Exploring factors influencing patient activation in Saudi rheumatoid arthritis patients: A Nationwide Cross-Sectional Survey-Results from the COPARA study.

OBJECTIVES: To evaluate patient activation in rheumatoid arthritis (RA) patients using patient activation measure 13 (PAM-13) on a national level in Saudi Arabia. METHOD: A national survey was administered across multiple centers in Saudi Arabia. Patient activation was assessed using the PAM-13. The Compliance Questionnaire for Rheumatology (CQR) and the RA Impact of Disease (RAID) tool were also administered. The data from the survey were analyzed, and the results were stratified based on activation level. All factors affecting patient activation were explored and reported. RESULTS: A total of 1241 participants were included. Most of the patients were females (85%), the mean age was 47 (±14), and most patients lived in the central region (47%). The mean (±standard deviation) patient activation score was 578.7 (±13.0). Patient activation was affected by multiple factors: demographic characteristics, such as education, with a beta value of 1.11 (95% confidence interval [CI] 0.64 ̶1.58, p < .001). Higher CQR scores were associated with higher activation levels, with a beta value of 2.61 (95% CI 0.80 ̶4.44, p = .005), and higher RAID scores were associated with lower activation levels, with a beta value of 3.13 (95% CI 1.36 ̶4.91, p = .001). CONCLUSIONS: Patient activation was affected by several demographic characteristics and the impact of RA. A higher activation may improve compliance. Future longitudinal studies are required to confirm these findings and should explore the underlying mechanism of these effects.

Exploring Impact of Multidisciplinary Care on Patient Activation in Saudi Rheumatoid Arthritis Patients: A Cross-Sectional Survey-Extended Results from the COPARA National Project.

Introduction: Multidisciplinary setting in healthcare provide positive patient outcomes. Objective: To evaluate the impact of specialized rheumatology clinics (multidisciplinary settings) on the activation and engagement of rheumatoid arthritis (RA) patients. Material and Methods: This cross-sectional survey assessed patient activation using the patient activation measure-13. Participants attending Specialized Rheumatology Clinics (SRC multidisciplinary clinics) were compared with age- and sex-matched patients attending Standard of Care (SOC). The study was observational in nature, assessing several demographic and therapeutic options and their relation to the clinical setting and patient activation. Results: This study included 117 SRC matched RA patients with 117 SOC. The majority of the included patients were female (n=211, 90.2%), >40 years of age (n=177, 75.6%), and had intermediate-to-high education (n=147, 62.8%). Patients in the SRC were also more likely to have activation levels 3 and 4 with an odds ratio of 3.194 (95% confidence interval [CI] 1.835-5.562, p<0.001). In addition, SRC participants were more likely to be in levels 3 and 4 activation, even after adjustment for confounding variables, with an adjusted odds ratio of 2.401 (95% CI 1.121-4.758, p=0.012) and 2.175 (95% CI 1.127-4.196, p=0.020), respectively. Conclusion: Establishing SRC for RA patients seems to have a positive impact on patient activation and engagement and adds to the previously explored benefits of multidisciplinary care in chronic disease management.

Exploring Factors Influencing Medication Compliance in Saudi Rheumatoid Arthritis Patients: A Nationwide Cross-Sectional Survey - Results from the COPARA Study.

Purpose: Compliance is essential to achieve treatment goals in rheumatoid arthritis (RA) patients. The current study evaluated compliance and related factors in a large and diverse population. Patients and Methods: Patients with RA who received active treatment were invited to participate in an online survey. The Arabic versions of the 5-Item Compliance Questionnaire for Rheumatology (ACQR-5) and the RA Impact of Disease (RAID) were used to measure compliance and disability, respectively. The patients were sub-grouped based on background disease-modifying anti-rheumatic drugs (DMARDs). Variables associated with high compliance were selected for the logistic regression analysis. Results: A total of 1241 patients completed the survey and were included in the final analysis. Of those, 1055 (85%) were females with a mean (±SD) age and disease duration of 47.14 ± 13.71 and 8.77 ± 7.43 years, respectively. The mean RAID was 4.4±2.58, with 980 (79%) having an unacceptable level state. Patients with an unacceptable RAID level had a lower compliance rate (78.8% vs 85.8%, p = 0.001). Demographics associated with high compliance were female sex and increased age, with reported odds ratios of 1.018 (95% CI: 1.007-1.028) and 1.464 (95% CI: 1.016-2.108), respectively. Compliance was similar between patients on Janus kinase inhibitors or biological DMARDs (88.14% vs 80.83%, p = 0.17), between monotherapy, double therapy, or triple therapy recipients (80% vs 82.23% vs 81.32%, p = 0.665), and between patients receiving injectable and oral therapy (77.32% vs 81.14%, p = 0.246). Conclusion: A high compliance level was observed in this population, with patient demographics influencing compliance rather than the medication type or route of administration. Interventional studies should focus on the of high-risk patients identified in this study.

Patterns of Response to Different Treatment Strategies in Seropositive Rheumatoid Arthritis Patients in a Tertiary Hospital in South-Western Saudi Arabia: A Retrospective Study.

PURPOSE: To study the pattern of response to different treatment strategies in seropositive rheumatoid arthritis (RA) patients and to describe our clinical practice in RA management. PATIENTS AND METHODS: Over a period of two years from April 2018 to April 2020, we conducted a retrospective analysis of data for 288 consecutive seropositive RA patients attending rheumatology clinics and the daycare unit at Aseer Central Hospital. Data were collected on patient demographics, disease duration, extraarticular manifestations, comorbidities and treatment. Disease activity was assessed using the clinical disease activity index (CDAI). RESULTS: Out of the total 288 patients, 42% (120) are on csDMRADs, while 54% (162) are on bDMRADs and 4% (6) are on tsDMARDs. Of the patients on csDMARDS, 51%, 43% and 7% of them were on remission, low and moderate disease activity, respectively. However, of the patients on non-csDMARDS, 36.3%, 49.4% and 14.3% of them were on remission, low and moderate disease activity, respectively. Failure of csDMARDs was affected by the presence of high disease activity at baseline, extraarticular lung manifestations and coexistent fibromyalgia, with a significant effect of the latter on remission rate. Among patients on non-csDMARDs, 42 (25%) showed one or more therapy changes. Tumor necrosis factor inhibitors were the predominant first-line agents in biologically naive patients (65%) followed by abatacept (18%). Abatacept was the most frequently prescribed second biologic in 52% of cases followed by tocilizumab in 19%. CONCLUSION: The current clinical practice in our hospital is consistent with the latest American College of Rheumatology (ACR)/The European League Against Rheumatism (EULAR) guidelines. Treat-to-target strategy was achieved in the vast majority of our patients, while remission was observed in almost half of the patients.

Correlation of Buccal Micronucleus with Disease Activity Score Using Buccal Micronucleus Cytome Analysis (BMCA) in Systemic Lupus Erythematosus.

BACKGROUND: A disease activity score obtained by using systemic lupus erythematosus disease activity index (SLEDAI) has traditionally been a reliable method to assess the SLE status of patients. More recently, a buccal micronucleus cytome assay (BMCA) has been developed for use as a biomarker of DNA damage in patients with SLE. There has been a very limited number of studies pertaining to the oral lesions in Arab population suffering from SLE in Asir region. Hence, it became utmost important to study epidemiological data of oral mucosal lesions in SLE patients. Distribution of oral lesions in SLE patients could also be helpful in better management of oral complications. AIM: The aim of this study was to determine the existence of a correlation between SLEDAI score and the degree of micronuclei (MN) formation using BMCA. MATERIALS AND METHODS: After thorough oral examination of adult Saudi SLE patients of Asir hospital and that of healthy control subjects, the subjects underwent BMCA from normal unaffected bilateral buccal mucosae. RESULTS: Pearson's correlation test showed that MN count did not significantly correlate with either disease activity or duration of SLE. CONCLUSIONS: Controlled state SLE does not lead to a significant increase in MN formation. Thus, the occurrence of premalignant lesions in the oral cavity could be minimized using proper management protocols.

WhatsApp-assisted Oral Health Education and Motivation: A Preliminary Randomized Clinical Trial.

AIM: The study aimed to assess the efficacy of using WhatsApp instant messages in enhancing the oral hygiene in patients with gingivitis. MATERIALS AND METHODS: Forty-three systemically healthy male dental patients with gingivitis were recruited consecutively and randomly divided into two groups: WhatsApp group (n = 24) and a control group (n = 19). At baseline visit, the participants were educated and motivated about oral health and given a folio on instructions about the oral hygiene preventive measures. The participants in the study group further received WhatsApp messages about the dental care at weekly intervals throughout the study (3 months). Plaque index (PI) and gingival index (GI) were measured at baseline and after 1 and 3 months. RESULTS: The averages of PI and GI were not significantly different between both groups at any time point of measurement (baseline, after one, and three months; p value >0.05). Intragroup comparisons revealed that the reductions in PI were highly significant after 1 and 3 months (-0.26 ± 0.26 and -0.57 ± 0.35, respectively, for WhatsApp group, and -0.24 ± 0.27 and -0.64 ± 0.4. respectively, for the control group; p value range: 0.001 to <0.001). Similar were the reductions in GI in each individual group (-0.17 ± 0.46 and -0.67 ± 0.05, respectively, for WhatsApp group, and -0.28 ± 0.29 and -0.69 ± 0.41, respectively, for the control group: p value < 0.001). CONCLUSION: Implementing WhatsApp instant messages does not appear to add extrabenefit to the traditional motivation and education on oral hygiene practices in terms of changes in PI and GI over time in patients with gingivitis. CLINICAL SIGNIFICANCE: Although the results were not motivating, this does not preclude the dental professionals from using WhatsApp and the similar technology to deliver oral healthcare advices.

The effectiveness of leflunomide in psoriatic arthritis.

OBJECTIVES: This study aimed to evaluate the effectiveness and safety of leflunomide alone and in combination with methotrexate in the treatment of psoriatic arthritis (PsA). METHODS: Patients were followed at the University of Toronto PsA Clinic. PsA patients who received leflunomide alone or in combination with methotrexate were identified from the PsA clinic database. Effectiveness was defined by drug persistence, a ≥40% reduction in actively inflamed joints, a ≥40% reduction in swollen joint count, and PASI50 and PASI75 response following treatment with leflunomide. Descriptive statistics and logistic regression analyses with stepwise selection were used for data analysis. RESULTS: 85 patients were identified. 43 patients (50.6%) were on leflunomide alone and 42 (49.4%) patients were on combined leflunomide and methotrexate therapy. 30 patients discontinued leflunomide mainly due to toxicity. Of the 55 patients who continued the drug, 38%, 48% and 56% achieved a ≥40% reduction of actively inflamed joint count at 3, 6 and 12 months, respectively. PASI50 was achieved by 27%, 28% and 38% at 3, 6 and 12 months, whereas PASI75 was achieved by 19% at 3 and 6 months and 32% at 12 months. Longer duration of PsA and higher swollen joint count at baseline were predictive for improvement of the swollen joint count at 3 months. The use of concomitant MTX was predictive of achieving PASI50 at 12 months. CONCLUSIONS: Leflunomide led to improvement in almost 50% of the patients by 1 year. Those also taking methotrexate were more likely to achieve a PASI50 response.