Najma Khalil

Background: Systemic lupus erythematosus (SLE) disease activity and damage assessments are crucial for understanding the disease burden across different lupus populations. This study aims to describe the disease characteristics, treatment, and disease activity and damage in the Saudi national prospective SLE cohort. Methods: Saudi SLE patients over 18 years of age were recruited prospectively from January 2020 to December 2023 from the national prospective cohort of SLE, Saudi Arabia. Data retrieved included patients’ sociodemographic characteristics, medical history, clinical manifestations and laboratory features, comorbidities, and medications at baseline visit, first follow-up at 3 months, and subsequent follow-up visits every 6 months. The SLE disease activity index 2000 (SLEDAI-2K) and Systemic Lupus International Collaboration Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) scores were computed at baseline and follow-up visits following a standardized protocol. The generalized linear model was employed to assess organ damage based on the SDI scores. Kaplan–Meier survival analysis was performed to assess major adverse cardiovascular events (MACEs) and mortality. The Cox regression model was used to adjust for lupus disease and cardiovascular risk factors. Results: The mean age at SLE diagnosis of the 488 patients was 30.6 ± 11.9 years. The mean SLEDAI-2K and SDI scores were 8.0 ± 7.2 and 0.61 ± 1.1, respectively. The SLEDAI-2K scores declined initially and increased in follow-up visits. The SDI scores also increased at the follow-up visits. Musculoskeletal organ damage was found in 10.7% of the patients, neuropsychiatric damage in 9.2%, skin damage in 6.1%, renal damage in 5.9%, and cardiovascular damage in 4.4%. The parameters analyzed for predicting organ damage progression did not reach statistical significance, which may be due to the limited statistical power of the study and may not reflect an absence of relationship. Oral prednisolone was administered to 43.1% of the patients and hydroxychloroquine to 89.2%. The Kaplan–Meier 5- and 10-year survival rates were 99% and 98%, respectively. The initial findings using Cox regression analysis indicated that a longer SLE duration is protective of MACEs. However, a sensitivity analysis with a time-dependent approach did not retain significance of the SLE duration on the outcome of early MACEs. There was a trend of obesity and earlier MACE occurrence. Conclusions: Lupus disease activity and disease damage increased from the baseline visit over time. The most prevalent organ damage included musculoskeletal, neuropsychiatric, renal, and cardiovascular systems, consistent with previous studies. Time-invariant analysis showed an association between a longer SLE duration and MACEs, but such findings did not retain significance with a time-dependent approach, which may be due to immortal time bias. Obesity was found to contribute to early MACEs.

Ear, nose and throat (ENT) involvement is a frequent and early manifestation of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This study aimed to comprehensively evaluate and compare ENT features in patients with granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA). In this cross-sectional study, 50 consecutive patients with GPA (n = 35) and EGPA (n = 15) were recruited from Rheumatology and ENT clinics at King Saud University Medical City, Riyadh, Saudi Arabia. Patients underwent clinical, audiological, imaging, and laboratory assessments. ENT evaluation included otologic, sinonasal, and laryngeal examinations, supplemented with standardized questionnaires and audiometry. Upper airway involvement was highly prevalent (90%) in both groups. Pulmonary involvement was more frequent in EGPA, whereas renal involvement did not differ significantly between the groups. Hearing loss, including subclinical sensorineural forms, occurred in 50% of patients and was associated with older age at diagnosis (≥ 34 years) and longer disease duration (median 8 vs. 1.5 years, p = 0.01). Otologic involvement did not differ between GPA and EGPA. Sinonasal manifestations varied: nasal edema, allergic rhinitis, and polyposis were more frequent in EGPA, whereas destructive lesions, including saddle-nose deformity, occurred only in GPA. Laryngeal involvement was present in 46%; subglottic stenosis occurred only in GPA (14%) and was absent in EGPA. ENT involvement is common in both GPA and EGPA, with distinct sinonasal and laryngeal patterns. Hearing loss is frequent and often subclinical, highlighting the importance of audiometric and tailored ENT assessments. Further prospective studies are needed to determine the value of routine audiometric screening.

Background: Systemic lupus erythematosus (SLE) is associated with an increased burden of cardiovascular disease (CVD), driven by dyslipidemia, hypertension, obesity, inflammation, and treatment. These factors can impact patient quality of life (QoL) by limiting physical activity. Objectives: To characterize lipid abnormalities as CVD risk factors in a Saudi SLE cohort and assess associations between lipid profile, SLE features, treatment, and patient-reported outcomes of physical activity. Methods: A cohort of adult SLE patients followed at King Saud University Medical City since 2021 was analyzed. Demographics, lipid profiles, blood pressure, BMI, SLEDAI-2K, SDI, disease duration, and treatment data were collected. Physical function and quality of life were assessed using the LupusQoL and PROMIS Physical Function T scores. Univariate and multivariate logistic regression analyses were conducted to identify associations between lipid abnormalities, SLE-related factors, and QoL physical activity measures. Results: A cohort of 169 patients (88.2% female, mean age 39.3 ± 12.4 years) was evaluated to assess the presence of dyslipidemia (23.7%), obesity (BMI ≥ 25, 66.3%), and hypertension (≥130/80 mmHg, 26.0%). Mean SLE duration was 9.2 ± 7.7 years and mean SLEDAI-2K was 11.0 ± 7.0. Among these patients, 52.7% used steroids, 88.2% used antimalarial drugs, and 53.8% used immunosuppressives. Dyslipidemia was associated with lower LupusQoL physical scores (adjusted OR 0.986; 95% CI 0.972–1.000; p = 0.0446). No significant associations were found between lipid levels and the PROMIS Physical Function T score. Conclusions: In this Saudi SLE cohort, dyslipidemia and other modifiable CVD risks were common. Dyslipidemia correlated with poorer LupusQoL-specific physical scores, which highlights the importance of lifestyle changes in patients with SLE.

Objective: Due to the increasing prevalence of rheumatological conditions worldwide, especially among women, and their known negative impact on body image, there is a growing demand for cosmetic procedures. Therefore, it is imperative to develop an evidence-based understanding of the safety of these procedures and their potential effects on the disease course to prevent undesirable exacerbations. Methods: An observational cross-sectional survey was conducted among adult patients diagnosed with rheumatic diseases. Data were collected using an electronic questionnaire that addressed demographics, disease characteristics, comorbidities, and perceptions of cosmetic procedures. Ethical approval was obtained from the Institutional Review Board of King Saud University and King Saud University Medical City. Appropriate descriptive and inferential statistical analyses were performed. Results: A total of 212 participants were included; among them, 92 participants considered or underwent cosmetic procedures, while 120 did not. A significant difference was observed between groups regarding disease-related impact on self-confidence (p = 0.01). Factors associated with undergoing cosmetic procedures included gender (female sex) (OR 12.02; 95% CI: 1.55–93.17; p = 0.017), higher educational level (OR 14.00; 95% CI: 1.32–147.42; p = 0.028), a monthly income of SAR 1000–5000 (OR 2.39; 95% CI: 1.03–5.53; p = 0.041) or SAR 5000–10,000 (OR 2.75; 95% CI: 1.19–6.33; p = 0.017), and employment status (OR 1.81; 95% CI: 1.03–3.18; p = 0.038). Conclusions: A substantial proportion of patients with rheumatic diseases considered or had undergone cosmetic procedures, primarily driven by appearance-related concerns and reduced self-confidence. Female sex, higher education, higher income, and employment status were significant predictors. Fear of disease flare-ups and potential side effects were the most common reasons for avoiding cosmetic procedures.