An assessment of the current treatment landscape for rheumatology patients in Qatar: Recognising unmet needs and moving towards solutions.

Objective This study assessed the mode of application (oral, intravenous or subcutaneous (SC)) currently employed in the treatment of rheumatoid arthritis (RA) in patients from Qatar in comparison with patients' individual preferences for the mode of application of their treatment. Methods This study included 294 RA patients visiting three clinics at the main referral hospital in Qatar who were interviewed using a standard questionnaire to determine their preference of mode of application for their disease-modifying antirheumatic drug (DMARD) treatment in relation to their currently employed mode of application. Results The majority of patients were female (76%), and 93% of male patients and 61% of female patients in the study clinics were of a nationality other than Qatari. The highest patient preference recorded was for an oral therapy (69%), compared with injection (23%) and intravenous (8%) therapy. In total, 85% of patients expressed a preference to remain on oral therapy compared with 63% and 58% of intravenous and SC injection patients indicating a preference to remain on their current method of administration. Conclusions This high preference for oral therapies highlights the considerable need for incorporation of new oral targeted synthetic DMARD therapies into clinical practice within the region.

Streptococcus agalactiae Septic Arthritis of the Shoulder and the Sacroiliac Joints: A Case Report.

Invasive group beta-streptococcal arthritis is being increasingly diagnosed as suggested by recent data. We report a case of a middle-aged lady from Sri Lanka who developed septic arthritis of the right shoulder and the left sacroiliac joint as well as an iliopsoas collection caused by Streptococcus agalactiae shortly after labor at Hamad General Hospital in Doha, Qatar. We conclude that Streptococcus agalactiae septic arthritis is rare. It can present with invasive disease in adults. It usually targets older females and immuno compromised patients especially those with risk factors for bacteraemia. Therefore a high index of suspicion is needed. Shoulder and sacroiliac joint affection is not uncommon for unknown reasons. Utilizing imaging modalities such as ultrasonography and magnetic resonance imaging is helpful.

Poststreptococcal reactive arthritis and the association with tendonitis, tenosynovitis, and enthesitis.

AIM: To study the clinical presentation of poststreptococcal reactive arthritis (PSRA) and its periarticular manifestation. METHODS: This is a retrospective study. The files of all patients diagnosed with PSRA between January 2004 and November 2007 were reviewed with a predetermined checklist. Patients were included if they met our study criteria for diagnosis of PSRA. RESULTS: A total of 33 files were reviewed; 26 of these patients (14 female, 12 male, Arab and Asian, aged 11-41 years) met our agreed protocol for the diagnosis of PSRA. The ethnic backgrounds of the patients were as follows: 18 patients were from Arab origins and 8 patients were Asians. Twenty-one patients (80%) had asymmetric complaints, whereas 5 patients (20%) had symmetrical complaints. Two patients (7.6%) had monoarthritis, 8 patients (30.76%) had oligoarthritis, and 11 patients (42.3%) had polyarthritis. Five patients (19.23%) had only polytendonitis, tenosynovitis, and/or enthesitis. Nine patients (34.61%) had tendonitis, tenosynovitis, or enthesitis alone or with arthritis/arthralgia. The average elevation of antistreptolysin antibodies titer was 624.8 and the average sedimentation rate 44 mm/H. The response to nonsteroidal antiinflammatory drugs was generally good (84.6%), being poor in only 4 patients (15.38%) who required treatment with corticosteroids. Prophylactic penicillin was given to 15 patients (57%). No patient had carditis on presentation or follow-up. CONCLUSIONS: It is concluded that polytendonitis, tenosynovitis, and enthesitis are common presentations in PSRA and could be the only manifestation of poststreptococcal infection.