbers of swollen and tender joints, X-rays and current medications were collected during outpatients visits to Hamad General Hospital. Disease Activity Score of 28 joints (DAS28) and Health Assessment Questionnaires (HAQ) scores were calculated. All patients with RA who were seen as rheumatology outpatients were invited to participate in the study. RESULTS: One hundred patients were seen and examined during their follow-up at the outpatient clinic; data were collected and analyzed. Females represented 67% of all patients, 6% had more than six swollen joints, 9% had more than six tender joints. DAS28 and erythrocyte sedimentation rate (DAS28) calculation revealed 49% of patients were in remission (DAS28 < 2.6), 15% had low disease activity (DAS28 2.6-3.2) and 36% had DAS28 > 3.2.Mean HAQ score was 1.02. Rheumatoid factor (RF) was positive in 63%, while anti-cyclic citrullinated protein antibody (anti-CCP) was positive in 71%, and 49% were positive for both. Radiography of hands and feet during the previous year was done in 65% of patients: 11% of them had erosions. Sixty-six percent were on one synthetic disease-modifying anti-rheumatic drug (DMARD) and 27% where on more than one synthetic DMARD and 7% where on no DMRD. Glucocorticoids were used in 51% and 29% were on biologics. CONCLUSION: Sixty-four percent of rheumatoid arthritis patients in Qatar were in remission or had low disease activity while the remaining 36% had active disease and among these patients 29% were on biologics.

Chorea as the first and only manifestation of systemic lupus erythematosus.

We report a case of right-sided hemichorea associated with systemic lupus erythematosus (SLE) in a female patient who presented with involuntary movements of hand and foot, without any other manifestation of SLE. Further workup showed positive tests for antinuclear antibody, anti-Smith antibody, anti-dsDNA, and antiphospholipid antibody (aPL). The patient was started on aspirin and hydroxychloroquine and her chorea resolved after three weeks of followup. This is one of the few reported cases of SLE where chorea is presented as the first and only manifestation of SLE.

Weight Gain and Hair Loss during Anti-TNF Therapy.

Objectives. To investigate the incidence of weight gain and hair loss as adverse effects of anti-TNF therapy in rheumatic diseases. Methods. Patients using anti-TNF therapy, who are followed in rheumatology clinic, were interviewed using a questionnaire to investigate the side effects of anti-TNF therapy. Patients who complained of hair loss and weight gain were asked additional questions concerning the relationship of these adverse effects to anti-TNF use, whether therapy was stopped because of these adverse effects and if the adverse effects reversed after stopping therapy. The files were reviewed to follow the weight change before, during, and after discontinuation of anti-TNF. Results. One hundred fifty consecutive patients (82 RA, 34 ankylosing spondylitis, 32 psoriatic arthritis, and 4 for other indications) were interviewed .Weight gain was observed in 20 patients (13.3%) with average gain of 5.5 Kg. Anti-TNF was stopped in five patients because of this adverse effect. Hair loss during anti-TNf therapy was reported in five females (3.3%) and anti-TNF therapy was stopped in all of them. Conclusion. Weight gain and hair loss appear to be associated with anti-TNF therapy and may be one reason for discontinuing the therapy.