Open Access Rheumatology: Research and Reviews (Jun 2022)

From Symptoms to Diagnosis: An Observational Study of the Journey of SLE Patients in Saudi Arabia

  • Karremah MF,
  • Hassan RY,
  • Faloudah AZ,
  • Alharbi LK,
  • Shodari AF,
  • Rahbeeni AA,
  • Alharazi NK,
  • Binjabi AZ,
  • Cheikh MM,
  • Manasfi H,
  • Abdulaziz S,
  • Hussein AH,
  • Alhazmi A,
  • Almoallim HM

Journal volume & issue
Vol. Volume 14
pp. 103 – 111

Abstract

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Mishal F Karremah,1 Rola Y Hassan,2,3 Ammar Z Faloudah,1 Lujain K Alharbi,4 Albraa F Shodari,1 Ahmad A Rahbeeni,1 Nouf K Alharazi,1 Ahmad Z Binjabi,1 Mohamed M Cheikh,3,5 Hanadi Manasfi,6 Sultana Abdulaziz,7 Albadr Hamza Hussein,4 Ahmed Alhazmi,2 Hani Almoallim1,3,8 1Department of Medicine, College of Medicine, Umm Alqura University, Makkah, Saudi Arabia; 2Department of Medicine, Division of Rheumatology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia; 3Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia; 4Department of Medicine, Division of Rheumatology, King Fahad Hospital, Madinah, Saudi Arabia; 5Department of Medicine, College of Medicine, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia; 6Department of Medicine, Specialized Medical Center, Riyadh, Saudi Arabia; 7Department of Medicine, King Fahad General Hospital, Jeddah, Saudi Arabia; 8Department of Medicine, Dr. Sameer Abbas Hospital, Jeddah, Saudi ArabiaCorrespondence: Hani Almoallim, Tel +966505703935, Email [email protected] and Objectives: Early diagnosis and treatment is associated with improved outcomes in patients with systemic lupus erythematosus (SLE). Studying the journey of SLE patients in Saudi Arabia is essential to direct future health-care plans.Patients and Methods: This is a cross-sectional, multicenter study. Eligibility criteria included a diagnosis of SLE that was confirmed by a rheumatologist. Patients younger than 18 at the time of interview were excluded. Primary objectives were to determine time from first symptoms to initial physician visit (Lag 1), time from initial physician visit to encounter with rheumatologist (Lag 2), time from first visit to a rheumatologist to diagnosis of SLE (Lag 3), and time from diagnosis to start of treatment (Lag 4). Secondary objectives were to determine the number and specialty of physicians seen by patients, the speciality type that confirmed the diagnosis, first symptoms experienced, and age at first diagnosis of SLE.Results: Three hundred patients (92.3% women) with SLE were evaluated. Mean age at diagnosis was 29.92 years. Mean disease duration was 8.1 years. The majority were college educated (43.0%). The most common initial symptom was joint pain (68%), followed by skin rash (23%), and fever (3.7%). Lag 1 was less than one month in 68.2% of patients. Lag 2 was less than one month in 33.4% of patients and exceeded one year in 25.8%. Lag 3 was less than 1 month in 68.7% of patients. Lag 4 was less than one month in 94.4% of patients. The diagnosis of SLE was made most frequently by rheumatologists (80%). Evaluation by primary care, orthopedic and dermatology physicians were associated with delays in diagnosis.Conclusion: Delay was marked in Lag 2. Causes of delay included evaluation by non-specialists and visiting higher numbers of physicians before diagnosis confirmation.Keywords: systemic lupus erythematosus, rheumatology, delay, Saudi Arabia, physician

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