Safety of COVID-19 Vaccine in Patients with Rheumatic and Musculoskeletal Diseases.

Objectives: The main purpose of this study was to determine the frequency of COVID-19 vaccine side effects in patients with rheumatic diseases and to examine any potential associations with medications, disease type, or comorbidities. Methods: A multicentre cross-sectional study from rheumatology units in different hospitals in Iraq was carried out between 8th of August 2021 and 4th of August 2022. Patients were eligible for inclusion if they have a rheumatic disease and have taken one or more doses of any COVID-19 vaccine. Results: A total of 661 (57.8% female, mean age 46.51± 12.97 years) patients with rheumatic illnesses who received the "COVID-19" vaccination were included in this study. Rheumatoid arthritis was the most frequent diagnostic group. The Pfizer vaccine was given to the majority of patients (74.6%), followed by Sinopharm (16.2%), and AstraZeneca (9.2%). Side effects were detected in 661(100%) and 528 (100%) patients following the first and second vaccination doses, respectively; among which the most frequent were injection site pain in 57.8% following the first dose and 47.6% after the second dose, followed by fatigue and fever. According to multivariate logistic regression models, age (B=-0.204, p = 0.000), had a significantly inverse correlation coefficient with the experience of greater side effects. Rheumatic disease flares reported in 9.9%, 10.3%, and 8.2% of patients who received the Pfizer, Sinopharm, and AstraZeneca vaccines, respectively. Conclusion: The "COVID-19" vaccination has a reassuring safety profile with no greater risk of adverse events in any specific illness or pharmacological therapy.

Challenges in Applying Treat to Target Strategy in Sample of Iraqi Patients with Rheumatoid Arthritis.

OBJECTIVE: To identify barriers and factors that might hamper RA patients from achieving clinical target. PATIENTS AND METHODS: A total of 100 consecutive RA patients (95 females: 5 males) were included in this retrospective cross-sectional study. Data were collected at one point in time using questionnaire and interview. Demographic data, disease duration, functional classes, medications, and compliance assessment on the current treatments by using the Compliance Questionnaire Rheumatology (CQR19) were recorded for all patients. Achievement of clinical target was defined using the Clinical Disease Activity Index (CDAI; score ≤ 10). The main barriers preventing reaching the clinical target were reported for all the patients with moderate to high disease activity. RESULTS: Among 100 patients with a recorded CDAI, 58 patients (58%) had not achieved the clinical target (CDAI > 10), for whom the barriers to disease control were recorded. The recorded barriers were drug unavailability/interruption (34.5%), under-treatment (20.7%), insufficient time to assess treatment response to recently initiated DMARDs (12.1%), non- inflammatory musculoskeletal pain (10.3%), had no further drug option available (10.3%), irreversible joint damage (5.2%), and other or non- identified barriers (6.9%). All patients completed CQR-19 items and poor compliance was identified as a predictor of high disease activity (P=0.001). Disease duration had a strong effect on the likelihood of patient response (P=0.035). There was a lower response rate among current smokers (P=0.007). Additionally, functional impairment appeared to be associated with high disease activity (P=0.0001). A significantly larger portion of low disease activity patients were presently on biological treatments (P=0.037) while steroid use had been associated with high disease activity (P=0.03). Age, gender, and Body Mass Index did not predict response to treatment. CONCLUSIONS: This study identified interruption of biologic drugs supply as a large barrier to RA treatment target. The data supported improved outcomes among patients receiving biological treatments. Additionally, certain factors were associated with high disease activity including longer disease duration, functional impairment, smoking, non-adherence, and steroid use.

Attitude of Iraqi Rheumatologists While Managing Rheumatic Diseases in the Era of COVID-19: An Online Survey.

BACKGROUND: The current crisis COVID-19 has affected the already challenging management of rheumatic diseases. Since no evidence-based approach is yet available, this survey was conducted to explore the Iraqi rheumatologists' attitude in the era of COVID-19 and how they have been managing their patients, especially with the continuously updating and sometimes conflicting reports. PATIENTS AND METHODS: A cross-sectional survey was distributed online via telephone and social media to rheumatologists in Iraq. A questionnaire was conducted about methods of patient education, preventive measures, and methods of arranging visits and treatment. In addition, an inquiry about the similarity of the practice between their local institutions and global ones. RESULTS: 144 rheumatologists answered the 14 obligatory questions, of which the majority were specialists. 122 rheumatologists participated in patient education. Half of participants used online information, social media and websites as a source to communicate and interact with their patients for education about COVID-19-related issues. CONCLUSION: Despite the lack of solid guidelines regarding the management of rheumatic diseases during the COVID-19 crisis, this survey showed the majority of Iraqi rheumatologists to be familiar with the updating recommendations. Also, as the majority are waiting for stronger evidence before attempting to embrace controversial issues, surely this reflects a responsible and scientific attitude.

Pan Arab Osteoporosis Society Guidelines for Osteoporosis Management.

Osteoporosis is the most common bone disease in humans. With its related fragility fracture, it represents a major public health problem in our region, with a significant medical and socio-economic burden. The high prevalence rate of vitamin D deficiency, the increase in life expectancy, the low socioeconomic level and the significant restriction to access to health care in some countries represent the major causes for the increasing prevalence of osteoporosis and incidence of fragility fractures in the Arabic countries. Bone mineral density (BMD) assessment is the gold standard to diagnose osteoporosis. However, a clinical diagnosis of osteoporosis may be made in the presence of a fragility fracture, without BMD measurement. Dual energy x-ray absorptiometry (DXA) is the preferred method for screening bone mineral density. For screening site of measurement, DXA of hip and spine is suggested. BMD assessment is recommended in all women 65 years of age and older and men 70 and older regardless of risk factors. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines are aimed to provide to health care professionals in the region of an updated process for the diagnosis and treatment of osteoporosis. It includes risk factors for osteoporosis and the indications for screening, diagnosis of osteoporosis, treatment of osteoporosis in postmenopausal and premenopausal women, and men; in addition to prevention and treatment of glucocorticoid-induced osteoporosis.