The economic burden of systemic lupus erythematosus in United Arab Emirates

AIMS

Our study aims to provide an enhanced comprehension of systemic lupus erythematosus (SLE) burden in United Arab Emirates (UAE), over a five-year period from payer and societal perspective.

MATERIALS AND METHODS

A Markov model was established to simulate the economic consequences of SLE among UAE population. It included four health states: i) the three phenotypes of SLE, representing mild, moderate, and severe states, and ii) death. Clinical parameters were retrieved from previous literature and validated using the Delphi panel-the most common clinical practice within the Emirati healthcare system. We calculated the disease management, transient events, and indirect costs by macro costing. One-way sensitivity analysis was conducted.

RESULTS

The estimated number of SLE patients in our study was 13,359. The number of SLE patients with mild, moderate, and severe phenotypes was 3,914, 8,109, and 1,336, respectively. Disease management costs, including treatment of each phenotype and disease follow-up, were AED 2 billion ($0.89 billion), whereas the costs of transient events (infections, flares, and consequences of SLE-related organ damage) were AED 1 billion ($0.44 billion). The productivity loss costs among adult-employed patients with SLE in the UAE were estimated at AED 7 billion ($3.1 billion). The total SLE cost over five years from payer and societal perspectives is estimated at AED 3 ($1.3 billion) and 10 billion ($4.4 billion), respectively. Additionally, the costs per patient per year from the payer and societal perspectives were AED 45,960 ($20,610) and AED 148,468 ($66,578), respectively.

CONCLUSION

Our findings demonstrate that the burden of SLE in the UAE is enormous, mainly because of the costly complications and productivity loss. More awareness should be created to limit the progression of SLE and reduce the occurrence of flares, necessitating further economic evaluations of novel treatments that could help reduce the economic consequences of SLE in the UAE.

AB1194 PREVALENCE OF FIBROMYALGIA IN THE RHEUMATOLOGY OPDS DURING COVID19 LOCKDOWN: A CROSS-SECTIONAL STUDY

Background

In the challenging times of Covid 19, anxiety increased among the general population. Fibromyalgia patients are more at risk of developing anxiety in these difficult times. This might result in more frequent visits to the rheumatology clinics with an exacerbation of their chronic pain syndrome.

Objectives

The main objective of this study is to compare the prevalence of FM in the rheumatology outpatients’ clinics during the Covid 19 lockdown period (2020) and during the same period in the previous year (2019).

Methods

A cross-sectional study is conducted through 5 rheumatology clinics located in the 3 biggest emirates of the country (3 in Dubai, 1 in Abu Dhabi and 1 in Sharjah) to detect the number and charachteristics of fibromyalgia from March 15 to May 15th2019, and March 15 to May 15th2020.

Results

Total number of patients seen from march to May 2019 was 3480 out of them 55 were fibromyalgia patients with frequency 0.0158%. While from march to May 2020 total number of patients seen were 1355 out of them 66 were fibromyalgia patients with frequency 0.0487%. Figure 1

Figure 1.

Total and fibromyalgia patients in March-May 2019 and March-May 2020

Descriptive analysis of fibromyalgia patients seen in the lockdown time March to May 2020 shows that; gender was 64 females 97%, 2 males 3%, profession 36 unemployed 54.5%, 28 white collar 42.4%, 2 blue collar 3%, Age minimum was 25 years, maximum 77 years, with mean 48.3±13 years. Table 1

Table 1.

Descriptive analysis of the fibromyalgia paients

Gender(Frequency)Female64 (97%)Male2 (3%)Profession(Frequency)unemployed36 (54.5%)White collar28 (42.4)Blue collar2 (3%)Fibromyalgia severity(Mean±SD)Tender Points15.7±3Pain6.5±2.1Fibromyalgia associates(Frequency)Headache32 (48.5%)Sleep Disturbance47 (71.2%)Fatigue65 (98.5%)IBS26 (39.4%)Anxiety43 (65.2%)Depression37 (56.1%)

Tender points were 15.7±3, VAS for pain 6.5±2.1, sleep disturbance was present in 47 patients 71.2%, fatigue 65 patients 98.5%, irritable bowel syndrome in 26 patients 39.4%, headache in 32 patients 48.5%, anxiety in 43 patients 65.2%, and Depression in 37 patients 56.1 %.

Comparing frequencies of fibromyalgia between March to May 2019 and 2020 shows a significantly higher frequency of fibromyalgia in March to May 2020, 3.1-fold more than 2019.

Conclusion

The prevalence of patients with fibromyalgia seen in the Rheumatology clinics significantly increased during the lockdown time in comparison to the same period of 2019.

References

[1]Elsevier. “Novel Coronavirus Information Center”. Elsevier Connect. Archived from the original on 30 January 2020.

[2]Reynolds, Matt (4 March 2020). “What is coronavirus and how close is it to becoming a pandemic?”. Wired UK. ISSN 1357-0978. Archived from the original on 5 March 2020. Retrieved 5 March 2020.

[3]Turak, Natasha (29 January 2020). First Middle East cases of coronavirus confirmed in the UAE CNBC.com. Retrieved 19 March 2020.

[4]Coronavirus: UAE confirms 294 new cases, 19 recoveries”. Khaleej Times. Retrieved 5 April 2020.

[5]Psychological impact of fibromyalgia: current perspectives. GalvezSánchez CM, Duschek S, Reyes Del Paso GA. Psychol Res Behav Manag. 2019 Feb 13;12:117-127.

[6]Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee. Arthritis and Rheumatism. 1990;33(2):160–172.

[7]Wolfe F, Clauw DJ, Fitzcharles M, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research. 2010;62(5):600–610.

Disclosure of Interests

None declared

Renoprotective effect of red grape (Vitis vinifera L.) juice and dark raisins against hypercholesterolaemia-induced tubular renal affection in albino rats

BACKGROUND

Red grape juice (RGJ) and dark raisins (DR) are rich in polyphenols and antioxidants. This study aimed to assess the efficacy of RGJ and DR in protec- ting the renal tubules against hypercholesteraemic-induced pathological changes.

MATERIALS AND METHODS

Forty albino rats divided into four groups (n = 10) were utilised in this study. They included the control, high cholesterol diet (HCD)-fed, HCD+RGJ-fed, and HCD+DR-fed groups. Body weight gain, food and water in- take, blood and insulin levels, lipid profile and kidney functions were assessed at the start of the experiment and after 12 weeks. The right kidney was dissected out and processed for both light and electron microscopic examination. Desmin and cytokeratin antibodies were utilised as histologic markers to assess the integrity of the proximal (PTs) and distal tubules (DTs) of the kidney.

RESULTS

Administration of HCD resulted in hypercholesterolaemia in rats as evi- denced by the lipid profile. The PTs of hypercholesteraemic rats appeared dilated with hyaline casts and mitochondria in most of the tubular cells were affected. Immunohistochemical assessment revealed affection of both PTs and DTs. Both RGJ and DR, when administered along with the HCD for 12 weeks, improved the lipid profile, kidney functions as well as the histologic and cellular changes-induced by hypercholesterolaemia in the rats. The effect of raisins was superior to RGJ which might be due to its high contents of fibres and proteins.

CONCLUSIONS

This study highlighted the importance of supplementation of red grape and raisins in protection against the harmful effects induced by deposition of fat on the renal tubules' structure and function.

A comparative study of the mechanical behaviour of thermally oxidised commercially pure titanium and zirconium

The objective of this study is to compare the mechanical behaviour of thermally oxidised commercially pure titanium (CP-Ti) and commercially pure zirconium (CP-Zr). For this purpose, these two bio-metals were thermally oxidised under the same condition (650°C for 6h) and the oxidised specimens were characterised using various analytical and experimental techniques, including oxygen uptake analysis, layer thickness and hardness measurements, scratch tests, dry sliding friction and wear tests and tribocorrosion tests in Ringer's solution. The results show that under the present thermal oxidation condition, 4 times more oxygen is introduced into CP-Zr than into CP-Ti and the oxide layer produced on CP-Zr is nearly 6 times thicker than that on CP-Ti. Thermally oxidised CP-Zr possesses a higher hardness, a deeper hardening depth and better scratch resistance than thermally oxidised CP-Ti. Under dry sliding and tribocorrosion conditions, thermally oxidised CP-Zr also possesses much better resistance to material removal and a higher load bearing capacity than thermally oxidised CP-Ti. Thus, thermally oxidised Zr possesses much better mechanical behaviour than thermally oxidised Ti.

Tumour necrosis factor receptor II polymorphism and juvenile idiopathic arthritis

OBJECTIVES

Juvenile idiopathic arthritis (JIA) is a complex polygenic disorder. The encouraging outcome of anti-tumour necrosis factor (TNF) treatment, as well as serological studies, has implicated TNF and its receptors (TNFRI and TNFRII, or TNFRSF1B) in the pathogenesis of JIA. The purpose of this study was to investigate the exon 6 TNFRII single nucleotide polymorphism (SNP) in a well-defined UK cohort of JIA patients, using case-control association analysis.

METHODS

A total of 435 patients, spanning seven JIA subgroups, and 261 healthy individuals were screened for the polymorphism using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.

RESULTS

No significant differences were observed between the SNP allelic or genotypic frequencies of patients and controls, or between JIA subgroups.

CONCLUSIONS

This TNFRII exon 6 SNP does not seem to be associated with susceptibility to JIA.

Genetic susceptibility in Dupuytren's disease. TGF-beta1 polymorphisms and Dupuytren's disease

Dupuytren's disease is a benign fibroproliferative disease of unknown aetiology. It is often familial and commonly affects Northern European Caucasian men, but genetic studies have yet to identify the relevant genes. Transforming growth factor beta one (TGF-beta1) is a multifunctional cytokine which plays a central role in wound healing and fibrosis. It stimulates the proliferation of fibroblasts and the deposition of extracellular matrix. Previous studies have implicated TGF-beta1 in Dupuytren's disease, suggesting that it may represent a candidate susceptibility gene for this condition. We have investigated the association of four common single nucleotide polymorphisms in TGF-beta1 with the risk of developing Dupuytren's disease. A polymerase chain reaction-restriction fragment length polymorphism method was used for genotyping TGF-beta1 polymorphisms. DNA samples from 135 patients with Dupuytren's disease and 200 control subjects were examined. There was no statistically significant difference in TGF-beta1 genotype or allele frequency distributions between the patients and controls for the codons 10, 25, -509 and -800 polymorphisms. Our observations suggest that common TGF-beta1 polymorphisms are not associated with a risk of developing Dupuytren's disease. These data should be interpreted with caution since the lack of association was shown in only one series of patients with only known, common polymorphisms of TGF-beta1. To our knowledge, this is the first report of a case-control association study in Dupuytren's disease using single nucleotide polymorphisms in TGF-beta1.

Genetic susceptibility in Dupuytren’s disease

Dupuytren’s disease is a benign fibroproliferative disease of unknown aetiology. It is often familial and commonly affects Northern European Caucasian men, but genetic studies have yet to identify the relevant genes.

Transforming growth factor beta one (TGF-β1) is a multifunctional cytokine which plays a central role in wound healing and fibrosis. It stimulates the proliferation of fibroblasts and the deposition of extracellular matrix. Previous studies have implicated TGF-β1 in Dupuytren’s disease, suggesting that it may represent a candidate susceptibility gene for this condition.

We have investigated the association of four common single nucleotide polymorphisms in TGF-β1 with the risk of developing Dupuytren’s disease. A polymerase chain reaction-restriction fragment length polymorphism method was used for genotyping TGF-β1 polymorphisms. DNA samples from 135 patients with Dupuytren’s disease and 200 control subjects were examined.

There was no statistically significant difference in TGF-β1 genotype or allele frequency distributions between the patients and controls for the codons 10, 25, −509 and −800 polymorphisms.

Our observations suggest that common TGF-β1 polymorphisms are not associated with a risk of developing Dupuytren’s disease. These data should be interpreted with caution since the lack of association was shown in only one series of patients with only known, common polymorphisms of TGF-β1. To our knowledge, this is the first report of a case-control association study in Dupuytren’s disease using single nucleotide polymorphisms in TGF-β1.

Association of the A561C E-selectin polymorphism with systemic lupus erythematosus in 2 independent populations

OBJECTIVE

E-selectin is expressed on cytokine stimulated endothelial cells and plays an important role in leukocyte-endothelium interactions and inflammatory cell recruitment. The gene for E-selectin is located at chromosome 1q 23-25 within the linkage area for systemic lupus erythematosus (SLE). The best characterized polymorphism in E-selectin molecule is A561C, which codes for Ser128Arg. We studied the prevalence of the A561C E-selectin gene polymorphism in patients with SLE and controls from 3 different ethnic populations.

METHODS

Three cohorts of patients with SLE (1987 American College of Rheumatology criteria) and matching population controls were studied. These consisted of Caucasians of British Isles descent, Caucasians of Spanish origin, and Caucasians of Turkish origin. We used polymerase chain reaction and restriction fragment length polymorphism to genotype patients and controls.

RESULTS

The numbers of patients and controls in each group were: UK (113 and 148), Spanish (145 and 179), and Turkish (93 and 96), respectively. The C allele occurred more frequently in UK and Spanish patients (OR 1.76, 95% CI 1.03-3.0, p = 0.037; and OR 1.84, 95% CI 1.1-3.09, p = 0.019), but not in Turkish patients (OR 1.03, 95% CI 0.55-1.97, p = 0.91).

CONCLUSION

In 2 of 3 populations studied, the E-selectin C allele was significantly more common in SLE than in controls. E-selectin may be a susceptibility gene to SLE in these populations. Its role in disease expression and longterm outcomes such as accelerated atherosclerosis requires further study.

Characterization of a prolactin gene polymorphism and its associations with systemic lupus erythematosus

OBJECTIVE

Hyperprolactinemia is associated with systemic lupus erythematosus (SLE), but the mechanism is unknown. Prolactin is expressed in T lymphocytes and is under the control of an alternative promoter region. We characterized a G/T single-nucleotide polymorphism (SNP) at position -1149 of this promoter and assessed its prevalence in patients with SLE.

METHODS

Electrophoretic mobility shift assays (EMSAs) were performed to determine DNA protein complex formation in the prolactin promoter. Transient transfection of reporter gene constructs containing the G/T promoter alleles into the Jurkat T cell line were used to determine transcription activity. Peripheral blood lymphocytes (PBLs) were treated in vitro with phytohemagglutinin (PHA) to determine levels of prolactin messenger RNA (mRNA).

RESULTS

EMSAs indicated that binding of a GATA-related transcription factor was altered by the G/T SNP at position -1149. Transient transfection studies in Jurkat cells showed that the G allele consistently produced higher promoter activity. PHA treatment of PBLs in vitro induced a greater increment of prolactin mRNA from patients with the GG(-1149) genotype than from those with the TT(-1149) genotype. Disease association studies in a cohort of SLE patients demonstrated an increased frequency of the prolactin -1149 G allele compared with control subjects.

CONCLUSION

We found a functionally significant polymorphism that alters prolactin promoter activity and mRNA levels in the lymphocytes. Altered local prolactin production by immune cells may contribute to disease progression by affecting T cell function.

Two novel polymorphisms in the human transforming growth factor beta 2 gene

We have identified two novel polymorphisms in the transforming growth factor beta 2 (TGFbeta2) gene; an insertion in the 5'-untranslated region (5'UTR) and a single nucleotide polymorphism (SNP) in exon 1. A 895-bp fragment was analysed covering part of the 5'UTR and exon 1. Single-strand conformation polymorphism (SSCP) analysis of polymerase chain reaction (PCR) products was performed to detect sequence variations. This was followed by the sequencing of samples demonstrating distinct banding patterns. A 4-bp insertion (ACAA) in the 5'UTR and a SNP (G > A) within exon 1 was identified. The 5'UTR polymorphism was found to be common in three Caucasian populations from Spain, Turkey and the UK. Exon 1 polymorphism is rare and results in an R to H amino acid substitution in codon 91. Both polymorphisms may prove useful for investigating possible associations of TGFbeta2 with disease.