Cancer tests are usually a complicated process of physician consultation, referrals to a secondary/tertiary care centre, lengthy wait times, risk of radiation exposure from radiological scans, and the need to undergo inconvenient procedures like endoscopy or tissue smear which may be associated with other risks.

In most of these cases, the findings are inconclusive and necessitate repeat or additional procedures. On the other hand, while negative findings are relieving, they imply that the individuals underwent arduous procedures that are retrospectively deemed unnecessary or avoidable. No viable alternatives provide meaningful insight into the status of malignancy in an asymptomatic individual.

Platforms like Trucheck, a non-invasive blood-based test, are a new paradigm in multi-cancer detection — a 'giant technological leap' to nip cancer in the bud. They are a culmination of years of collaborative international research and innovation and have been developed, tested, and validated on population-sized cohorts.

To put into perspective, Trucheck, for example, can detect up to 77 types of cancers (including several aggressive types) that account for -81 per cent of all cancer cases and ~84 per cent of all cancer-related deaths in Europe. It also has 92.1 per cent sensitivity in detecting cancers across all stages and types and has a further 93.1 per cent sensitivity in localising cancer to the appropriate tissue or organ of origin in the CTC-positive cases (yielding a combined sensitivity of 85.8 per cent). In different cases, it further detects and localises cancers with 100 per cent specificity* (versus healthy individuals) irrespective of the extent of the disease and gives a zero False Positive Rate.

Adoption of such a system not only offers cost-effectiveness and efficiency but also helps prioritise referrals and clinical work-up in individuals with positive findings. This can significantly reduce the number of avoidable referrals and alleviate the burgeoning burdens on the cancer management infrastructure, which in turn can free up valuable resources for those individuals who need them most. It can further reduce wait times, free up resources, reduce the avoidable allocation of resources and go a long way toward saving precious lives.

In suspected cases, for example, those presenting with a palpable lump or mass on imaging, the usual ('Gold Standard') clinical work-up involves a biopsy to obtain a tissue sample followed by histopathological examination (HPE). However, this is not feasible for screening in asymptomatic cases in which other methods are used to identify or locate indications of malignancy, such as radiological scans or endoscopic procedures. These screening methods are, however, specific for particular cancer types and necessitate an individual to undergo as many tests as suspected of cancer.

Understanding the financial impact on cancer tests

Cancer has a significant impact on the financial health of patients and their families. Today, the estimated 16.1 million individuals living with cancer face annual out-of-pocket medical expenditures 61 per cent higher than those without cancer (US$1,000 vs US$622). About one in four report problems paying bills, and one-third worry about paying bills. A 2017 systematic review of 45 studies found that 12 per cent to 16 per cent of those with cancer were in debt due to their treatment, about half reported some level of financial distress, and between 4 per cent and 45 per cent were nonadherent with medication because of cost. 

Cancer also has significant indirect costs related to lost income. An analysis of 492,146 cancer deaths in persons aged 16 to 84 years in the United States in 2015 found US$94.4 billion in lost earnings, with an average loss of US$191,900, which likely underestimated productivity loss.

Many studies have examined the potential reductions in cancer-related deaths if malignancies diagnosed after metastasis were, instead, diagnosed at earlier stages. Although stage IV cancers represented 18 per cent of all diagnoses, they accounted for 48 per cent of all cancer-related deaths within five years.

Researchers found that if these patients had been diagnosed at stage III, there would have been 51 fewer cancer-related deaths per 100,000 (or 15 per cent of all cancer-related deaths).

If one-third of metastatic cancers were diagnosed at stage III, one-third at stage II, and one-third at stage I, there would be 81 fewer cancer-related deaths per 100,000 (or 24 per cent fewer cancer-related deaths).

Barriers to early cancer detection

There are numerous barriers to the early detection of cancer, both medical and socioeconomic, including:

• Lack of symptoms: Liver, pancreatic, and ovarian cancers are typically diagnosed late in the disease course because they rarely present with symptoms early within the disease course.
• Awareness: Individuals may not be aware of the signs and symptoms of cancer or assume they are part of some other condition.
• Access: Lack of access to screening and diagnostic testing can delay early diagnosis and treatment.
• Financial: Those who are uninsured or underinsured or who have low socioeconomic status, may be less likely to obtain screening or early diagnosis.
• Fear: This includes fear of learning about cancer as well as fear of its treatments.
• Human nature: Many young people feel invincible and healthy and reject the need for screening. Yet, among adults younger than 50 years, rates of cancer linked to obesity are rising. Millennials born around 1985 are now twice as likely to develop one of six obesity-linked cancers as baby boomers born around 1950 were the same age.
• Weak referral systems: Many people present with early-stage symptoms to their primary care provider. The clinician may not recognise the symptoms or may not have access to a robust referral network.

Dr. Ramin Ajami, Oncology Specialist and Founder, LifeGen.

Final thoughts

Despite significant improvements in detection and treatment over the past two decades that have dramatically improved the five-year mortality of many cancers, it remains the second most common cause of death worldwide.

Cancer diagnosis also exerts a significant economic burden on the healthcare system. Population-based screening may be responsible for mortality reductions in several cancers, particularly breast, cervical, and colorectal cancers. However, population-based screening comes with several risks, including the risk of false-positive and false-negative results as well as under- and overdiagnosis.

The advent of non-invasive blood-based tests for multiple cancers has revolutionised cancer screening and led to the early detection of numerous tumours.

Cost-effectiveness, sensitivity and specificity, and clinical utility are vital benefits that must be considered when determining coverage and screening recommendations, as well as the impact on the healthcare system if thousands more cancers are diagnosed in the earlier stages.

Cancer screening of a large population would still be cheaper than treating a few with late-stage cancer. What cannot be measured in figures are the psychological and social costs of the losses that could be prevented.

— Dr. Ramin Ajami is an Oncology specialist and founder of LifeGen.

Kingdom of Saudi Arabia (KSA)-based Al Arrab Consulting Company (ARCC) signed a strategic partnership agreement with Lexica, a specialist Health and Life Sciences consultancy in the UK, at the recently concluded Global Health Exhibition in Riyadh. The agreement was signed by ARCC’s CEO, Eng. Husam ALasker, and Lexica’s CEO Tina Nolan.

ALasker shared that ARCC is fast expanding into the area of management consulting, serving a number of industries in the government and commercial sectors. The health sector in the Kingdom of Saudi Arabia is one of the most visible areas they service.

“This ceremony was extremely important as it expands and aligns with our values for Saudi Vision 2030. This is a union between expertise and experience between the United Kingdom and Saudi Arabia. Al Arrab consulting’s role in this is not only of a leader, but the firm is creating benchmarks in the industry, especially in shaping the healthcare industry and supporting the government’s vision. This partnership brings value with Al Arrab having the necessary experience of the market and Lexica’s long track record of success in serving clients in this sector in the United Kingdom and Europe.

“This is just the beginning of our partnerships which will expand outside the domains of healthcare and tap into areas of logistics and supply chain. The aim is to work together to strengthen our focus on IT, AI, primary care, and tertiary care in hospitals, alongside the KSA Ministry of Health (MOH),” says Dr. Amany Ali Ballow, Consultant Immunology, subspeciality Histocompatibility and Immunogenetics.

As a national consulting firm, Al Arrab has worked with government entities to create change and make transformation plans real. In our interview, we discuss the projects the firm has underway among other topics. Transcript below:

How is Al Arrab Consulting aligning with the Health Sector Transformation program as part of the Kingdom’s Vision 2030?

The Kingdom’s Vision 2030 inspired various government sectors and the private sector alike to work according to new visions and priorities. It has encouraged everyone to look through a different perspective, that embraces the future. Like many companies, we began to identify how we can contribute with passion towards helping agencies and sectors in the transformation journey by providing practical and applicable solutions, supporting the transformation process, and transferring knowledge in multiple forms.

As for the Health Transformation program, there is no doubt that it is a promising plan and has significant positive effects. If the transformation process succeeds, we will undoubtedly reflect all of this on the citizen and service levels. At the same time, it will provide higher efficiency and optimal investment of resources, and we must put in the work there.

Can you tell us about your work with the Ministry of Health?

As you know, the Health Transformation program is a qualitative program that focuses on how to enhance the quality of the health services provided to the citizens. This program introduced a new model of care and moved to focus on the quality of health systems and the effectiveness of responding to the needs of citizens within multiple stages and levels that were not there before.

Today we work with the Ministry of Health and the Health Holding Company in several areas.

We contribute to supporting the issue of establishing the joint services company, implementing the targeted transformation process, and supporting the launch of its services to the health clusters affiliated with the Health Holding Company.

We also have two projects related to the "partnership with the private sector" projects, where we carry out a specialised technical study for projects to be offered to the private sector, and this enhances the role of the private sector in managing and operating health services.

In fact, we feel proud to be participating in this qualitative program and seek to expand our contribution with multiple parties within this sector.

What aspects do you see as enhancing the value provided to the clients of Al Arrab Consulting “ARRC”?

We see that many of our clients need three things combined: qualitative, practical, and workable solutions while changing the equation sometimes accordingly, supporting making these solutions fundamentally a reality and providing practitioners who are able to do so, a true partner who shares the desire to succeed and has the necessary passion for it.

This is indeed what we are trying to provide in our various works, whether the project is small or large. Each client has their own interest. We direct our team to the fact that our success is only possible if what our clients aspire to is achieved with the importance of maintaining the objectivity and impartiality of the consultant appropriate to the nature of the project.

We also realise that all of the above cannot be achieved without the presence of a professional, expert, and practicing team, and this is what makes us focus a lot on the processes of attracting competencies. We are preparing an opportunity for the ambitious.

Are there any interesting projects in the pipeline that you want to tell us about?

We expect further expansion and growth during the next stage in terms of the nature of services and the entities in which we work. In the previous period, we were able to achieve global and regional partnerships to build a wide network of experts and specialists from Europe, America, Canada and the region, which enhanced our ability to provide quality services in highly specialised fields. We are also working on preparing to launch several initiatives related to social responsibility, in which there is a duty to transfer and disseminate knowledge to the community.

There is no doubt that there are many things that we will do, but time doesn’t allow us to mention them all now.

The clinical laboratory sector is one of the most fundamental areas of the current healthcare value chain and it has undeniably gained importance in Saudi Arabia in recent years. Besides assisting in the identification of diseases by determining their presence, absence, and extent, laboratory tests further evaluate the effectiveness of treatments leading to improved patient outcomes and advancing community public health.

Dr. Nashat Nafouri, Chairperson of Healthcare Interest Group and the Executive Officer, Saudi Quality Council, Medical and Quality Director at FutureLab Medical Laboratories in Jeddah, tells Omnia Health how the future of medical labs in Saudi is being shaped by digitalisation and strategy. Excerpts from the interview:

As the clinical laboratory sector gains significance, what does the future of medical labs look like in Saudi Arabia?

The future for medical labs in Saudi Arabia is very promising but will be challenging and very competitive for lab services providers. The clinical laboratory sector will play vital role in advancing the quality of life of patients from many different angles in line with 2030 vision. Public private partnership initiatives are expected to enable accessibility by reducing waiting times. Several world-class institutions featuring diagnostic centres of excellence are also entering the Saudi market as major mega players, which will change the dynamics of classical and routine clinical laboratory services. Hence, the patient can comfortably select niche services to meet their personal needs.

Patients, or even healthy individuals that seek regular checkups, will be pampered in these centres with prime services designed to offer personalised options, such as an investigative or preventive test from an analytical boutique. The pandemic created and enriched a unique demand for lab home visits. The appealing nature of the service gave rise to a culture of comfort for a large segment of the population. In conclusion, the laboratory industry is reinventing itself endogenously.

Tell us about the impact of AI and machine learning on lab digitisation. How will Total Laboratory Automation and IT innovations further support this?

There are six characters rebooting the medicine and health field — 0, 1, A, C, G, and T. Digital technology has played a role in medicine since the 70s, starting with disease management that enabled diagnosis through computerised instrumentations and faster communication by mobiles. But the breakthrough of the human genome project, which reached completion in 2000, and the enormous acceleration of digitalisation, both technologies transformed medicine into a new era of disease prediction, jointly working in tandem to advance disease prevention from the gene level. We expect to understand the causes of many chronic diseases and cancers with bioinformatics and ensure better prevention and disease management with the effective utilisation of big data where labs serve as the hub for it. Laboratories are helping shape a new health economy fuelled by knowledge and innovation.

Machine learning is not new in laboratories. Lab instruments could self-diagnose themselves without any human interaction. Theragnostic, which represents imparting the right therapy at the right time and place, is here to stay. It was recently combined with the Internet of things (IoT) to make home diagnostics accessible at the tip of a finger. In the digital literacy era, I would not be surprised if each home were to have a diagnostic robot connected to a medical cloud community.

In a report, the Saudi Ministry of Defense said that clinical laboratory testing is now a “global business”. What kinds of strategies are being implemented in KSA labs to increase efficiencies and align with the business objectives of the healthcare industry, as a part of the Kingdom’s Vision 2030?

The initiatives in this domain are enormous and diversified. For example, the recent government mandate on conducting genetic testing locally created immediate demands for highly specialised testing laboratories and accessibility. The COVID pandemic helped increase the number of labs that adopted molecular biology testing as a new technology platform over routine immunological testing. Now these labs need to think about utilising this platform when testing other diseases.

Compared to the public sector, laboratory operations are much more complicated in the private sector due to limited resources. However, with the introduction of a new model of care that focuses on the prevention and ease of accessibility, public private partnership initiatives, and the recent launch of the national insurance centre will provide a fundamental and dynamic shift in the supply and demand of diagnostic services. Quality, efficiency, sustainability, and cost-effectiveness will play a major role in reshaping future laboratory business and operational strategies.

Laboratory technology has generally been distinguished as the vanguard of medical advances, but leadership skills and training are just as crucial. Tell us about the concept of triangle success for future laboratories: the 3Cs and I model.

Leadership is not just a slogan for climbing the ladder fast, but it is about actions, deeds, and devotion. Leadership in the lab profession is built on accumulated wisdom alongside skillsets such as critical thinking, patience, trial and error, dedication, understanding, team play, etc. Laboratory leadership is well-rooted in medicine and became the first to launch the Laboratory Leadership Competency Framework published by the World Health Organization (WHO) in 2019. In my opinion, seeding quality and safety culture under wise leadership will be the DNA of successful future laboratories.

The 3Cs (competency, confidence, and consistency) and I (intellectual property) models were developed to restructure healthcare algorithms on safety and quality culture, which is beyond the accreditation compliance and may take decades to build a strong foundation.

With the 12 quality system essentials (QSE) unified standards, laboratories worldwide maintain consistency. With repeated peer reviews in different accreditation models whether national or international, laboratory workforce shall build confidence and improve competency in the long run. The intellectual aspect can be ensured by using a unique leadership approach and management style, which the laboratory could patent to increase its development business growth and Return on Investment (ROI).

Saudi Arabia’s new holding company appointed by the government to take over healthcare services, the Health Holding Company (HHC), has a wide-ranging brief as it embarks on the task of digitising and advancing the kingdom’s healthcare system.

Taking over from tasks once done by the Ministry of Health (MoH), the HHC will focus on providing medical services and care via upcoming health clusters, a set of independent companies that focus on specialist services.

It marks a new era in Saudi Arabia’s healthcare sector, allowing the MoH to focus on regulating and supervising all public and private health institutions in the country, as part of a nationwide plan to overhaul the performance of the country’s healthcare spanning from cities to remote regions, with the HHC focusing on areas such as expanding digital health programmes and virtual medical services.

The newly established body will also provide specialist services including cancer and renal rehabilitation and critical care in the areas of cardiology, vascular neurology, and trauma. This is part of a move within the country’s privatisation programme that aims to make healthcare more widely accessible. The project has been in place since 2018, with reported plans to privatise 290 hospitals and 2,300 primary health centres by 2030.

The establishment of the HHC is also a key element of the Saudi 2030 plans and lays the legal foundations for implementing the transformation strategy in the MoH that will take place in successive stages over the coming years.

The local health clusters will implement a set of programmes aimed at enhancing community health through the prevention and early detection of diseases by means of developing primary healthcare services and within this, a more comprehensive, effective, financially sustainable and integrated health system.

Preventable disease poses a huge challenge to the country’s healthcare system. Around US$26 billion are spent directly and indirectly on diabetes-related issues alone each year, now a major public health issue in Saudi Arabia. Fortunately, creative use of technology is helping to reduce these costs.

Additional challenges are the likes of preventable or treatable heart disease. According to the latest World Health Organisation (WHO) data published in 2020, coronary heart disease deaths in Saudi Arabia reached 39,037 or 29.13 per cent of total deaths.

The Saudi Ministry of Health and private providers have been harnessing technology in this battle, which has paved the way for today’s move to digitisation. The MoH online portal has already included several mobile and online apps that offer free educational health services to citizens such as a vaccination reminder service for children based on their age and the Hajj Health Companion providing healthcare advice, information and bulletins from the ministry during Hajj rituals.

The incoming system will also aim to improve access to health services through optimal coverage and a comprehensive and equitable geographical distribution, expanding the provision of e-health services and digital solutions, as well as improving the quality of health services.

New apps will be part of this strategy based on the success of recent applications such as Sehhaty, offering pharmacy discounts, and booking system, Mawid. The world has seen a huge impact of technology on improving healthcare access and saving lives in remote areas with less access to clinics and expertise, from applications that support instant communication to medical professionals and devices and machines that reduce the reliance on city or urban-based facilities among some of the solutions.

In Saudi Arabia, around 16 per cent of the population lives in remote, rural areas, according to the World Bank. These areas depend on primary healthcare centres that lack specialists such as nutritionists and psychologists, which technology can help transform. While such centres are mostly staffed with general medicine, family medicine, and obstetrics and gynaecology physicians, whose numbers are more concentrated in urban areas, there are many needs not yet being met in the more remote communities.

Access to emergency care will also be a top priority, ensuring rapid evaluations and care and support from a pre-hospital emergency medical service. Research has shown that the distribution is not equivalent in the rural to urban areas, so rectifying this with the support of technology and virtual medicine, will be of high priority in the coming years.

The Health Sector Transformation Programme also works on harmonising and coordination between all health sector entities, VRPs and relevant government entities, in addition to aligning and linking with strategic national goals during the transformation journey.

With an increasingly mobile workforce and a growing gig economy, plus a population moving around the country for the likes of tourism and pilgrimage, patients will be able to find local doctors more easily, research hospitals and book medical appointments. Additionally, safe sharing of medical records and the use of AI will transform both patient experience and security as the system moves into a new era.

Technology relating to healthcare management in Saudi Arabia since the coronavirus pandemic, has also played a key role in shaping its vision realisation programme, having seen the positive impact it had during one of the world’s most challenging times.

This model will be utilised and developed to further track current and potential epidemics, enabling the healthcare system to not only better manage but prevent further crises. Saudi Arabia’s government and private sectors combined developed and launched approximately 19 apps and platforms that serve public health functions and provide healthcare services.

Health education processes continued using an established electronic learning infrastructure with a promising direction toward wider adoption in the future.

Telecommunication companies exhibited smooth collaboration as well as innovative initiatives to support ongoing efforts. Risk communication activities using social media, websites, and SMS text messaging also followed best practice guides and will form the basis for future developments.

The use of artificial intelligence in integrating different data sources during future outbreaks will now be further explored, in addition to reducing the number of mobile apps to merge them into single apps to better merge functions and maximise potential.

The pandemic alone highlighted the strain placed on the kingdom’s health services by the COVID-19 outbreak showing the need for more robust apps such as booking platforms for vaccinations and remote access to patient records.

Since then, multiple cloud solutions have been developed and continue to be advanced, with multi-cloud solutions boosting the provision of healthcare to the country’s 35 million people.

Such cloud provision helps public healthcare providers including hospitals, clinics, and pharmacies boost efficiency. Now, there are more VMware solutions coming to the forefront of healthcare aiding the growth of the country’s healthcare providers. This has been proven recently as it is more widely adopted, offering highly secure software-defined services for greater security, reassuring patients and medical professionals of data protection, as well as better cloud management, signalling a safer future for both patient and provider.

Medical equipment regulations vary significantly from country to country, going from in-depth to completely non-existent. Over time, this disparity prompted a growth in the number of laws governing medical technology.

In 1992, the Global Harmonisation Task Force (GHTF) was founded to push for the standardisation of medical device laws around the world. It was an informal coalition whose original members were the US, the European Union, Japan, Australia and Canada. The Kingdom of Saudi Arabia also joined the GHTF.

Then in 2001, a model regulation was published by the World Health Organisation (WHO) with the goal of avoiding further inconsistencies amongst laws applicable to medical devices. It served as a template for lawmakers to follow when the time came for them to develop their own medical device regulations.

This model drove home the point that the medical device sector is intricate and nuanced, and pointed to problems with the rules and regulations that govern the industry.

The GHTF was then succeeded in 2011 by the International Medical Devices Regulation Forum (IMDRF), formed voluntarily by medical device regulators from around the world. The objective of the IMDRF was to accelerate the regulatory convergence and harmonisation process for medical devices. Australia, Brazil, Canada, China, Europe, Japan, Russia, Singapore, South Korea, the UK and the US are all current members of IMDRF.

Saudi Arabia has since adopted regulations governing medical devices that are grounded in the standards set by the IMDRF and the GHTF.

Manufacturing, importation, marketing, and distribution of medical devices in Saudi Arabia are all regulated by the Saudi Food & Drug Authority (SFDA). SFDA has published several regulations and guidance notes providing clarity on the laws applicable to the medical device industry.

Medical Device Marketing Authorisation in Saudi Arabia

SFDA issued a guideline note on Medical Device Marketing Authorisation. This was in accordance with the Medical Device Law, issued by Royal Decree No. (M-54). The purpose of the guidance note is to provide clarity on the steps involved in procuring Medical Device Marketing Authorisation (MDMA) for the commercial distribution or use of medical devices.

For launching a medical device in the Saudi Arabian market, the guidance note is applicable to both domestic and foreign medical device manufacturers and their authorised representatives.

Definition of a medical device

Based on the definition provided by IMDRF, a medical device is defined as any; machine, instrument, application device, transplant device, laboratory reagents, laboratory calibration materials, software or operating materials for medical devices, or any similar or related device manufactured alone or with other devices.

To be defined as a medical device, the above should serve at least one of the following purposes:

• Diagnose, prevent, control, control, treat, relieve, relieve or compensate for injuries
• Examination, replacement, modification, anatomical support or support influencing the functions of the body’s organs
• Support or enable life to continue
• Regulate or assist pregnancy
• Sterilise medical devices and supplies
• Give information for medical or diagnostic purposes derived from laboratory tests of samples from the human body

Regulatory requirements

Authorisation regarding marketing a medical device in Saudi Arabia can be obtained from SFDA. Upon receipt of such marketing authorisation, the medical device can be marketed, distributed and used.

The applicant is responsible for ensuring that they observe all laws, rules and guidelines relevant to their application. The essential principles for safety and performance must be met, and the medical device must be eligible under the conditions indicated.

— Jean Abboud is the Head of Corporate, KSA at BSA Ahmad Bin Hezeem & Associates LLP.

Karolina Soroko was 13 when she started experiencing pain in her joints caused by Systemic Juvenile Idiopathic Arthritis. It started in the lower body, and in a year, the pain disease spread to all joints, including the fingers. For a teenage school-goer, it was sometimes painful to even hold a pen. 

“I was a super active kid at school, physically fit and healthy. I was an equestrian, captain of the basketball team, and ran long distances. At first, it was hard for me and my family to understand what caused such pain. We had no family history of even rheumatic pains. The doctors took about a year to diagnose the issue. Systemic Juvenile Idiopathic Arthritis, an autoimmune disease. I have been living with it ever since,” said Soroko, who is in a much better condition now and works as a swim instructor in Dubai. 

“It was a life-changing experience with multiple visits to the doctors and constant medication. I missed out on school quite a lot. However, I did not resign to the condition and tried to stay active as much as my condition permitted. At 25, even when I had difficulty walking sometimes, I decided to take up swimming full-time and become an instructor. That changed my life. It made my body more mobile and active and reduced inflammation,” added Soroko. 

Systemic Juvenile Idiopathic Arthritis is a sub-type of juvenile arthritis, an autoimmune/autoinflammatory condition, and is a group of disorders that causes arthritis (stiff, swollen, and painful joints) in children as young as two year old.   

“Systemic Juvenile Idiopathic Arthritis is a rare condition and affects up to 10 per cent of children. As compared to Juvenile Idiopathic Arthritis, which predominantly causes arthritis/inflammation in peripheral joints, Systemic Juvenile Idiopathic Arthritis causes more systemic symptoms. Lungs, heart, and liver are more commonly affected and often there is a faint skin rash associated with fever. Children often get sick with these symptoms,” says Dr. Bhavna Khan, Consultant Rheumatologist at King’s College Hospital London, UAE, and member of the Middle East Arthritis Foundation (MEAF). 

Dr. Bhavna Khan, Consultant Rheumatologist at King’s College Hospital London and member of Middle East Arthritis Foundation

Typical symptoms of this disease are high spikes of fever, a faint pinkish rash all over the body, and joint pains with stiffness and swelling. A child may also experience chest pain, difficulty in breathing, etc. According to medical experts, this disease is treated as an infection. Its symptoms, however, remain unresponsive to antibiotics.

On what causes this disease, Dr. Khan says, “The exact cause of this disease is unknown. In a genetically susceptible child, when immune cells come in contact with a triggering agent such as infections or other environmental factors, immune cells in the body initiate rapid and excessive immune responses that may attack our body structures such as joints, skin, lungs, heart and certain blood cells,” added Dr. Khan. 

Diagnosing this disease, therefore, is very challenging. There is no single test that confirms it and doctors usually rely on the clinical correlation of symptoms, examination findings, blood tests showing high markers of inflammation and radiological findings of inflammation in organs.  

Gut health and its correlation with Systemic Juvenile Idiopathic Arthritis 

There is mounting evidence that the gut microbiome influences the development of Juvenile Idiopathic Arthritis, alongside a host of other inflammatory joint diseases, says Dr. Nasr Al Jafari, Functional Medical Practitioner, Medical Director, DNA Health and Wellness. 

“We know that environmental factors impacting the composition of the microbiome, such as delivery mode, infant feeding practices and early exposure to antibiotics, all increase the risk of chronic inflammatory diseases including Juvenile Idiopathic Arthritis. This predisposition appears to exert an effect through a variety of mechanisms, including impaired development of the immune system, alterations in the balances of pro-versus anti-inflammatory bacteria, and low-grade inflammation and intestinal permeability. Intestinal permeability is so closely associated with food allergies and food hypersensitivities that some leading researchers think intestinal permeability is a prerequisite for developing autoimmune disease.”

Dr. Nasr Al Jafari, Functional Medical Practitioner, Medical Director, DNA Health and Wellness.

Diet too plays a major role in influencing the composition of the gut microbiota and the health of the gut barrier since we are constantly exposing our gut to different compounds in foods. “If our gut mucosal immune system is sensitised to food, the inflammatory cytokines produced in response to it can further damage the gut barrier.

Therefore, if we can identify the foods that are contributing to microbial imbalances, intestinal permeability, and abnormal mucosal immune responses — and remove them from the diet for some time — we can quiet inflammation and restore gut barrier integrity. This is the overall basis for the autoimmune protocol diet (AIP),” adds Dr. Al Jafari. 

The autoimmune protocol diet is a short-term anti-inflammatory, a nutrient-dense elimination diet. It initially eliminates grains, legumes, dairy, nightshades, eggs, nuts, seeds (including coffee, cocoa, and seed-based spices), refined sugar, and food additives. The basic rationale is avoidance of any foods that might trigger intestinal inflammation, promote microbial dysbiosis, or that are highly immunogenic and represent common sensitivities.

After symptoms are reduced, these foods can be gradually reintroduced into the diet. 

To the parents and caregivers of children suffering from Systemic Juvenile Idiopathic Arthritis, Dr. Al Jafari says: “You can have a genetic predisposition to autoimmune disease, but you won’t develop it until you have something that triggers a breakdown of the gut barrier. Nutrition plays a major role in this process; therefore, we can use food and supplementation to great effect in controlling symptoms, often leading to a complete remission of the condition.” 

The Middle East Arthritis Foundation is organising a full-day free-to-attend community event on October 15, 2022 to spread more awareness about the disease. Attendees can register for the event at http://www.arthritis.ae/wad/.

---

Suneeti Ahuja-Kohli is a seasoned freelance journalist based in Dubai.

In our interview with Dr. Essam Saad Al-Ghamdi (CMO) and Executive Medical Director of Al Inma Medical Services Company, we discover the legacy of Al Inma Medical Services as he highlights its special projects and partners.

Full interview and excerpts below:

Can you tell us about the history of Al Inma Medical services?

We believe that the private healthcare sector plays a significant role in supporting the healthcare field in the Kingdom of Saudi Arabia. Al Inma Medical Services Co. Ltd. was established to provide comprehensive medical services for the society through owning and operating medical care projects according to highest international standards, managed by qualified medical and administrative teams.

We are working hard with MOH and other stakeholders in the field to provide the best medical services according to international quality and safety standards, which have a positive role in the serving of the society and enhance the level of medical services in Saudi Arabia.

As the executive medical director of Al Inma, can you tell us more about the vision of the organisation?

Our vision and values at Hayat National Hospitals Group motivates us to choose highly qualified vocational and academic cadres in both medical and administrative fields. This helps us meet our desired objectives according to our strategic plans to develop the quality of medical services depending on the latest scientific bases and seeking the local and international accreditation for our hospitals and their projects.

When it comes to the Health Sector Transformation Program, established as part of the Kingdom’s Vision 2030, how does Al Inma align with the vision?

After more than 20 years in the field of integrated healthcare, we believe that increasing the investment in the medical care sector in KSA and the MENA region became an urgent necessity. In order to continue to lead, we must always strive to align with the Health Sector Transformation Program as a part of the Kingdom’s Vision 2030, by developing the services we provide to the community.

We are always keen to earn our customer's trust through following the latest global technologies in health sector. This will motivate us to enhance investments, and discover the most efficient ways to expand on new healthcare projects that can meet the growing needs of the health sector in KSA.

What does the future of healthcare look like in the Saudi ecosystem and what are some exciting developments underway for Al Inma as part of it?

The keyword is Digitalisation. It is the future of everything and we have to work according to strategies to drive the rapid development in this field and in accordance with the Kingdom’s Vision 2030. We have many new electronic applications in the field of medical care that will take effect very soon, and will have a positive impact on the quality of service for the benefit of society.