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

Date and doum palm natural fibers as renewable resource for improving interface damage of cement composites materials

Abstract Background Various recent studies have investigated the use of traditional fibers (metallic or synthetic) as reinforcement in mortar. In recent times, there has been growing interest in using natural fibers as reinforcement in cement composites. This study was conducted to assess the impact of date palm, doum palm, and sisal fibers on the mechanical properties of cement composites. Genetic modeling was chosen to find the shear damage at the fiber-matrix interface of the three cement composites using genetic crossing operator, which allows us to calculate the damage at the interface using two damages of the matrix and the fibers, respectively. Results Our objective is to examine and evaluate the interface damage of date palm/mortar, doum palm/mortar and sisal/mortar under different mechanical tensile stresses ranging from 25 to 37 MPa with fiber volume fraction from 1 to 5%. It was found that the interface damage of date palm/mortar and doum palm/mortar cement composites was minimal compared to that of sisal/mortar. However, several researchers found that an increase in fiber volume fraction leads to decrease in mechanical properties and density in cement composites what we confirmed in this study that interface damage increases when the volume fraction increases. Conclusions The results are in line with the findings of a recent experimental study on the use of other plant fibers. Their results showed that incorporating ramie fibers resulted in a 27% increase in compressive strength, whereas the use of synthetic fibers resulted in 4% decrease in tensile strength in compression. It is recommended the use of doum and date palm natural fibers in the composition of mortars with a fiber volume fraction of 1 to 5% in order to reduce and avoid interface damage and limit the negative impact of synthetic fibers on the environment