Enhancing the care of women with rheumatic diseases during pregnancy: challenges and unmet needs in the Middle East.

Pregnancy in women with rheumatic disorders is known to be associated with risks for both the mother and fetus; however, these risks can be minimized with proper planning and careful management of the disease. In the Middle East, there are specific cultural challenges that may have a negative impact on the care that women with rheumatic disorders receive. There is a need for cross-collaboration between specialist physicians, improved awareness of rheumatic disorders among the general public and more open discussion with patients about the potential complications of pregnancy. Women in the region are often unwilling to discuss their disease with their partner and are even less likely to seek advice regarding family planning from their physician. The objective of this review is to highlight the specific challenges of pregnancy management and to discuss why establishing specialist pregnancy clinics for women with rheumatic disorders could be an effective solution. Such clinics can provide high quality care before, during and after pregnancy as shown in several European and US centers. Additionally, such clinics could be useful for the collection of pregnancy outcomes data from the Middle East, which may currently be lacking in the region, in order to highlight where further improvements can be made. With specialist care and analysis of pregnancy outcomes, the standard of care for women with rheumatic disorders in this area could be significantly improved.

Comparison between familial and sporadic systemic lupus erythematosus in Kuwaiti patients.

To validate the use of multiplex case families in studying the pathogenesis of systemic lupus erythematosus (SLE), we investigated the pattern of familial SLE in relation to sporadic SLE in the highly consanguineous Kuwaiti population. We sought to determine whether familial and sporadic SLEs have the same clinical and serological features. We compared 21 cases of familial SLE in 21 families with 42 non-familial SLE controls matched for age, sex and duration of disease. Twenty-one families, in which the diagnosis of SLE was verified in at least two relatives, were included in the study. The diagnosis was made according to the revised 1982 American College of Rheumatology criteria. There were no significant differences in clinical features or serological manifestations between familial SLE cases and their matched controls. However, our results showed that the frequency of La/SSB antibodies was higher in the sporadic group (P = 0.048), although this was not significant after application of Bonferroni's correction for the number of comparisons. Familial cases of SLE were more likely to present at younger age of 20 years and sporadic cases at 26 years (P = 0.006). The prevalence of familial SLE was 27.4%. We have found that familial and sporadic cases of SLE are broadly similar, and it is justified to include multiple case families in genetic studies.