Early and late effects of therapeutic plasma exchange in patients with systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis: A single-center experience.

Therapeutic plasma exchanges (TPE) is considered as one of the treatment modalities that is used in systemic autoimmune diseases. This study aimed to describe the early and late effect of TPE in patients with systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) presented with acute kidney injury (AKI). Retrospective study comprised patients with SLE and AAV with AKI seen between January 2000 and June 2014 at King Faisal Specialist Hospital and Research Center in Riyadh. All patients underwent TPE. Retrospectively, all patients were assessed for early and late renal outcome at 12- month and 24-month intervals. Renal outcome was assessed according to serum creatinine level, glomerular filtration rate, active urine sediment, and proteinuria. P <0.05 was considered significant. A total of 68 patients were included, 58 patients (51 females) had SLE and 10 patients (7 females) had AAV completed TPE. All patients had active disease and had AKI. At the first 12 months, 18 patients (17 SLE and 1 AAV) showed complete response and 14 patients had partial response while 22 patients did not show therapeutic benefit. The nonresponders (22 patients) entered the late assessment interval (24 months) without any therapeutic response. Statistically, there was no significant difference between the patient's response to TPE at the first and second assessment intervals and the baseline serum creatinine level. TPE might be an alternative rescue treatment in lupus nephritis with AKI.

Musculoskeletal pain in the community.

OBJECTIVE: To estimate the prevalence of musculoskeletal (MSK) pain in Al-Qaseem province in central Saudi Arabia. METHODS: Over a period of 18 months extending from September 1993 through to the end of February 1995, a house-to-house survey was conducted in Al-Qaseem province and included 5,894 adults asking regarding musculoskeletal pain. RESULTS: We obtained a response from 5,823 (98.8%), 2,667 (45.8%) men, and 3,156 (54.2%) women. The mean age was 34.14 +/- 15.16 years. Musculoskeletal pain was reported by 1,477 (25.4%), 762 (13.1%) men and 715 (12.3%) women. Musculoskeletal pain was significantly correlated with age (r =0.454), married status (r=0.238), unemployment (r=0.122), lower educational attainment (r=0.347), frequent attendance at local doctor (r=0.703), consumption of medications for pain (r =0.551), and change in ability to work (r=0.492). We found no association with sex or body mass index. CONCLUSION: Musculoskeletal pain, although common in the community, is less prevalent than reported from Western countries, but has similar socio-medical consequences.

How common is back pain in Al-Qaseem region.

OBJECTIVE: The aim of this study was to estimate the prevalence of back pain in the adult population of Al-Qaseem Central Province, Kingdom of Saudi Arabia and to find associated features and factors. METHODS: A house-to-house survey covering 1,000 household in the towns and villages of Al-Qaseem province was carried out over a period of 18 months extending from September 1993 until the end of February 1995. A total of 5,894 adults, aged 16 years and above, were questioned by trained staff regarding back pain, and the demographic data in addition to general, medical and social history. RESULTS: A response was obtained in 5,743 (97.4%). Their mean age was 34.14 15.16 (range 16-99). Back pain was reported by 1,081 (18.8%), wherein 499 (8.8%) were men, and 574 (10%) were women. Back pain was more prevalent in married (23.3%) individuals than unmarried (6.4%). Adjusted odds ratio (OR) for back pain in married individuals was 1.88 (95% confidence intervals [CI] 1.49-2.37). Back pain was strongly correlated with age (correlation coefficient = 0.378 P < 0.01). It also showed significant correlation with weight and height, depression, family history of back pain, change in work ability, frequency of attendance at local doctor, use of medication and lower education level. The association with body mass index became evident only after comparing the heaviest 20th percentile to the lightest (OR 1.335 [95% CI, 1.279-1.402]). Certain occupational status (unemployed, farmers, professional workers and housewives) were associated with back pain. CONCLUSION: Back pain was relatively common in this largely unindustrialized community although its prevalence is lower than reported from some western countries.

Knee osteoarthritis in Al-Qaseem, Saudi Arabia.

OBJECTIVE: The aim of this study was to estimate the prevalence of clinical osteoarthritis (OA) of the knee in Al-Qaseem, a central province in the Kingdom of Saudi Arabia (KSA). METHODS: A house to house survey of randomly selected inhabitants of Al-Qaseem, KSA was conducted. A total of 10,406 persons were interviewed of whom 5,894 were above the age of 16 years. The study was carried out at King Khalid University Hospital and College of Medicine, Riyadh, KSA, from September 1993 to February 1995. They were questioned regarding musculoskeletal complaints, and those positively identified were interviewed further by a team of trained medical staff and later examined by trained doctors including rheumatologists. RESULTS: We found 766 (13%) cases of clinical OA of the knee in the 5,894 adult population (13%). The prevalence of OA increased with increasing age reaching 30.8% in those aged 46-55 years and 60.6% in the age group 66-75 years. The odds ratio (OR) for the association between clinical OA of the knee and age adjusted for sex and body mass index (BMI) was 1.0894 (95% CI, 1.08-1.09). The association of clinical OA of the knee with female sex was also significant [OR (adjused for age and BMI) was 1.261 (95% CI, 1.0456-1.5208)]. CONCLUSION: Clinical OA of the knee is common in this community, particularly in the older age groups.

Mouth and genital ulcerations in the community.

OBJECTIVE: To estimate the prevalence of mouth and genital ulceration in the community and its relationship to rheumatic diseases. METHODS: A house to house survey was carried out over a period of 18 months extending from September 1993 to February 1995, on 5,894 individuals utilizing detailed questionnaires on symptoms of musculoskeletal diseases and associated symptoms including history of mouth, genital ulcers, eye symptoms, and skin changes. After the initial phase, a 2nd phase was completed by trained nurses and paramedical staff, the purpose of which was to explore in detail, the history of those responding positively to any of the questions in phase one. The 3rd stage was conducted by general practitioners and rheumatologist to interview and examine those identified in phase 2 at King Fahad Hospital, Buraidah, Kingdom of Saudi Arabia. RESULTS: We identified 7 (0.1%) cases of genital ulceration, 43 (0.7%) cases of mouth ulceration, 263 (4.5%) cases of reddish eye or blurred vision, and 124 (2.1%) cases of skin rashes. Only 2 cases had both mouth and genital ulceration in addition to eye disease, skin rash and musculoskeletal pain. There was significant correlation between mouth ulcers and skin rash, eye symptoms, genital ulcerations, male sex, single status, weight loss and backpain. CONCLUSION: The vast majority of mouth and genital ulcers are not associated with a known rheumatic disease.

Prevalence of systemic lupus erythematosus in central Saudi Arabia.

OBJECTIVE: Although systemic lupus erythematosus of varying severity has been seen in our clinics, there is no information regarding the prevalence of the disease among Saudi nationals. We conducted this study to determine the prevalence of systemic lupus erythematosus in Al-Qaseem region of the Kingdom of Saudi Arabia. METHODS: A community survey of towns and villages in the Al-Qaseem area of central Saudi Arabia was conducted in 3 phases to determine the prevalence of systemic lupus erythematosus in the region. RESULTS: Of the 10,372 studied, 2 cases of systemic lupus erythematosus were identified using the criteria set for the diagnosis of systemic lupus erythematosus by the American College of Rheumatology. Based on that, the prevalence of systemic lupus erythematosus was estimated to be 19.28 per 100,000 population in the region. CONCLUSION: The estimated prevalence of systemic lupus erythematosus in Al-Qaseem area is similar to that found in western countries.