Rheumatic and musculoskeletal diseases (RMDs) encompass a spectrum of degenerative, inflammatory conditions predominantly affecting the joints. They are a leading cause of disability worldwide and an enormous socioeconomic burden. However, worldwide deficiencies in adult and paediatric RMD knowledge among medical school graduates and primary care physicians (PCPs) persist. In October 2017, the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD), an international think tank of RMD and related experts, met to discuss key challenges and opportunities in undergraduate RMD education. Topics included needs analysis, curriculum content, interprofessional education, teaching and learning methods, implementation, assessment and course evaluation and professional formation/career development, which formed a framework for this white paper. We highlight a need for all medical graduates to attain a basic level of RMD knowledge and competency to enable them to confidently diagnose, treat/manage or refer patients. The importance of attracting more medical students to a career in rheumatology, and the indisputable value of integrated, multidisciplinary and multiprofessional care are also discussed. We conclude that RMD teaching for the future will need to address what is being taught, but also where, why and to whom, to ensure that healthcare providers deliver the best patient care possible in their local setting.
Hereditary angioedema (HAE) is a rare but serious and potentially life threatening autosomal dominant condition caused by low or dysfunctional C1 esterase inhibitor (C1-INH) or uncontrolled contact pathway activation. Symptoms are characterized by spontaneous, recurrent attacks of subcutaneous or submucosal swellings typically involving the face, tongue, larynx, extremities, genitalia or bowel. The prevalence of HAE is estimated to be 1:50,000 without known racial differences. It causes psychological stress as well as significant socioeconomic burden. Early treatment and prevention of attacks are associated with better patient outcome and lower socioeconomic burden. New treatments and a better evidence base for management are emerging which, together with a move from hospital-centered to patient-centered care, will enable individualized, tailored treatment approaches.
Aim This study is a longitudinal multicenter study which aims to find the prevalence, the demographic data, survival and mortality rates of patients with systemic lupus erythematosus (SLE) in Oman. Method All Omani patients, pediatrics and adults diagnosed with SLE, who fulfill either the 1997 American College of Rheumatology or Systemic Lupus International Collaborating Clinics classifications criteria for SLE were included from January 2006 till February 2020. Results In total 1160 patients were included in this cohort. Data analysis showed that patient’s ages ranged from 2‐82 years with female predominance and female‐to‐male ratio of 7:1 (87.7% female,12.3% male). The mean prevalence of SLE among different age groups was 38.8 (range 5‐63 per 100 000 inhabitants). The mortality rate was found to be 5%. Male patients had significantly higher mortality rate than females (7.6% vs 5.4%, P value = .04). Sepsis was the commonest cause of mortality (34%). The coexistence of systemic sclerosis correlates significantly with death (P = .002). Survival analysis in our data showed 5, 10, 20, 40‐year survival rates of 100%, 100%, 99% and 90% respectively for antinuclear antibody (ANA) positive patients and lower survival rate for ANA negative patients with 5,10, 20, 40‐year survival rates of 100, 99%, 99% and 75%, respectively. Conclusion This study showed that the mean prevalence of SLE in Oman to be 38.8 (range 5‐63) per 100 000 inhabitants. The 40‐year survival rate among patients with positive ANA was found to be 90%, while patients with negative ANA had worse survival outcomes.
Background: Coronavirus disease 2019 (COVID 19) is a worldwide pandemic that has devastated the world in a way that has not been witnessed since the Spanish Flu in 1918. In this study, we aim to investigate the outcomes of patients with rheumatic diseases infected with COVID19 in Oman. Methods: A multi-center retrospective cohort study included patients with underlying rheumatological conditions and COVID-19 infection. Data was collected through the electronic record system and by interviewing the patients with a standard questionnaire. Results: 113 patients with different rheumatic diseases were included with the following rheumatological diagnoses: rheumatoid Arthritis (40.7%), systemic lupus erythematosus (23.1%), psoriatic arthritis (8%), Behcet's disease (7%), ankylosing spondylitis (6.2%), other vasculitides including Kawasaki disease (4.4%) and 10.6% other diagnoses. The mean (SD) age of patients was 43 (14) years, and 82.3% were female. The diagnosis of COVID-19 was confirmed by PCR test in (84.1%) of the patients. The most common symptoms at the time of presentation were fever in 86%, cough (81%), headache (65%), and myalgia (60%). Hospitalization due to COVID-19 infection was reported in 24.1% of the patients, and 52.2 % of these patients had received some form of treatment. In this cohort, the intake of immunosuppressive and immunomodulating medications was reported in 91.1% of the patients. During the COVID-19 infection, 68% of the patients continued taking their medications. Comorbidities were present in 39.8% of the patients. Pregnancy was reported in 2% of the patients. The 30 days mortality rate was found to be 3.5%. Diabetes, obesity, and interstitial lung diseases (ILD) were the strongest risk factor for mortality (p-value 0.000, 0.000, and 0.001), respectively. Rituximab was given in 3.8 % of the patients, and it was significantly associated with increased mortality among our patients (P-value <0.001). Conclusion: COVID-19 infection in patients with rheumatic diseases have an increased mortality rate in comparison to the general population, with diabetes, morbid obesity, chronic kidney diseases, interstitial lung disease, cardiovascular disease, obstructive lung disease, and liver diseases as comorbidities being the most risk factors associated with death. Greater care should be provided to this population, including the prompt need for vaccination.
The aim of this study is to assess the level of knowledge and acceptance for biosimilars and nonmedical switching in Arab rheumatologists. Methods:A cross-sectional survey was conducted during the Arab League Against Rheumatism conference using a structured questionnaire consisting of 17 questions. Results:The participants were mainly females (50.7%), practicing in the Gulf region (65.7%) with a median [Interquartile Range (IQR)] age and years of practice as consultants of 44 (13) years and 10 ( 14) years, respectively. The median (IQR) selfperceived knowledge of biosimilars was 5.3 (4) out of 10. Most physicians agreed that the evidence published to grant biosimilars an approval for the studied indication was enough (40.6%), yet most of them believed it was not enough for extrapolation of indications (40.6%). The mean (standard deviation) likelihood to prescribe biosimilars in the future was 5.39 (2.6). The majority of rheumatologists (59.8%) believe that nonmedical switching could pose harm to patients. Most physicians agreed that nonmedical switching will lead to a significant saving in cost (58.5%) with the majority expecting a cost reduction between 30% and 50% to justify nonmedical switching. Conclusion:This is the first study to evaluate acceptance of biosimilars and nonmedical switching on a diverse population of rheumatologists in the Middle East. Future educational activities task forces should target these topics.
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