Objectives: To examine whether inflammatory bowel disease (IBD) influences disease activity and radiographic progression in patients with axial spondyloarthritis (axSpA). Methods: This was a longitudinal cohort study of axSpA patients from a tertiary referral centre. Active axSpA was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI ≥4) in a dataset of 1268 patients. Radiographic progression, defined as a ≥ 2-unit increase in the modified Stoke Ankylosing Spondylitis Score (mSASSS) over 2 years, was evaluated in a subset of 471 patients with available longitudinal radiographic data. Generalized estimating equation models were used to assess associations between IBD and each outcome, adjusting for key confounders. Results: Among 1451 axSpA patients, 184 (13%) had IBD. Compared with axSpA-only patients, those with IBD had lower HLA-B27 positivity and higher rates of uveitis, peripheral arthritis and elevated C-reactive protein. However, IBD was not associated with an increased risk of active axSpA (OR 0.98, 95% CI 0.75–1.28) or radiographic progression (OR 1.45, 95% CI 0.78–2.73). Sensitivity analyses accounting for time-varying IBD status confirmed these findings. Conclusion: AxSpA-IBD patients exhibited distinct clinical features but did not have worse disease activity or greater radiographic progression than those with axSpA alone. These findings suggest that while IBD and axSpA share overlapping immunopathogenic mechanisms, IBD does not exacerbate axSpA severity. Further research is needed to explore the effects of IBD severity and duration on long-term axSpA outcomes to delineate the interaction between these two diseases.

Background: Antiphospholipid antibodies (aPLs) are antibodies directed against cell membrane components and can be associated with clinical features or be asymptomatic. Testing and interpreting these antibodies is associated with many challenges and pitfalls in clinical practice. Objective: To review all antiphospholipid antibody testing and describe the testing practices, indications for testing and interpretation of results to infer local challenges with aPL testing and subsequently address ways to overcome those challenges. Methods: This is a retrospective analysis of all aPL testing done in a tertiary center between 2014 and 2018. Characteristics of study patients collected through chart review were described using the mean and standard deviation for continuous variables and proportion for categorical variables. Group differences were compared between patients with any aPL-positive result and those with no positive result using chi-square or Fisher’s exact test as appropriate for categorical variables and a simple regression model for numerical variables. Results: Among 414 patients undergoing aPL testing, mainly adult females, 62 (14.9%) patients had at least one positive antibody, of those, 26 (42%) had repeat testing done. Testing was mostly done for obstetric indication (107, 25.8%), with 36 patients having one or two early pregnancy losses <10 weeks as their testing indication. A total of 27 (6.5%) patients were labeled with APS/possible APS based on chart review, but on review of the testing of those patients according to classification criteria, only nine patients satisfied the criteria for APS. Conclusion: This study highlights the clinical challenges associated with aPL testing, including the controversies around indication for testing, the low rates of repeat testing to confirm persistence, and the common misinterpretation of results. Having an aPL testing profile, explicit reference ranges, results commentary, and close interaction between ordering physicians and laboratory staff might be starting points to overcome these challenges.

Introduction: Thalassemia is an inherited blood disorder characterized by defective hemoglobin production, leading to chronic anemia. Patients, particularly those who are transfusion-dependent, face a heightened risk of infections due to disease-related factors like anemia and treatment-related complications such as iron overload and splenectomy. This study explores the factors contributing to infections in thalassemia patients to improve management strategies. Methods: A retrospective analysis was conducted on 303 patients with thalassemia at a tertiary care center from 2007 to 2022. Data were collected on demographics, transfusion dependency, splenectomy status, ferritin levels, vaccination history, and culture results. Logistic regression analysis was used to identify infection risk factors, with significance set at p < 0.05. Results: Out of 303 patients, 72 (23.8%) experienced culture-positive infections, with Escherichia coli being the most isolated pathogen. Patients with infections had significantly higher ferritin levels and were less likely to be on chelation therapy. Combined chelation therapy, however, showed a protective effect (OR: 0.02, p = 0.01). Female patients were more susceptible to infections (OR: 2.94, p = 0.04), while mortality was notably higher in patients with positive cultures (22% vs. 3%, p < 0.001). Conclusion: This study highlights the strong link between iron overload, chelation and risk of infection in thalassemia patients. Effective management, including proper chelation therapy and monitoring ferritin levels, is critical for reducing infections and improving outcomes. Further studies are needed to confirm these findings and guide future management strategies.

Background: Chronic obstructive pulmonary disease (COPD) is a significant burden in Saudi Arabia. Improving the attitudes, awareness, and knowledge of healthcare providers toward advance directives and/or advanced care planning (ACP) can increase the use of advance directives. This study aims to investigate healthcare providers’ knowledge, attitudes, and practices concerning advance directives for COPD patients in Riyadh, Saudi Arabia. Methods: This cross-sectional study was employed to assess the knowledge, attitudes, and practices of healthcare providers towards ACP for COPD patients in Riyadh between June and December 2024. The questionnaire was adapted from previous research. Multiple logistic regression was performed to assess the factors associated with good knowledge and positive attitude. Results: A total of 268 participants were included in the analysis. The total mean of knowledge score was 6.96 ± 2.22 out of 12. A total of 161 participants (60.1%) had a poor knowledge score, and 107 participants (39.9%) had a good knowledge score. The total mean of attitude score was 16.23 ± 23.21 out of 26. A total of 148 participants (55.2%) had a poor attitude score and 120 participants (44.8%) had positive attitude. Participants with over 15 years of experience exhibited significantly higher odds of good knowledge (OR = 6.76, 95% CI = 1.03−44.21, p = 0.04). Participants who lived in the Western region had significantly lower odds of good knowledge (OR = 0.32, 95% CI = 0.14–0.71, p = 0.005). Nurses and respiratory therapists had significantly lower odds of having positive attitude (OR = 0.19, 95% CI = 0.09−0.42, p = 0.0001 and OR = 0.34, 95% CI = 0.16–0.75, p = 0.007, respectively). Participants who lived in the Western region had significantly lower odds of having positive attitude (OR = 0.42, 95% CI = 0.19–0.95, p = 0.005). Conclusions: Healthcare providers in Saudi Arabia demonstrated a moderate level of knowledge of ACP for COPD patients. This was accompanied by a moderately positive attitude towards this practice. Future studies should examine effective educational and professional interventions to enhance ACP practices.

Background: Gout and asymptomatic hyperuricemia (AH) are common conditions for elevated levels of uric acid in the blood. While gout is a well-known and widely recognized condition, AH may be less familiar to healthcare professionals. This study aimed to estimate and determine the knowledge and treatment of AH versus gout among physicians in Saudi Arabia. Methods: A standardized, online validated questionnaire was used to collect data from physicians in Saudi Arabia. The tool comprised two parts: a 3-item section on demographics and a 37-item section assessing knowledge (18 items) and practice (19 items) related to the management of AH and gout. Convenience sampling was employed for participant recruitment. Data were analyzed using descriptive and inferential statistics, and p < 0.05 was considered statistically significant. The questionnaire was validated by three experts in rheumatology and clinical pharmacy, with a KR-20 of 0.87. Results: Of the 744 participants, 53.9% were female, and 59.1% were aged 24–34. A total of 58.7% had attended continuing medical education (CME) on AH or gout during the last three years. The mean practice score was significantly higher among residents compared to physicians without specialty training (mean difference = −1.43632, 95 %CI: −2.4575–−0.4151, p < 0.001) and consultants compared to physicians without specialty training (mean difference = −3.2769, 95% CI: −4.7918–−1.7620, p < 0.001). Male physicians scored higher than female physicians (1.73 ± 1.08 vs. 1.46 ± 1.09, p = 0.001). Consultants and orthopedic specialists demonstrated the highest knowledge levels (p < 0.001). Conclusion: The knowledge and practice of physicians for managing AH or gout were unsatisfactory. Younger female general practitioners were more likely to exhibit poor knowledge and practice in managing AH or gout cases. Despite advanced diagnostic tools and treatment processes, physicians have many misconceptions. Hence, continuous medical education focusing on AH or gout is vital to address these misconceptions.

Background/Objectives: Axial spondyloarthritis (axSpA) is classified using two principal systems, the modified New York (mNY) and the Assessment of SpondyloArthritis international Society (ASAS) classification criteria. Although developed for research, both are widely used in clinical practice. We assessed the self-reported use of, and attitudes toward, both criteria sets among rheumatologists in Saudi Arabia, including the perceived need for their modification. Methods: A cross-sectional online survey was conducted using a 23-item questionnaire adapted from a published multinational survey. Wilcoxon signed-rank, chi-square goodness-of-fit, and Fisher’s exact tests were applied. Results: Among 54 respondents (estimated response rate, 22%), the ASAS criteria were rated significantly more useful (mean 4.26 vs. 3.85; Wilcoxon p = 0.001) and were used more frequently (Wilcoxon p < 0.001; high use, 75.9% vs. 57.4%) than the mNY criteria. When radiographs were negative, 90.7% reported ordering sacroiliac magnetic resonance imaging (MRI). Inflammatory back pain (77.8%) and dactylitis (63.0%) were most frequently rated as “very specific”. Overall, 79.6% considered the ASAS criteria sufficiently specific for clinical trials, while 51.9% perceived a need to modify them. No statistically significant associations were detected between demographic variables and the outcomes examined. Conclusions: Respondents reported greater use of, and higher perceived usefulness for, the ASAS than the mNY criteria, a pattern that aligns directionally with multinational survey data. These self-reported findings may inform local education and future studies of how classification criteria and sacroiliac MRI are applied in practice.