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Objective. The purpose of this pilot study was to assess the prevalence of oral manifestations among systemic lupus erythematosus (SLE) patients in Qatar, in order to warrant future studies that would investigate each one of these manifestations with detail and further scrutiny. Methods. Study procedures took place between November 2014 and April 2016. All patients visiting the outpatient rheumatology clinics at Hamad General Hospital, Doha, Qatar, were asked to join. The American College of Rheumatology (ACR) 1997 criteria of SLE were used. The patients were examined initially by a rheumatologist and were later scheduled for an appointment with a dentist at the same institution. A total of 77 patients were recruited for the study. Results. Prevalence rates for the different oral manifestations ranged from 2.4% for soft palate ulcers, cheilitis, and oral candida to 88.1% for the presence of cavitation. Gingivitis, periodontal disease, cavities, and missing teeth were observed in more than 50% of the sample. The prevalence of periodontal disease and missing teeth was higher among those with an SLE duration > 8 years. On the contrary, the prevalence of gingivitis and cavities was higher among those with an SLE duration ≤ 8 years. Conclusion. This study found high rates of gingivitis, periodontal disease, cavities, and missing teeth among SLE patients in Qatar. It is recommended that healthcare providers of such patients monitor the presence of any oral manifestations in order to arrange for early treatment and prevention efforts. Future prospective longitudinal studies with adequate sample size and power are needed in order to ascertain any causation factors or common etiology pathways. [ABSTRACT FROM AUTHOR]

Objective Genetic factors underlying susceptibility to rheumatoid arthritis (RA) in Arab populations are largely unknown. This genome-wide association study (GWAS) was undertaken to explore the generalizability of previously reported RA loci to Arab subjects and to discover new Arab-specific genetic loci. Methods The Genetics of Rheumatoid Arthritis in Some Arab States Study was designed to examine the genetics and clinical features of RA patients from Jordan, the Kingdom of Saudi Arabia, Lebanon, Qatar, and the United Arab Emirates. In total, >7 million single-nucleotide polymorphisms (SNPs) were tested for association with RA overall and with seropositive or seronegative RA in 511 RA cases and 352 healthy controls. In addition, replication of 15 signals was attempted in 283 RA cases and 221 healthy controls. A genetic risk score of 68 known RA SNPs was also examined in this study population. Results Three loci ( HLA region, intergenic 5q13, and 17p13 at SMTNL2/GGT6) reached genome-wide significance in the analyses of association with RA and with seropositive RA, and for all 3 loci, evidence of independent replication was demonstrated. Consistent with the findings in European and East Asian populations, the association of RA with HLA-DRB1 amino acid position 11 conferred the strongest effect ( P = 4.8 × 10−16), and a weighted genetic risk score of previously associated RA loci was found to be associated with RA ( P = 3.41 × 10−5) and with seropositive RA ( P = 1.48 × 10−6) in this population. In addition, 2 novel associations specific to Arab populations were found at the 5q13 and 17p13 loci. Conclusion This first RA GWAS in Arab populations confirms that established HLA-region and known RA risk alleles contribute strongly to the risk and severity of disease in some Arab groups, suggesting that the genetic architecture of RA is similar across ethnic groups. Moreover, this study identified 2 novel RA risk loci in Arabs, offering further population-specific insights into the pathophysiology of RA. [ABSTRACT FROM AUTHOR]

Periodic fever with aphthous stomatitis, pharyngitis, and adenitis (PFAPA) is an autoinflammatory disease manifested as recurrent febrile episodes associated with one of the following cardinal features: aphthous ulceration, pharyngitis, and cervical adenitis. It was initially described in children and thought to be a disease of pediatric age group. Few adult cases were also reported in the literature. We describe the case of a 39-year-old female affected by PFAPA who presented with a history of febrile episodes associated with aphthous ulceration, stomatitis, and tonsillitis for 4 years. The febrile episodes occurred at a regular interval of 4 weeks and resolved within 5 days. The patient underwent tonsillectomy without any significant improvement. The patient responded only to a single high dose of steroid during the attack. Although PFAPA was initially thought to be a disease of pediatric age group, it should be considered in patients with recurrent febrile illness in all age groups. [ABSTRACT FROM AUTHOR]

Data on spondyloarthritis (SpA) from the Middle East are sparse and the management of these diseases in this area of the world faces a number of challenges, including the relevant resources to enable early diagnosis and referral and sufficient funds to aid the most appropriate treatment strategy. The objective was to report on the characteristics, disease burden, and treatment of SpA in the Middle East region and to highlight where management strategies could be improved, with the overall aim of achieving better patient outcomes. This multicenter, observational, cross-sectional study collected demographic, clinical, laboratory, and treatment data on 169 consecutive SpA patients at four centers (Egypt, Kuwait, Qatar, and Saudi Arabia). The data collected presents the average time from symptom onset to diagnosis along with the presence of comorbidities in the region and comparisons between treatment with NSAIDs and biologics. In the absence of regional registries of SpA patients, the data presented here provide a rare snapshot of the characteristics, disease burden, and treatment of these patients, highlighting the management challenges in the region. [ABSTRACT FROM AUTHOR]

This open-label study investigated the safety and efficacy of tocilizumab in Middle Eastern patients with rheumatoid arthritis (RA). Patients whose Disease Activity Score based on 28 joints (DAS28) was >3.2 received tocilizumab 8 mg/kg intravenously every 4 weeks for 24 weeks. Patients receiving aTNF ± nonbiologic disease-modifying antirheumatic drug(s) (DMARD(s)) switched to tocilizumab; patients receiving nonbiologic DMARD monotherapy added tocilizumab. Primary end points were adverse events (AEs), serious AEs (SAEs), and laboratory parameters; secondary end points were DAS28, Health Assessment Questionnaire-Disability Index, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Eighty-eight of 95 patients completed 24 weeks. Overall, 125 AEs were reported in 43 (45%) patients; the most common were increased hepatic enzymes (16%) and cholesterol (11%). Eight patients experienced SAEs. Significant changes from baseline to week 24 occurred for hemoglobin, neutrophils, platelets, total cholesterol, and liver enzymes (P<0.05). DAS28, CRP, and ESR decreased significantly from baseline at each visit (P<0.0001). At week 24, the proportions of patients reporting DAS28 clinically meaningful improvement (decrease ≥1.2), low disease activity (DAS28 ≥2.6 to ≤3.2), and remission (DAS28 <2.6) were 92%, 23%, and 64%, respectively. Safety and efficacy of tocilizumab were consistent with values reported in Western patients. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the prevalence and predictors of osteoporosis and the impact of life style factors on bone mineral density (BMD) in premenopausal and postmenopausal Qatari women. Methods: This is a cross-sectional study. A total of 821 healthy Qatari women aged 20–70 years had given consent and participated and the study was conducted from June 2005 to December 2006 at the Rumaillah Hospital, Hamad Medical Corporation (HMC), Doha, State of Qatar. All subjects completed a questionnaire on reproductive and life style factors. Height and weight were measured. All subjects underwent dual-energy X-ray absorptiometry (DXA) to determine factors influencing BMD of the spine and femur. The main outcome measures were menopausal status, socio-demographic and lifestyle factors and BMD measurements. Results: The prevalence of osteoporosis in postmenopausal women was 12.3%. BMI was significantly higher among postmenopausal women ( P < 0.001) when compared to premenopausal women. The subjects who regularly consumed dairy products had better BMD at spine, neck and ward sites ( P < 0.05). Those doing regular household work for 3–4 h a week had higher BMD at all sites compared to those who did not do their own household work. Multiple regression analysis showed that education level and body mass index were strong positive predictors showing high significance. Conclusion: The relation between lifestyle and BMD were explored in Qatari women. The prevalence of osteoporosis in Qatari women is comparable to other countries. BMD values were higher in women who were taking diary products regularly, and were involved with household work. [ABSTRACT FROM AUTHOR]

Pyomyositis is a primary infection of the striated muscles. We describe the clinical and imaging features of pyomyositis in two patients, one diabetic and the other immunocompetent. Treatment with incision, drainage and antibiotics was successful and resulted in full recovery. Increased awareness, especially in immuno-competent patients, should lead to earlier diagnosis, correct treatment and a better outcome. [ABSTRACT FROM AUTHOR]

Epidemiological evidence suggests that obesity has effects on bone density. Obese subjects have increased bone density relative to non-obese subjects yet this relationship is not fully understood. However, the influence of these factors has not been well documented in Arabian Gulf women. The aim of this study was to determine the relationship between obesity and bone mineral density (BMD) as a risk factor for osteoporosis in premenopausal, menopausal and postmenopausal Qatari women. This is a cross-sectional study, performed during a period from September 2003 to October 2004. A total of 1000 women were targeted for the study, however, only 649 healthy Qatari women aged 20–70 years had given consent and participated in this study. All subjects completed a questionnaire on reproductive and life style factors. Height and weight were measured. Dual-energy X-ray absorptiometry (DXA) was used to determine Bone Mineral Density (BMD) of the spine and femur. The main outcome measures were menopausal status, socio-demographic, obesity and lifestyle factors and BMD measurements. It is observed from our survey that 27.7% of the studied subjects had osteoporosis/osteopenia. Illiterate subjects were more likely to have low bone mineral density (35%). Walking daily for more than 30 minutes contributed to increase the BMD at spine and femur. Also, doing regular household work for 1–2 h/day also contributed towards high BMD. Multiple regression analysis showed that obesity, educational level and taking multivitamin supplements were strong positive indicators for BMD at spinal sites and for femoral sites, BMD was higher among the obese subjects. Finally, the present study revealed that obesity is a protective factor for osteoporosis. The study concludes that in a population of Qatari women there is a positive association between obesity and BMD at both spinal and femoral sites. BMD at spine and femur sites were higher in obese group and than the non-obese group. [ABSTRACT FROM AUTHOR]

Objective To describe the clinical characteristics, serologic, radiological and clinical disease activity, and modality of therapy in patients with rheumatoid arthritis ( RA) at tertiary outpatient care in Qatar. Methods The study design was cross-sectional where 100 consecutive cases who met 1987 American College of Rheumatology criteria for diagnosis of RA were enrolled in this study. Demographic data (sex, nationality and age) numbers of swollen and tender joints, X-rays and current medications were collected during outpatients visits to Hamad General Hospital. Disease Activity Score of 28 joints ( DAS28) and Health Assessment Questionnaires ( HAQ) scores were calculated. All patients with RA who were seen as rheumatology outpatients were invited to participate in the study. Results One hundred patients were seen and examined during their follow-up at the outpatient clinic; data were collected and analyzed. Females represented 67% of all patients, 6% had more than six swollen joints, 9% had more than six tender joints. DAS28 and erythrocyte sedimentation rate ( DAS28) calculation revealed 49% of patients were in remission ( DAS28 < 2.6), 15% had low disease activity ( DAS28 2.6-3.2) and 36% had DAS28 > 3.2.Mean HAQ score was 1.02. Rheumatoid factor ( RF) was positive in 63%, while anti-cyclic citrullinated protein antibody (anti- CCP) was positive in 71%, and 49% were positive for both. Radiography of hands and feet during the previous year was done in 65% of patients: 11% of them had erosions. Sixty-six percent were on one synthetic disease-modifying anti-rheumatic drug ( DMARD) and 27% where on more than one synthetic DMARD and 7% where on no DMRD. Glucocorticoids were used in 51% and 29% were on biologics. Conclusion Sixty-four percent of rheumatoid arthritis patients in Qatar were in remission or had low disease activity while the remaining 36% had active disease and among these patients 29% were on biologics. [ABSTRACT FROM AUTHOR]

Objectives. To investigate the incidence of weight gain and hair loss as adverse effects of anti-TNF therapy in rheumatic diseases. Methods. Patients using anti-TNF therapy, who are followed in rheumatology clinic, were interviewed using a questionnaire to investigate the side effects of anti-TNF therapy. Patients who complained of hair loss and weight gain were asked additional questions concerning the relationship of these adverse effects to anti-TNF use, whether therapy was stopped because of these adverse effects and if the adverse effects reversed after stopping therapy. The files were reviewed to follow the weight change before, during, and after discontinuation of anti-TNF. Results. One hundred fifty consecutive patients (82 RA, 34 ankylosing spondylitis, 32 psoriatic arthritis, and 4 for other indications) were interviewed .Weight gain was observed in 20 patients (13.3%) with average gain of 5.5 Kg. Anti-TNF was stopped in five patients because of this adverse effect. Hair loss during anti-TNf therapy was reported in five females (3.3%) and anti-TNF therapy was stopped in all of them. Conclusion. Weight gain and hair loss appear to be associated with anti-TNF therapy and may be one reason for discontinuing the therapy. [ABSTRACT FROM AUTHOR]

We report a case of right-sided hemichorea associated with systemic lupus erythematosus (SLE) in a female patient who presented with involuntary movements of hand and foot, without any other manifestation of SLE. Further workup showed positive tests for antinuclear antibody, anti-Smith antibody, anti-dsDNA, and antiphospholipid antibody (aPL). The patient was started on aspirin and hydroxychloroquine and her chorea resolved after three weeks of followup. This is one of the few reported cases of SLE where chorea is presented as the first and only manifestation of SLE. [ABSTRACT FROM AUTHOR]