Roaa Aljohani

Fibromyalgia (FM) is associated with substantial symptom burden, functional impairment, and lower quality of life, but data on caregiver burden remain limited. This multicenter cross-sectional study assessed caregiver burden, quality of life (QoL), and associated factors among informal unpaid family caregivers of patients with FM recruited consecutively from two rheumatology centers between November 2025 and March 2026. FM impact was evaluated using the Revised Fibromyalgia Impact Questionnaire (FIQR), caregiver burden using the Arabic abridged Zarit Burden Interview (ZBI-12), and caregiver QoL using the Arabic WHOQOL-BREF. Overall, 130 patient–caregiver pairs were included. Patients had a mean age of 45.35 ± 10.72 years, 88.5% were female, and the mean FIQR score was 70.99 ± 19.52. Caregivers had a mean age of 39.55 ± 13.45 years, 85.4% lived with the patient, and the mean ZBI-12 score was 14.15 ± 10.82. Higher ZBI-12 scores correlated with higher FIQR scores (ρ = 0.36, p < 0.001) and lower environment (ρ = −0.51, p < 0.001) and psychological WHOQOL-BREF scores (ρ = −0.46, p < 0.001). In adjusted models, higher FIQR scores remained associated with higher caregiver burden and lower WHOQOL-BREF scores across all domains. These findings support considering caregiver outcomes when evaluating the impact of FM.

Background/Objectives: Neutropenia and lymphopenia are common hematologic manifestations of systemic lupus erythematosus (SLE), but whether they represent distinct phenotypes is not well established. This study evaluated their prevalence, patterns, and associated factors. Methods: This multicenter retrospective study included 353 adults with SLE from three Saudi centers. Cytopenias were defined using prespecified laboratory criteria. Patients were classified as having neither abnormality, isolated neutropenia, isolated lymphopenia, or both. Multivariable logistic regression was used to assess factors associated with ever-neutropenia and ever-lymphopenia. Results: Leukopenia occurred in 141 patients (39.9%). Ever-neutropenia and ever-lymphopenia were each observed in 88 patients (24.9%); 47 (13.3%) had isolated neutropenia, 47 (13.3%) had isolated lymphopenia, and 41 (11.6%) had both abnormalities. Persistent neutropenia and lymphopenia occurred in 22 (6.2%) and 23 (6.5%) patients, respectively. Most neutropenia was mild, and only three patients had severe neutropenia. The four phenotypes differed in age, body mass index, autoimmune hemolytic anemia, platelet count, anti-Smith positivity, and immunosuppressive exposure. No included variable was independently associated with ever-neutropenia. Ever-lymphopenia was independently associated with male sex (aOR 2.66, 95% CI 1.22–5.81), anti-Smith positivity (aOR 2.71, 95% CI 1.40–5.24), and exposure to azathioprine (aOR 2.07, 95% CI 1.16–3.71), mycophenolate mofetil use (aOR 2.79, 95% CI 1.42–5.52), and rituximab use (aOR 3.83, 95% CI 1.50–9.75). Conclusions: Neutropenia and lymphopenia each occurred in one-quarter of patients with SLE, whereas persistent cytopenias were uncommon. No independent associations were identified for ever-neutropenia. The demographic, serologic, and treatment-related associations of ever-lymphopenia support separate evaluation of the two abnormalities in SLE.

Systemic lupus erythematosus (SLE) is associated with increased mortality compared with the general population, with outcomes influenced by ethnicity and organ involvement. Data from the Middle East and North Africa (MENA) remain limited, particularly regarding long-term survival and mortality predictors. To estimate and compare all-cause mortality and survival rates among adult patients with SLE in the MENA region and identify predictors of mortality. A systematic review and meta-analysis of cohort studies reporting survival and mortality in patients with SLE in the MENA region was conducted. Eligible studies were identified through a comprehensive database search and screened according to PRISMA guidelines. Data on treatment exposures and clinical predictors of mortality were extracted. Twelve cohort studies, including 3,478 adults with SLE from five MENA countries (Türkiye, Iran, Egypt, Israel, and Tunisia), were analyzed. The pooled all-cause mortality rate was 9.9% (95% CI: 7.2%–14.0%; I² = 89.7%). Survival remained high at 5 years (93.9%) and 10 years (90.0%), but declined at 15 years (85.5%) and 20 years (71.7%), with long-term estimates highly sensitive to single-study exclusion. Leave-one-out analysis slightly increased survival estimates and reduced heterogeneity. Major mortality predictors included renal involvement, cardiovascular disease, infections, hypertension, diabetes, hematologic abnormalities, and male sex. Higher cumulative corticosteroid and cyclophosphamide exposure was linked to increased mortality, whereas hydroxychloroquine and azathioprine appeared protective. Infection was the leading cause of death, followed by active disease, renal failure, and cardiovascular complications. Patients with SLE in the MENA region show high short-term survival, but long-term outcomes remain variable. Mortality is mainly driven by renal, cardiovascular, and infectious complications, with treatment exposure contributing to risk. These findings highlight the need for multicenter registries, standardized reporting, and strategies to reduce infection burden and optimize nephritis care.

The optimal duration of immunosuppressive (IS) therapy in lupus nephritis (LN) remains unclear, and tapering strategies for IS, corticosteroids (CS), and biologic therapies vary in practice. This study aimed to compare these practices between nephrologists and rheumatologists in Saudi Arabia and to examine factors influencing tapering decisions. We conducted a national cross-sectional 28-item online survey among nephrologists and rheumatologists involved in LN management across Saudi Arabia. A total of 142 physicians participated, evenly divided between the two specialties. Both groups reported that sustained clinical remission, stable renal function, and absence of recent flares were key criteria for tapering. Rheumatologists used the SLEDAI-2 K more frequently than nephrologists for readiness assessment (35.2% vs. 5.6%, p < 0.001) and post-taper monitoring (47.9% vs. 11.3%), whereas nephrologists more often considered repeat kidney biopsy before tapering (25.4% vs. 8.5%, p = 0.006). Rheumatologists predominantly tapered CS first (97.2% vs. 64.8%, p < 0.001). Most physicians initiated IS dose reduction within one year after sustained remission. In adjusted analyses accounting for practice context, nephrologists were less likely to taper CS first (adjusted OR 0.10) or rely on the SLEDAI-2 K (adjusted OR 0.09), but were more likely to delay IS withdrawal, favoring prolonged maintenance before discontinuation (adjusted OR 6.47), and to opt for immediate biologic discontinuation (adjusted OR 7.54). Disease flare was the most commonly reported challenge, with nearly half of physicians re-initiating the same induction therapy. Tapering practices for IS, CS, and biologic therapies in LN differ substantially between specialties, highlighting the need for harmonized, multidisciplinary tapering strategies.

This study assessed the prevalence and clinical characteristics of Behçet’s disease (BD) in the Middle East and North Africa (MENA) region, providing updated pooled estimates and identifying gaps in current epidemiological knowledge. We conducted a systematic review and meta-analysis of studies reporting the prevalence, epidemiology, or clinical features of BD in the MENA region, published in PubMed, MEDLINE, and Web of Science databases from 2014 onward. The eligible studies had observational designs and diagnoses based on internationally validated criteria. The study quality was assessed using the AXIS and MINORS tools. Pooled prevalence estimates and clinical feature proportions were calculated with 95% confidence intervals (CI); heterogeneity was quantified using I². Ten studies (sample size, 31–5218) from seven countries were included. The reported prevalence ranged from 0.06% in Turkey to 0.66% in Jordan. The pooled prevalence was 0.003 (300/100,000 population; 95% CI 0.001–0.005; p = 0.004) with a high heterogeneity (I² = 87.3%). No significant sex difference was observed in disease risk (odds ratio 1.55, 95% CI 0.59–4.05; p = 0.374). The pooled prevalence of major clinical features showed oral ulcers, genital ulcers, ocular involvement, and positive pathergy tests in 98.7%, 73.7%, 36.6%, and 54.6% of patients, respectively. BD prevalence in the MENA region remains among the highest worldwide. Clinical manifestations are consistent with global patterns but show regional variability, highlighting the need for standardized reporting, consistent epidemiological methodologies, and targeted strategies to support early diagnosis and recognition of the disease.

Objective: Lupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus (SLE). Existing data on LN in Saudi Arabia are primarily retrospective and derived from single centers. Therefore, this systematic review presents a unique and comprehensive analysis of the disease characteristics and outcomes of LN in Saudi Arabia. Method: A systematic search of MEDLINE, ScienceDirect, Embase, Cochrane, and PubMed databases was conducted up to April 2024. Eligible articles reporting on LN in Saudi Arabia were included, and disease characteristics and outcomes were analyzed. Results: A total of 36 studies met the inclusion criteria. The prevalence of LN among SLE patients in Saudi Arabia ranged from 19% to 55%, with biopsy-proven LN reported in 11% to 42.7% of cases. Females accounted for 66% to 94.9% of patients, with a mean age at diagnosis between 23.8 and 39.7 years. Hypertension was present in 45.8% to 62.9% of patients, with nephrotic-range proteinuria in 20.7% to 58.5% and mean serum creatinine levels between 60 and 112.68 µmol/L. Class IV LN was the most common histopathological finding, occurring in up to 72% of cases. Complete remission was achieved in up to 81.5% of patients within 12 months, though lower remission rates were observed in those with proliferative LN. End-stage renal disease (ESRD) rates ranged from 5.5% to 30.7%, with proliferative LN, older age, and hypertension being significant predictors of progression to ESRD. Five-year survival rates ranged from 92% to 96%, while 10-year survival reached 95%. Infection and renal failure were the leading causes of mortality. Conclusion: LN is highly prevalent in lupus Saudi patients, with Class IV LN being the most common and associated with poor outcomes. Although survival has improved, many patients still progress to ESRD. Prospective trials are needed to evaluate outcomes in the current era of biological therapies.

Rationale: Discoid lupus erythematosus (DLE) is a chronic, refractory condition causing visible scarring and significant psychological distress. Standard treatments often fail to provide adequate relief, necessitating new therapeutic options. Patient concerns: A 43-year-old woman with longstanding DLE experienced recurrent scalp lesions unresponsive to multiple therapies, including high-dose corticosteroids, which caused adverse effects. A 19-year-old woman with systemic lupus erythematosus presented with persistent discoid scalp lesions, disfigurement, and emotional distress despite standard treatments. Diagnoses: Both patients were diagnosed with refractory DLE, confirmed by clinical findings and skin biopsies. Interventions and outcomes: Both patients received monthly intravenous anifrolumab (300 mg) alongside hydroxychloroquine and methotrexate. Significant improvement was noted after the first dose, including reduced lesion severity, erythema, and itchiness, with visible hair regrowth. The first patient Cutaneous Lupus Erythematosus Disease Area and Severity Index-Activity score improved from 18 to 3, allowing complete corticosteroid discontinuation. The second patient Cutaneous Lupus Erythematosus Disease Area and Severity Index-Activity score decreased from 8 to 1. No adverse effects were reported. Lessons: These cases demonstrate anifrolumab potential as a treatment for refractory DLE, offering rapid and sustained improvement in disease severity and quality of life while reducing corticosteroid dependency. These findings suggest anifrolumab as a viable alternative for challenging DLE cases, warranting further research to confirm its efficacy and safety in larger populations.