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Objectives Systemic lupus erythematosus (SLE) is a chronic autoimmune multi-systemic disorder of the connective tissue, characterized mainly by involvement of the skin, joints, kidneys, and serosal membranes. It affects females particularly at childbearing age more commonly than males. Lupus nephritis affects around half of patients with SLE. Data about SLE and lupus nephritis in Saudi Arabia are still scarce. In this study, we aimed to evaluate the prevalence, clinical and laboratory findings of SLE and different histological types of lupus nephritis among Saudi patients at King Fahad Medical City. Methods This is a retrospective study for adult patients who have been evaluated at king Fahad medical city between 2014 and 2019 and fulfilled the Systemic Lupus International Collaborating Clinics classification criteria (SLICC). Results 112 patients, 103 (92%) females and 9 (8%) males, with confirmed diagnoses of SLE were reviewed. Skin rash (69.6%), photosensitivity (61.6%), mucosal ulcerations (45.9%), arthralgia and/or arthritis (44.6%) are the most common clinical features. Ninety seven (86.6%) out of 112 patients had a recorded first visit 24 hour urine protein level, out of those only 26 (23.2) patients presented with significant proteinuria of more than 0.5grams per day. Forty four (39.2%) have undergone kidney biopsy. Class IV and III lupus nephritis are the most common reported biopsy results (43.18% and 27.28% respectively). During the study period, three patients (2.7%) developed end-stage kidney disease requiring dialysis and five (4.5%) had renal transplant. Conclusion Our study provided insight on the demographics, characteristics and presentation of SLE patients and the outcome of lupus nephritis in Saudi Arabia.

Psoriatic arthritis (PsA) is a chronic, inflammatory arthropathy occurring in up to 30% of patients with psoriasis, and is characterized by multiple manifestations including peripheral arthritis, enthesitis, dactylitis, spondylitis, and psoriatic skin and nail disease. This complex and heterogeneous disease is poorly understood and its diagnosis and treatment are suboptimal, particularly in Africa and the Middle East, where very few studies into the impact of PsA have been carried out. This article aims to highlight the disease burden of PsA in the region as well as to identify unmet clinical needs. A non-systematic review was carried out in the PubMed database and the most relevant publications were selected. Expert rheumatologists practicing in Africa and the Middle East provide an insight into the challenges of treating PsA in daily practice, along with recommendations for improvements.

 AIM: This study aimed to assess the prevalence and determinants of osteoporosis [lumbar spine (LS) and femoral neck (FN)] among patients with type 2 diabetes at King Salman Hospital.MATERIALS AND METHODS: One hundred seventy patients with type 2 diabetes were enrolled in this cross-sectional study in the period from the 1st of January until the 1st of July 2015. Patient selection was based on self-report of the previous diagnosis by a physician, being on an antidiabetic agent, or a fasting glucose of 126 mg/dl as per the American Diabetes Association criteria. A dual energy X-ray absorptiometry scan with the bone mineral density (BMD) categorization based on the WHO cut of levels of T-scores and determination of vitamin D levels were performed. A detailed questionnaire was used to collect demographic data.RESULTS: Out of 170 participants, 50 (29.4%) were diagnosed as having osteoporosis, while 68 (40%) were diagnosed with osteopenia. Age was determined as a risk factor for a decreased BMD in patients with osteopenia (odds ratio (OR) = 1.1, 95% confidence interval (CI) = (1.0-1.1), p = 0.039) and osteoporosis (OR = 1.1, CI = 1.0-1.2, p < 0.001). Similarly, oral hypoglycemic agents (OHA) increased the risk of decreased BMD in osteopenia (OR = 2.6; CI = 1.0-6.7; p = 0.023) as well as osteoporosis, (OR = 3.8; CI = 1.3-10.9; p = 0.013), while vitamin D deficiency increased the risk of osteopenia OR = 3.0; CI = 1.2-7.2; p = 0.012). Increased BMI decreased the risk of both osteopenia and osteoporosis (OR = 0.9; CI = 0.9-0.99; p = 0.031 vs. OR = 0.9; CI = 0.80-0.95; p = 0.003).CONCLUSION: Advanced age, OHA and vitamin D deficiency are determinants of decreased BMD in Saudi women with type 2 diabetes, while an increased BMI protects against low BMD.

The aim of this study is to use transthoracic echocardiographic (TTE) imaging methods to identify cardiac dysfunction in asymptomatic systemic lupus erythematosus (SLE) patients and to determine the association between echocardiographic findings and serology. This is a prospective cross-sectional study where 50 patients with confirmed diagnoses of SLE were recruited from rheumatology outpatient clinics. Clinical and serological evaluation to confirm the diagnosis of lupus was done in all patients. Fifty SLE patients, 46 (92%) females and 4 (8%) males, were recruited. Anti-double-stranded DNA (Anti-dsDNA), anticardiolipin, lupus anticoagulant, and anti-β2-glycoproteins were positive in 52.1, 32.6, 13.3, and 15.6%, respectively. Transthoracic echocardiogram revealed mitral regurgitation in 16 patients (32%), pericardial effusion in16 patients (32%), aortic regurgitation in five patients (10%), and tricuspid regurgitation in 10 patients (20%). Eleven patients had left ventricular hypertrophy (22%), and eight patients had ventricular systolic dysfunction (16%). Only four patients had ventricular diastolic dysfunction (8%). A significant association between mitral and tricuspid valve regurgitation and positive anti-dsDNA (p

Background Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect different systems. Thyroid dysfunction is common in SLE. Several studies reported a varied prevalence of thyroid diseases in SLE patients. Objective To report the prevalence of thyroid dysfunction in Saudi patients with SLE. Methods Retrospective review of medical charts of SLE patients who attended rheumatology clinic at King Fahad Medical City between 2014 and 2015 was conducted.The primary outcome was the prevalence of thyroid dysfunction; the secondary outcome was the association between SLE and thyroid diseases. Pearson’s chi-squared test was used to compare the distribution of thyroid diseases, and a student t-test was used to assess the association of SLE activity and thyroid diseases. A p-value less than 0.05 was considered significant. Result The overall prevalence of thyroid dysfunctions was 26 (17.2%) out of 151 SLE patients. The most common dysfunctions were subclinical hypothyroidism 11 (7.3%) and hypothyroidism 7 (4.6%). Hypothyroidism patients were found to have a positive and equally high frequency (57%) of anti-Tg and anti-TPO, and equal frequency of a positive anti-Tg and anti-TPO (64%) was found in subclinical hypothyroidism patients as well. No association was found between SLE activity and thyroid diseases. Conclusion Our SLE patients had a high prevalence of subclinical hypothyroidism (7.3%). No significant association between SLE activity and thyroid diseases.

Objective The aim of this study is to evaluate the prevalence, clinical, laboratory and histological types of lupus nephritis (LN) among Saudi patients. Methods This is a retrospective study that done at King Fahad Medical City, Riyadh, Saudi Arabia, where clinical and laboratory data collected for a period from 2011–2016. All patients fulfilled the Systemic Lupus International Collaborating Clinics classification criteria (SLICC). Results Out of 112 patients, 103 (92.0%) females, 9 (8.0%) males, mean age 34 (33.87±10.42) years. The mean of initial proteinuria level was 0.72 gm (0.72±1.34) and the mean serum creatinine 34.00 (82.33±83.88). The most common clinical characteristics were skin rash 70% and photosensitivity 61%. With regards to comorbidities; Hypertension was found in 31 (27.7%), Hyperlipidemia in 16 (14.3%) and Diabetes mellitus in 12 (10.7%) of SLE patients. Laboratory investigations revealed 67.0% had a positive ANA, 60.7% positive Anti DsDNA, 27.7% positive aPL, 17.9% positive Anticardiolipin igG, 18.8% positive Anticardiolipin IgM, and B2glycoprotein IgG was positive in 8.9% of patients. 44 (39.8%) out of 112 patients had a kidney biopsy and the histological types were as follow; Focal segmental glomerulosclerosis (FSGS) 2.2%, class I 2.2%, class II 6.8%, class III 27.2%, class IV 43.1%, V 6.8%, minimal change disease (MCD) 2.2%, Thrombotic Microangiopathy (TMA) 2.2%, non-specific 2.2% Normal 2.2%, poor biopsy 2.2%. Conclusion The most notable clinical manifestations were skin rash 70% followed by photosensitivity 61% and arthralgia 39%. Patients with Hypertension, hyperlipidemia and diabetes mellitus had a higher risk of developing LN at any stage by 10%–28%. The commonest class of lupus nephritis among our patients as proven by kidney biopsy is class IV 43.1% followed by class III 27.2%.

Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder that is a diagnosis of exclusion. It is characterized by high spiking fevers, arthritis or arthralgia, and an evanescent salmon-coloured rash. Many other systemic manifestations and laboratory test abnormalities may occur. Biologic drugs, TNF-α inhibitors, and IL-1 and IL-6 blockers have been used for the treatment of patients with AOSD refractory to conventional treatment or those with life-threatening manifestations aiming for better disease control. Data on biologic treatments in AOSD are limited and consist mainly of case reports, small case series and retrospective studies. Using biologic agents (anti-TNF-α, anti-IL-1 and anti-IL-6) with traditional immunosuppressive drugs resulted in significant improvement of disease outcomes. IL-1 and IL-6 inhibitors seem to be more efficient than TNF-α inhibitors.

We describe a case of Immunoglobulin G4-related disease (IgG4-RD) coexisting with Behçet’s disease. A 49-year-old man, with a diagnosis of Behçet’s Disease for 15 years who was found to have an acute kidney injury. His investigations revealed an elevated IgG4 level and the abdominal computerized tomography showed a retroperitoneal mass, which was diagnosed to be IgG4-RD based on histology. The patient showed symptomatic and radiological improvement after starting high dose steroid for 1 month followed by a maintenance dose. Our case report suggested that the two diseases arose separately.

In recent years, biological drugs have been widely administered to treat rheumatic diseases including psoriatic arthritis (PsA). However, the safety of these drugs has not been adequately established in pregnancy. We report a case of a pregnant PsA patient treated with etanercept, an anti-tumor necrosis factor (TNF-α) agent. She continued to receive etanercept treatment during pregnancy without any complications, finally giving successful birth to a baby girl at 39 weeks. This suggests that etanercept may be selected to treat PsA patients with active arthritis who desire pregnancy with lower risks.

Background: Patients satisfaction is increasingly being recognized as a central element in monitoring quality of health care services; the assessment of which may offer ways of optimizing health care delivery and preventing waste of medical resources. This study was designed to assess satisfaction and its determinants among patients attending governmental primary health care clinics. Methods: This was a cross-sectional study of a representative sample of patients attending two governmental clinics in Riyadh, Saudi Arabia. Data was collected via a self-administered questionnaire and stratified random sampling with equal allocation was adopted to select a significant number of patients of equal gender representation. Results: A total of 200 patients participated in the study, 71% were 21-40 years old with equal gender distribution, 77% were Saudis, 72.5% were satisfied with the services provided. The only factor that had a significant impact on overall satisfaction was the waiting time between registration and consultation, with those waiting over 30 minutes more often reporting to be dissatisfied with the service provided. (p=0.002). Conclusion: Overall, participants were satisfied with the services they received. However, those who had longer waiting time between registration and consultation showed higher rate of dissatisfaction.

Background and Objective: Neuropsychiatric disorders including depression are common clinical manifestations of systemic lupus erythematosus (SLE). Depression in patients with SLE is under-recognized, although it is a treatable clinical entity. The present study aimed to determine the prevalence of depression and identify the relationship between depression and SLE disease characteristics. Patients and Methods: This multicenter cross-sectional study was conducted in the rheumatology clinics of four tertiary referral hospitals in Saudi Arabia between April and September 2014. Patients' demographic data and SLE disease characteristics such as disease duration, severity and drug treatments were collected. A validated Arabic Beck Depression Inventory (BDI) score was used to estimate the prevalence of depression. Results: A total of 68 patients with SLE (64 women, 4 men) were enrolled in the study. Forty-six (67.6%) patients were found to have BDI scores indicating depression; of them, only four patients (8.7%) were receiving antidepressant treatments. Higher prevalence of depression was associated with steroid treatment (P = 0.046). Conclusions: The study results revealed high prevalence of depression among Saudi patients with SLE. Most of the study population were not adequately treated, suggesting inadequate recognition and treatment of depression in SLE.

Diabetes mellitus (DM) is a chronic systemic disease with a wide range of complications, including complications in the musculoskeletal system. DM is a common disease in nearly all countries and continues to increase in numbers and significance. Approximately 90 % of patients have type 2 DM which is caused by resistance to insulin. Type 1 DM results from an absolute deficiency of insulin due to an autoimmune destruction of insulin-producing beta cells within the pancreas. Diabetic patients suffer from diverse rheumatic conditions that affect their life quality. This article reviews the rheumatic conditions that are associated with DM and the pathophysiologic relationships that might link these conditions; it also summarizes recent advances in the field of diabetes and rheumatic conditions. The rheumatic conditions that are discussed in this review include limited joint mobility, Dupuytren’s contracture, flexor tenosynovitis, carpal tunnel syndrome, adhesive capsulitis, diffuse idiopathic skeletal hyperostosis, neuropathic osteoarthropathy, diabetic muscle infarction, crystal induced arthritis, osteoarthritis, and reflex sympathetic dystrophy.