Dia Shehab

SYSTEMIC LUPUS ERYTHEMATOSUS IN KUWAIT : HOSPITAL BASED STUDY

The present study describes the clinical characteristics of patients with systemic lupus erythematosus (SLE), from the rheumatology service of the two main teaching hospitals in Kuwait. It was a retrospective-cum-prospective clinical study of 108 SLE patients. There were 98 females and 10 males, with a median age of 31.5 y. Kuwaitis constituted 69%, while 31% were expatriates. The mean disease duration was 62 months. The main clinical features were: musculoskeletal involvement (87%), photosensitivity (48%), malar rash (43%), discoid lesions (10%), oral ulcers (33%), vasculitic skin lesions (10%), haematological features (53%), constitutional symptoms (51.4%), neuropsychiatric manifestations (23%), renal involvement (37%), serositis (29%), clinical manifestations of antiphospholipid syndrome (21%), cardiac involvement (10%) and pulmonary manifestations (19%). In conclusion, the clinical features of SLE in Kuwait were similar to most major studies from developed countries. Main differences included prominent haematological and mucocutaneous manifestations and possibly a low prevalence of anti-Sm antibodies. Whether these differences are due to the environment or genetic factors, remains to be studied.

Prevalence of Low Back Pain among Physical Therapists in Kuwait

Objective: To determine the life and point prevalence rates and study the characteristics of work-related and non-work-related low back pain (LBP) among physical therapists in Kuwait and its effect on their regular activities. Subjects and Methods: A specially designed self-administered questionnaire was distributed to 143 physical therapists in Kuwait. The questionnaire included demographic data, history and characteristics of LBP before and after working as a physical therapist, the effect of LBP on regular activities and current LBP. A visual analogue scale was used to score the intensity of the pain. Results: One hundred (70%) of the 143 physical therapists completed the questionnaire; mean age and standard deviation of the respondents were 35.9 ± 8.45 years. The lifetime prevalence of work-related LBP was 70% (61.8% in males and 74.2% in females) and the point (current) prevalence rate was 57% (31.6% in males and 68.4% in females). All the 100 therapists were college graduates who worked full-time and 82% were employed in general hospitals and rehabilitation centers. The most common areas of specialty were orthopedics (32%) and neurology (23%). Fifty percent reported that LBP affected their regular activities, 28.6% reported limitation due to pain and 11.4% changed their work settings because of LBP. The main site of pain was at low back and buttocks. Pain intensity was scored similarly among male and female physical therapists. Conclusion: Work-related and point prevalence rates of LBP among physical therapists in Kuwait are high and affect their daily activities, necessitating changes in work settings.

Is Low-Back Pain Prevalent among Kuwaiti Children and Adolescents?

Objective: To measure the magnitude of the problem of low-back pain among 10- to 18-year-old Kuwaiti schoolchildren in Hawalli Governorate. Subjects and Methods: A cross-sectional multistage stratified random sample of 400 schoolchildren (199 males and 201 females) of ages 10–18 years were selected from two junior and two high schools in Hawalli Governorate, Kuwait. Data on age, gender and characteristics of low-back pain such as duration, location and frequency were collected through personal interviews using a questionnaire. Low-back pain was defined as pain in the back from the 12th rib to the buttock area. Results: According to our definition, reported lifetime prevalence of low-back pain was found to be 57.8% (50.8% in male and 64.7% in female students), while the point prevalence was 35% (20.6% in male and 39.3% in female students). More female students reported low-back pain than male students, and the prevalence of low-back pain was found to increase with age in both sexes. The age of onset of low-back pain was 14 years in males and 13 years in females. The majority of students (92.1% in males, 84.6% in females) reported pain in the low back. Almost 46% of students related their low-back pain to accidents. A significantly higher proportion of male students (58.4%, compared to females 36.2%) reported low-back pain caused by accident or with duration of recovery less than a week (21.8% for males as compared to 16.2% for female students). Female students reported more recurrent or continual low-back pain. Conclusion: Low-back pain is common among Kuwaiti students in Hawalli Governorate. Prevalence of low-back pain increased with age in both sexes. Female students reported more frequent low-back pain than male students.OBJECTIVES We presented our experience with the diagnosis and treatment of low back pain in children. METHODS We retrospectively reviewed 29 children (15 girls, 14 boys; mean age 12 years; range 9 to 17 years) who were treated for low back pain and had appropriate follow-ups. Etiologic causes were sought by clinical evaluation, radiologic studies, and laboratory tests. Patients with unknown etiology underwent symptomatic treatment. The mean follow-up period was 42 months (range 12 to 96 months). RESULTS Etiology was determined in 26 patients (89%), which included spondylolysis/spondylolisthesis (n=8), Scheuermanns disease (n=6), neoplasia (n=5), discitis/vertebral osteomyelitis (n=4), and lumbar disc herniation (n=3). Spondylolysis was managed conservatively, except for one patient who had in situ spinal fusion for associated spondylolisthesis. Five patients with Scheuermanns disease were treated conservatively, while one patient required spinal fusion. Surgical treatment with biopsy, curettage, and bone grafting was performed for all neoplasias, but one which was followed-up conservatively. Two patients with discitis were managed with antibiotic treatment and two patients with vertebral osteomyelitis (Potts abscess) underwent both medical treatment and surgical drainage and stabilization with strut graft. Lumbar disc herniation was treated conservatively in two patients, while one had surgical treatment with excision of disc fragments and limited laminectomy. Finally, all the patients became asymptomatic on final examinations. CONCLUSION Serious consideration should be given to persistent low back pain in children. Clinical, radiologic, and laboratory findings can be elaborated into etiologic diagnoses and complete relief can be achieved with appropriate treatment.

Attitudes to knee osteoarthritis and total knee replacement in Arab women: a qualitative study.

BackgroundTotal Knee Arthroplasty (TKA) is offered to patients with knee osteoarthritis (OA) in the oil-rich countries in the Gulf region without adequate understanding of their perceptions, preferences or pain experiences. This study aimed to explore the pain experience and mobility limitation as well as the patient’s decision making process to undertake TKA among women with knee pain in the waiting list for surgery.MethodsFive focus group discussions were conducted comprised of 39 women with severe knee OA from the waiting list for TKA in the only orthopaedic hospital in Kuwait. Discussions were recorded, transcribed and coded for themes to identify the factors considered to be important in decision-making for TKA.ResultsExperiencing knee pain was central to daily living and affected patients and their families. Mobility limitation was shaped by a strong sense of expected obligation to take care of the family. Two major sources of TKA delay were identified; one was due to late clinical advice to undergo TKA which was the result of receiving several consultations from different clinicians each of whom tried the medical management for OA. The second delay occurred after the clinical advice for TKA and was mainly due to ambivalence of patients because of fear of the operation and the lack of information about TKA that resulted in unclear expectations of the surgery.ConclusionsBoth verbal and written information about TKA should be provided as part of preoperative rehabilitation. This is critical to improve doctor-patient interactions and facilitate informed decision about the procedure and thus achieve patient-centered healthcare.

Impact of Three-Phase Bone Scintigraphy on the Diagnosis and Treatment of Complex Regional Pain Syndrome Type I or Reflex Sympathetic Dystrophy

Objective: To determine the impact of three-phase bone scintigraphy (TPBS) on the diagnosis and management of complex regional pain syndrome type I (CRPSI) or reflex sympathetic dystrophy (RSD). Subjects and Methods: Twentyconsecutive patients with a recent clinical evidence of CRPSI were referred for TPBS as part of their routine management plan. All patients underwent neurological examinations with special attention to the evaluation of clinical features of vasomotor, sudomotor, motor and sensory dysfunction. Patients were followed prospectively. When both the clinical and TPBS results supported the diagnosis of CRPSI, patients were started on treatment. Results: Of the 20 patients, TPBS supported the diagnosis of RSD in 9 who were treated with steroids and physiotherapy. Complete follow-up was available for 7 of them and all had a satisfactory response to treatment. For the remaining 11 patients RSD was diagnosed clinically but not confirmed by TPBS. On follow-up there was no evidence that TPBS failed to identify RSD in these 11 patients. Conclusion: The results indicate that TPBS confirmed the clinical diagnosis of RSD, and, more importantly, had a significant impact on its management.

Incidence of musculoskeletal pain in adult Kuwaitis using the validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire.

BACKGROUND The WHO-ILAR Community Oriented Program for Control of Rheumatic Diseases (COPCORD) primarily aims to estimate the burden of musculoskeletal symptoms/disorders. We estimated the incidence of musculoskeletal pain in the first community-based COPCORD study in Kuwait. SUBJECTS AND METHODS The validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire was used in a survey of 2500 randomly selected Kuwaiti households to assess the frequency of musculoskeletal pain, disability, and health-seeking behavior in adult Kuwaitis. Those subjects reporting no musculoskeletal pain were identified and followed-up for a period of one year by contacting them every 2 weeks. Once a respondent reported pain, an appointment to report to hospital was offered and the subject was examined by a rheumatologist using American College of Rheumatology (ACR) criteria. RESULTS Of 5159 adults who were non-complainers in an earlier prevalence phase of the study, 3341 responded to phone calls (response rate of 65%). The incidence of musculoskeletal pain was 6.6% (95%CI, 3.4%-9.7%). Age- and sex-adjusted incidence rates were 7.2% (95%CI, 3.4%-10.5%) for females and 6.1% (95%CI, 3.1%-9.2%) for males. The incidence rate increased with increasing age, body mass index, and with being married. The common sites of pain were knee, low back and shoulder. CONCLUSION The incidence of musculoskeletal pain among Kuwaiti adults is reported for the first time. Further studies adopting the same instrument in other communities are warranted to compare with our findings.

Normal Values of Lower Limb Nerve Conduction in Kuwait

Objectives: To establish the normal electrophysiological values of the common lower limb nerves and to study the relationship of conduction velocity (CV) of the lower limb nerves to height and age in healthy adult subjects. Methods: Nerve conduction investigations were performed on the lower limbs of 51 screened healthy volunteers using standard electrophysiological techniques. Results: Fifty-one subjects (21 males and 30 females) participated in the study. The mean (± SD) ages of the subjects were 38 (±8.82) and 36 (±8.58) years for males and females, respectively. The tibial motor nerve showed a mean (± SD) CV of 46.1 (±3.3) m/s, distal latency (DL) 4.4 (±0.8) ms, and amplitude 8.8 (±3.4) mV for males. For females, the results were CV 47.8 (±3.4) m/s, DL 3.9 (±0.85) ms and amplitude 12.0 (±3.4) mV. Peroneal motor parameters were CV 47.1 (±3.3) m/s, DL 3.9 (±0.53) ms, amplitude 5.6 (±2.2) mV for males and 49.3 (±2.3) m/s, 4.0 (±0.56) ms, 6.0 (±2.2) mV for females, respectively. The sural sensory nerve parameters were CV 48.7 ± 6.0 m/s, DL 2.9 (±0.3) ms, amplitude 18.9 (±3.3) μV for males and 51.5 (±4.9) m/s, 2.7 (±0.24) ms and 21.6 (±6.3) μV for females. Most CV values were significantly correlated with height, and there was a significant difference between males and females. However, after adjustment for height by the linear regression method, all significant gender differences disappeared. Conclusion: This study established the normative conduction parameters of the commonly tested nerves of the lower limbs for our electromyography laboratory in Kuwait. Gender differences disappeared when the data were adjusted for age and height.

Normative Data of Nerve Conduction Studies in the Upper Limb in Kuwait: Are They Different from the Western Data?

Objective: To establish the normal electrophysiological data for the median, ulnar and radial nerves and to compare our results with the Western data published in the literature. Methods: Nerve conduction studies were performed prospectively in the upper limbs of 50 carefully screened healthy individuals between the ages of 16 and 56 years using standardized technique. Results: The median motor distal latency (DL) was 3.1 (0.3) ms, amplitude 11.01 (2.8) mV, conduction velocity (CV) 56.5 (3.5) m/s. The ulnar motor studies gave DL of 2.4 (0.3) ms, amplitude 9.2 (2.2) mV, CV 60.4 (5.0) m/s. Sensory studies for the median nerve were: DL of 2.3 (0.3) ms, amplitude 63.3 (18.9) µV for men and 79.3 (28.8) µV for women and CV 56.6 (7.6) m/s. For the ulnar nerve (DL) 2.0 (0.23) ms, amplitude 54.5 (18.4) µV for men and 63.9 (16.8) µV for women and CV 51.7 (5.3) m/s. The radial sensory studies were DL 1.95 (0.3) ms, amplitude 18.7 (5.5) µV and CV 52.3 ms. Only gender showed a statistically significant effect on the sensory nerve action potential for the median (p = 0.04) and ulnar nerves (p = 0.07). Conclusion: Normative conduction parameters of commonly tested nerves in the upper limb were established in our EMG lab in Kuwait. The mean motor nerve conduction parameters for the median and ulnar nerves compare favourably with the existing literature data. However, for the sensory nerves, higher value for the nerve action potential amplitude was demonstrated in the study. Gender was shown to have a significant effect on the sensory amplitude of the median and ulnar nerves.