Accessibility to biologics and its impact on disease activity and quality of life in patients with rheumatoid arthritis in Kuwait

Objective: Biologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or patients with contraindications to cDMARDs or poor prognostic factors. The purpose of this study was to compare the prescription rates of biologics in Kuwaiti and non-Kuwaiti patients and to assess whether this had an impact on disease activity and quality of life in RA patients. Methods: Data were extracted from the Kuwait Registry for Rheumatic Diseases. Adult patients who satisfied the ACR classification criteria for RA from four major hospitals in Kuwait were evaluated from February 2013 through May 2018. The treatment agents, disease activity, and quality of life of Kuwaiti patients were compared with non-Kuwaiti patients. Results: A total of 1651 RA patients were included; 806 (48.8%) were Kuwaiti patients. Among Kuwaiti patients, 62.5% were on biologic drugs in comparison with 14% of non-Kuwaiti patients. In comparison with non-Kuwaiti patients, Kuwaiti patients had significantly lower numbers of swollen joints (p < 0.001) and disease activity score-28 scores (p = 0.02) and less steroid use (p < 0.001) yet a significantly higher health assessment questionnaire-disability index (p < 0.001). Regression analysis showed that DAS-28 scores were significantly associated with the treatment type (p < 0.001) and that nationality was significantly predictive of the treatment type (p < 0.001). Conclusion: In the setting of easy accessibility to treatment for Kuwaiti patients, biologics were prescribed by rheumatologists at a higher rate than for non-Kuwaitis. This may explain the lower disease activity and the lower rate of steroid use in Kuwaiti patients than non-Kuwaitis. Key points: • Significant discrepancies in the rates of prescribing biologic therapies between KP and NKP in Kuwait were observed. • Several treatment outcomes were significantly better in the KP group than in the NKP group even after adjustment of confounding factors. • The poor access to biologic therapies was suggested to limit the effectiveness of RA treatments in the NKP group

Painful pachydermodactyly in a 39-year-old woman: case report and review of the literature

We chronicle the case of a 39-year-old female who presented to the rheumatology clinic with a history of chronic, symmetrical polyarticular pain in her hands. Meticulous diagnostic workup to exclude ubiquitous culprit aetiologies, such as rheumatoid arthritis and psoriatic arthritis, was performed. A detailed clinical examination was performed and, coupled with the radiological imaging findings, divulged an underlying diagnosis of pachydermodactyly. The patient was commenced on etoricoxib to alleviate the pain, and was advised to avoid repetitive trauma to her hands. The present report delineates a unique case of painful pachydermodactyly, affecting both proximal interphalangeal joints as well as distal interphalangeal joints. To the best of our knowledge, this is the first case from the state of Kuwait. We further review the literature in order to better elucidate the varying clinical manifestations of an elusive and rare rheumatological condition.</p

A Pilot Study of Micro Solar Still Technology in Kuwait

Water scarcity is a global issue recognized by the United Nations under Goal 6 of its Sustainable Development Goals (SDGs), which is to ‘Ensure availability and sustainable management of water and sanitation for all’. This challenging goal requires innovations, especially in areas with freshwater scarcity. Coupling this with the expected significant growth in population, especially in developing countries, presents major challenges to obtaining the appropriate levels of water provision needed. The development of seawater desalination technologies offers hope to alleviate freshwater shortages whilst supporting SDG 6. This research addresses the development of small-scale technology utilizing solar energy for providing clean drinking water in rural, hot, arid, and remote communities. To alleviate water scarcity in rural and isolated areas, a micro solar still (MSS) system that supports a multistage distillation process can be utilized, which evaporates and condenses the saline feed water into pure drinking water with highly efficient solar heat collectors. The focus of this study was to assess the performance of two prototypes, with minor improvements to the wicking structure. Such a system has the advantage of recycling wasted latent heat in the process to increase productivity. Two prototypes were tested to assess the performance of the solar still construction material and yield, and to test the water quality and quantity under the climatic conditions of Kuwait. The operation and efficiency of the prototypes were observed across four characteristics: solar irradiance, ambient temperatures, feed water and water production. The performances of the two prototypes were comparable to the results of previously published work on MSS prototypes that utilize wicking. The recovery rates of the two prototypes were 22 and 25%, respectively. The maximum production of potable water achieved from the two prototypes was 900 and 1160 g, respectively, using a feed of 4 and 3.7 kgs. The quality of the produced water met the WHO’s standards for drinking water

Kuwait Recommendations on Vaccine Use in People with Inflammatory Rheumatic Diseases

People with IRD are at increased risk of infection, and in 2011 EULAR made general recommendations for vaccination in these patients. Global and European perspectives are important, but they cannot accurately reflect the individual situations of patients in different countries and regions. Based on our clinical experience and opinions, we have sought to tailor the original EULAR recommendations to include advice for vaccination with new agents approved in the intervening years—including the new class of targeted synthetic disease-modifying antirheumatic drugs. We have also considered the specific demographic needs of patients in local populations in the Gulf region. The resulting 16 recommendations are grouped into four main categories covering general vaccination guidelines and best-practice for all patients with IRD, followed by a set of recommended vaccines against specific pathogens. The last two categories include recommendations for certain patient subgroups with defined risks and for patients who wish to travel