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Bader A Al-Mehmadi,1 May Musaad M Alelaiwi,2 Haya Sulaiman A Alnumayr,3 Basil Saeed Alghamdi,4 Bandar Abdullah Alomari,4 Hayat Saleh Alzahrani5 1Department of Internal Medicine, College of Medicine, Majmaah University, Al-Majmaah, 11952, Saudi Arabia; 2College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia; 3College of Medicine, Qassim University, Buraydah, Saudi Arabia; 4Department of Internal Medicine, King Fahad Hospital, Medina, Saudi Arabia; 5Department of Family and Community Medicine, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi ArabiaCorrespondence: Hayat Saleh Alzahrani, Department of Family and Community Medicine, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Tel +96611822000, Email Hsaalzahrani@pnu.edu.sa; hayatsalzahrani@gmail.comPurpose: The aim of this study is to determine the general population’s knowledge on the different symptoms of rheumatic diseases, the key factors for diagnosis delays from the patient’s perspective, the length of delay from the onset of symptoms to the diagnosis, and the effect this holds on the disease activity, response to therapy, and the development of complications and nonreversible deformities in patients diagnosed with rheumatic diseases.Patients and Methods: This is a cross-sectional study. Our target study population were the residents of Saudi Arabia. Data were collected via an online questionnaire and analyzed with SPSS.Results: The overall prevalence of rheumatic disease in our cohort was 8.7%. Joint pain (75.7%), joint swelling (47.1%) and morning stiffness (32.9%) were the first and most common presenting symptom. Persistence of symptoms (N=32, 45.7%) and symptom worsening (N=21, 30.0%) was the predominant cause to visit rheumatologist. The duration between first symptom and rheumatic disease diagnosis is significantly longer for patients aged < 50 years compared to that of those with ≥ 50 years of age. Results show that 36.4% of patients aged ≥ 50 years had delayed diagnosis due to late appointment compared with 5.7% of patients aged < 50 years. In addition, patients with longer duration of symptoms were likely to have more visits to the rheumatologist. Most of the participants of < 50 years significantly agreed that rheumatologists treat autoimmune diseases, only a few approved that they treat muscle problems.Conclusion: Most participants in our study have lesser knowledge about their symptoms and they did not know where to consult for the treatment of their disease. This caused unnecessary delays and worsening and aggravation of the symptoms. There is an increased need to organize an awareness campaign in the general population regarding autoimmune and rheumatic diseases.Keywords: rheumatic diseases, delayed diagnosis, misdiagnosis, referrals, consultations, Saudi Arabia

Background: Antimicrobial resistance is increasing at an alarming rate. The use of antibiotics without a prescription by a patient or other family members and their inappropriate storage have caused serious health issues as it would lead to antibiotic resistance and exposure to the risk of harmful adverse effects unnecessarily. Therefore, the study aimed to evaluate the current behaviour of antibiotic usage, storage, re-usage and misuse among the residents of Saudi Arabia., Methods: This is a cross-sectional study. Our target study population was the residents of Saudi Arabia. Data were collected by an online questionnaire and analysed by SPSS., Results: A total of 738 participants answered the online questionnaire from all ages, genders, nationalities, and socioeconomic backgrounds residing in different regions across the Kingdom of Saudi Arabia. 76.42% knew that an antibiotic is a chemical substance used to treat infections. The participants were questioned about when they started using antibiotics, to which 95.66% (n=706) responded after consulting a physician, 3.25% (n=24) said when they felt ill for any reason, and 1.08% (n=8) replied after first attempting herbal medicine. A total of 147 participants admitted that they store excess pills of antibiotics after being prescribed for an infection and reuse them later on for symptoms like sore throat and fever., Conclusions: The results indicated that nearly half of the participants used leftover antibiotics. Participants having children in their homes significantly reuse antibiotics. However, one-third of the participants didn't complete the antibiotics course. A large portion of the population, regardless of age, level of education, or professional background, have continued to store leftover antibiotics after an infection treatment and reuse them once they think they need them for new symptoms. This advice further revises the current measures to fill those gaps and reduce this habit., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Al-Mehmadi B et al.)

Background: The 2021 American College of Rheumatology (ACR) rheumatoid arthritis (RA) guideline considers the specific context of the United States which differs from that of Saudi Arabia in many aspects that may impact recommendations. The objective of this project was to adapt a set of prioritized recommendations from the 2021 ACR guideline for the treatment of rheumatoid arthritis RA for the context of Saudi Arabia, by the Saudi Society for Rheumatology (SSR)., Methods: The process followed the GRADE-ADOLOPMENT methodology, and the reporting adhered to the RIGHT-Ad@pt checklist. Working groups included a coordination group and a 19-member panel representing different stakeholder groups. The Evidence to Decision (EtD) tables included evidence on health effects from the source guideline and contextual information from the Saudi setting., Results: The panel prioritized and adapted five recommendations from the source guideline. The process led to modifying two out of the five prioritized recommendations, all listed here. In naive patients with low disease activity, methotrexate (MTX) is conditionally recommended over sulfasalazine (SSZ) (modified direction); hydroxychloroquine (HCQ) is conditionally recommended over SSZ (unmodified). Initiation of csDMARDs with short-term glucocorticoids is conditionally recommended over csDMARDs alone in naive patients with moderate to high disease activity (modified direction). Switch to subcutaneous MTX is conditionally recommended over addition/switch to alternative DMARD(s) in patients taking oral MTX who are not at target (unmodified). Discontinuation of MTX is conditionally recommended over gradual discontinuation of the bDMARD or tsDMARD for patients taking MTX plus a bDMARD or tsDMARD who wish to discontinue a DMARD (unmodified)., Conclusion: Rheumatologists practicing in Saudi Arabia can use the adoloped recommendations generated by this project while adopting the rest of the recommendations from the 2021 ACR guidelines., (© 2022. The Author(s).)