CT-based comprehensive scoring system for assessing hip arthropathy in ankylosing spondylitis: feasibility study with clinical correlation.

OBJECTIVE: To develop a CT-based scoring system for assessment of hip arthropathy in AS. METHODS: All AS patients were prospectively recruited, consented, and underwent whole-body stereoradiographs and pelvis CT, which were assessed by two independent radiologists. Stereoradiographs were assessed according to Kellgreen-Lawrence and BASRI-h. For the Hip arthropathy CT score in AS (HACTSAS), joints were divided into 7 segments and scored for joint space, osteophytes, subchondral cysts/erosions. Patients were clinically assessed for range of motion (ROM), pain, and clinical scores (BASMI, BASFI, ASQol, BASDAI and ASDAS). Radiological scores correlations with clinical parameters were compared. ROM sensitivity and specificity for hip arthropathy (BASRI-h ≥ 2) were calculated. RESULTS: Sample included 112 patients, with 36/112 females and 76/112 males. Average age was 51.0 ± 11.2 years and mean duration of AS was 20.9 ± 9.6 years. ICC for HACTSAS, Kellgreen-Lawrence and BASRI-h were 0.89, 0.89 and 0.82 respectively. HACTSAS showed moderate absolute correlation with ROM (ρ=-0.41) and BASMI (ρ = 0.45), and weak with pain (ρ = 0.18) and BASFI (ρ = 0.25). BASRI-h and Kellgreen-Lawrence exhibited moderate correlation with ROM (ρ=-0.44 and ρ=-0.40, respectively), weak with pain (ρ=-.27and ρ=-0.23, respectively) and BASFI (ρ=-0.16 and ρ=-0.18, respectively), but only weak with BASMI (ρ=-0.34 and ρ=-0.36, respectively). Internal rotation <15°, abduction <31°, and intermalleolar distance <75cm were, respectively, 73%, 70% and 73% sensitivity and 81%, 65% and 68% specific for hip arthropathy. CONCLUSION: HACTSAS exhibited higher correlation with BASMI and BASFI when compared with BASRI-h, but less correlation with pain and ROM. Internal rotation was the best clinical discriminator for hip arthropathy.

Assessment of enthesopathy in conventional pelvis radiography: Another tool for spondyloarthritis diagnosis beyond sacroiliitis.

INTRODUCTION/OBJECTIVES: Enthesitis is a cardinal feature of spondylarthritis (SpA), and the pelvis is a common site of enthesitis. This study aimed to establish the association between pelvic enthesis involvement on pelvic X-ray and SpA diagnosis through a radiographic enthesis index (REI) and to assess the reliability and accuracy of this REI. MATERIALS AND METHODS: The participants were SpA patients and a control group composed of patients with chronic lumbar pain without SpA. Three blinded observers assessed each pelvic radiography three times. Three zones were used: Zone I (ZI), the iliopubic ramus; Zone II (ZII), the pubic symphysis, and Zone III (ZIII), the ischiopubic ramus. A grading system was created from 0 to 3 [Grade 0, normal; Grade 1, minimal changes (subcortical bone demineralization and/or periosteal wishkering, seen as radiolucency and trabeculation of the cortical bone upon tendon insertion); Grade 2, destructive changes (Grade 1 findings and erosions at the enthesis site); and Grade 3, findings of Grade 2 plus >2 mm whiskering out of the cortical bone) for the REI. The sum of the results of the three zones was called the total REI. For statistical analysis, we used the weighted kappa statistic adjusted for prevalence and bias using Gwet's agreement coefficient. RESULTS: We enrolled 161 patients, 111 of them with SpA (39.6 % with axial SpA and 47.7 % with peripheral SpA) and 50 without SpA. In the SpA group, 36.7 % and 25.7 % had REI Grades 2 and 3 in ZIII, respectively, while only 6 % of the controls had these grades. For ZI, the frequency of Grades 1 to 3 was 42.3 % in the SpA group (8.1 %, 14.4 %, and 19.8 %, respectively), compared to only 2 % in the controls. ZII was unaffected in most of the patients with SpA (82.9 %) and in the controls (98 %). In the control group, Grade 0 was the most common REI grade in all three zones. The agreement was almost perfect for each zone and between the independent readers. The ROC-curve analysis showed that the highest performance areas were the total REI, ZIII, and ZI. Most (75 %) of the SpA patients without sacroiliitis on X-ray were REI-positive. The sensitivity of the REI for SpA diagnosis was 82 %, while the sensitivity of sacroiliitis on X-ray was 38.7 %. CONCLUSIONS: The assessment of pelvic enthesis using the REI on pelvic radiography may be useful for SpA diagnosis. Total REI, ZIII, and ZI had the highest accuracy and almost perfect reliability. The REI is especially helpful in patients without sacroiliitis on imaging.

Prevalence of positive tuberculin skin test in a Brazilian sample of rheumatoid arthritis and spondylarthritis patients

SUMMARY OBJECTIVE: Patients with rheumatic diseases have an increased risk of infections, especially tuberculosis. In this study, we aimed to recognize the positivity rate of tuberculosis skin test in patients with rheumatoid arthritis and spondyloarthritis and the characteristics of the patients with positive results. METHODS: Retrospective study of tuberculosis skin test results in patients followed from 2004 to 2021 in a single rheumatology unit. Data related to clinical and epidemiological features, along with treatment information referring to the period in which the tuberculosis skin test was performed, were collected from patients' charts. RESULTS: A total of 723 tests were identified (448 tests in 269 rheumatoid arthritis patients and 275 in 174 spondyloarthritis patients). In the rheumatoid arthritis sample, 31/275 (11.5%) individuals had positive tests, and in the spondyloarthritis, 38/174 (21.8%) had positive tests. In the rheumatoid arthritis sample, patients with positive tuberculosis skin tests used a higher dose of methotrexate than those with negative results (median of 25 mg/week versus median of 20 mg/week respectively; p=0.02). In the spondyloarthritis sample, tuberculosis skin test positivity was associated with alcohol ingestion (13.1% versus 2.9% in users and non-users respectively; p=0.02) and sulfasalazine use (15.7% of positivity in users versus 5% in non-users; p=0.01). CONCLUSION: The tuberculosis skin test-positive prevalence in rheumatoid arthritis was lower than in the spondyloarthritis sample. Patients with rheumatoid arthritis using a higher dosage of methotrexate or with spondyloarthritis using sulfasalazine had more frequency of tuberculosis skin test positivity and should be carefully followed by the attending physician in order to avoid the appearance of full-blown tuberculosis.

Qualidade de vida em pacientes com espondiloartrites: análise comparativa entre as formas axial, periférica pura e mista / Quality of life in spondyloarthritis: a comparison among axial, peripheric and mixed forms

Introdução: As espondiloartrites são doenças musculoesqueléticas crônicas que podem ter envolvimento axial, periférico ou misto. Devido ao grande comprometimento físico esta doença causa importante redução da qualidade de vida, mas não se sabe se isto acontece de igual maneira nas 3 formas. Objetivo: Estudar a associação entre qualidade de vida e formas de espondiloartrites. Método: Coletaram-se dados acerca de epidemiologia, perfil clínico, comorbidades e de qualidade de vida (através do SF-12 ou Short Form Health Survey­12 questions). Resultados: Incluíram-se 120 indivíduos: 60 EpA e 60 controles. O SF-12 físico tinha mediana de 38,05 para espondiloartrites e 55,1 para controle (p<0,0001). No quesito mental as medianas foram de 42,1 e 50,1 com p=0,04. Não foi possível demonstrar diferenças nos subgrupos de espondiloartrites, tanto no aspecto físico como mental (p=0,33 e 0,30 respectivamente). Conclusão: Existem diferenças significativas na qualidade de vida entre espondiloartrites e controles, mas não entre os subgrupos das espondiloartrites.

Introduction: Spondyloarthritis are chronic musculoskeletal diseases divided as axial, peripherical and mixed diseases. Due to a great physical involvement, it reduces patients' quality of life, but it is unknown how the 3 forms of the disease behave in such context. Objective: To study the quality of life association with spondyloarthritis forms. Methods: Data collection included: epidemiologic data, clinical profile, and quality of life data evaluated through the SF-12 (Short Form Health Survey­12 questions). Results: About 120 individuals were included: 60 spondyloarthritis and 60 controls. The physical SF-12 showed median of 38.05 for spondyloarthritis and 55.1 for controls (p<0.0001). The medians in mental SF-12 were 42.1 and 50.1 with p= 0.04. No differences in quality of life in the spondyloarthritis subgroups could be detected (with p=0.33 and 0.30 for physical and mental aspects). Conclusion: There was a significant difference in quality of life between spondyloarthritis sample and controls but not among the spondyloarthritis subgroups.

First-line biologic therapy with tumor necrosis factor inhibitors for psoriatic arthritis: a prospective observational study

ABSTRACT BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects multiple joints. It is associated with psoriasis and treated with synthetic and biologic drugs. OBJECTIVE: The objective of this study was to assess the outcomes of patients who received biologic therapy with tumor necrosis factor (TNF) inhibitors in terms of effectiveness, safety, functionality, and quality of life. DESIGN AND SETTING: A prospective observational study was performed at a single center in Belo Horizonte, Brazil. METHODS: Patients with PsA who received their first TNF inhibitor treatment were followed up for 12 months. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Clinical Disease Activity Index (CDAI). Functionality was measured using the Health Questionnaire Assessment (HAQ), and quality of life was evaluated using the European Quality of Life Five Dimensions (EQ-5D). Multiple linear regression was used to identify predictors of the clinical response at 12 months. RESULTS: A total of 143 patients treated with adalimumab or etanercept were evaluated. Most of the clinical measures were significantly improved at 12 months. However, 31%-51% of the patients did not achieve good clinical control. No differences were observed between adalimumab and etanercept, except for poor functionality at 12 months among patients treated with etanercept. The main predictors of a worse clinical response were female sex, etanercept use, poor functionality, or lower quality of life at baseline. The main adverse reactions were alopecia, headache, injection site reaction, sinusitis, flu, dyslipidemia, and infections. CONCLUSION: TNF inhibitor therapy was effective and safe. However, despite improvements in clinical measures, most patients did not achieve satisfactory control of the disease.

Reflections on the prevalence of human leukocyte antigen-B27 and human leukocyte antigen-B51 co-occurrence in patients with spondylarthritis.

We performed a literature mini-review of the clinical profile of patients with spondylarthritis who are also human leukocyte antigen (HLA)-B51-positive. It seems to us that patients with HLA-B27 and HLA-B51 are more common in men, Asians and between the third and ninth decades of life. They are more likely to develop peripheral joint conditions, with cutaneous manifestations (e.g., oral ulcers) and uveitis. Therefore, more robust epidemiological studies with more accurate methodology and multicenter locations are needed to better map the role of the interaction between HLA-B51 in patients with spondylarthritis.

Enthesitis-related arthritis: monitoring and specific tools

Abstract Objective: In this article, the authors aimed to review the different tools used in the monitoring of enthesitis-related arthritis. Sources: The authors performed a literature review on PubMed, Google Scholar, and Scopus databases. The dataset included the original research and the reviews including patients with enthesitis-related arthritis or juvenile spondylarthritis up to October 2020. Summary of finding: Enthesitis-related arthritis is a category of juvenile idiopathic arthritis. It is characterized by the presence of enthesitis, peripheral arthritis, as well as axial involvement. The only validated tool for disease activity measurement in juvenile idiopathic arthritis is the Disease Activity Score: It has proven its reliability and sensitivity. Nevertheless, due to an absence of validated evaluation tools, the extent of functional impairment, as well as the children and parents' perception of the disease, could not be objectively perceived. Despite the great progress in the field of imaging modalities, the role they play in the evaluation of disease activity is still controversial. This is partially due to the lack of validated scoring systems. Conclusion: Further work is still required to standardize the monitoring strategy and validate the outcome measures in enthesitis-related arthritis.

2021 clinical practice guideline for the early detection, diagnosis, treatment, and monitoring of patients with axial spondyloarthritis. Colombian Association of Rheumatology.

BACKGROUND: Axial Spondyloarthritis is a rheumatic condition affecting young patients with social and occupational consequences. Diagnosis delay is associated with functional impairment and impact on quality of life, requiring a multidisciplinary approach. OBJECTIVE: To develop a set of recommendations based on the best available evidence for early detection, diagnosis, treatment and monitoring adult patients with axial spondyloarthritis. METHODS: A working group was established, questions were developed, outcomes were graded, and a systematic search for evidence was conducted. A multidisciplinary panel of members was established (including patient representatives), minimizing bias in relation to conflicts of interest. The GRADE approach "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence as well as the direction and strength of recommendations. In total, 11 recommendations with regard to diagnosis (n = 2), pharmacological treatment (n = 6), non-pharmacological treatment (n = 2) and monitoring (n = 1) are presented. RESULTS: Sacroiliac joint radiography as the first diagnostic method, and the use of disease activity scales for patient monitoring (ASDAS or BASDAI), are recommended. Nonsteroidal anti-inflammatory drugs are the first treatment option; in case of intolerance or residual pain, acetaminophen or opioids are recommended. In patients with axial involvement, it is recommended not to use conventional disease-modifying antirheumatic drugs or systemic or local glucocorticoids. In patients with failure to non-steroidal anti-inflammatory drugs, anti-TNF or anti-IL17A is recommended. In those patients presenting with anti-TNF failure, starting an anti-IL17A is recommended. Exercise, physical and occupational therapy are recommended as part of treatment. It is recommended not to use unconventional therapies as the only treatment option. CONCLUSIONS: This set of recommendations provides an updated guide on the diagnosis, treatment and monitoring of patients with axial spondyloarthritis.

Enthesitis-related arthritis: monitoring and specific tools.

OBJECTIVES: In this article, the authors aimed to review the different tools used in the monitoring of enthesitis-related arthritis. SOURCES: The authors performed a literature review on PubMed, Google Scholar, and Scopus databases. The dataset included the original research and the reviews including patients with enthesitis-related arthritis or juvenile spondylarthritis up to October 2020. SUMMARY OF FINDING: Enthesitis-related arthritis is a category of juvenile idiopathic arthritis. It is characterized by the presence of enthesitis, peripheral arthritis, as well as axial involvement. The only validated tool for disease activity measurement in juvenile idiopathic arthritis is the Disease Activity Score: It has proven its reliability and sensitivity. Nevertheless, due to an absence of validated evaluation tools, the extent of functional impairment, as well as the children and parents' perception of the disease, could not be objectively perceived. Despite the great progress in the field of imaging modalities, the role they play in the evaluation of disease activity is still controversial. This is partially due to the lack of validated scoring systems. CONCLUSIONS: Further work is still required to standardize the monitoring strategy and validate the outcome measures in enthesitis-related arthritis.

Clinical and laboratory features of patients with undifferentiated spondyloarthritis and ankylosing spondylitis / Características clínicas y de laboratorio de pacientes con espondiloartritis indiferenciada y espondilitis anquilosante

ABSTRACT BACKGROUND: The terms Spondyloarthritis and spondyloarthropathy (Spa) are used to define a group of diseases with related clinical characteristics and genetics. AIM: To report the clinical and demographic characteristics of ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA) and to evaluate the frequency of cyclic citrullinated peptide antibody (anti-CCP) positivity. MATERIAL AND METHODS: Two hundred patients with USpA or AS, 100 control patients with a diagnosis of rheumatoid arthritis (RA) and 100 healthy volunteers were included. For each patient, their detailed medical histories, physical examination, whole blood counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-CCP, routine biochemical tests, and HLA-B27 test results were evaluated. ASDAS and BASDAI scores and morning stiffness were used to evaluate the disease activity. RESULTS: The presenting symptom of 73 (73%) patients in the AS group and 58 (58%) patients in the USpA group was pain in axial joints. A family history of Spa was positive in 32 patients from both groups (32%). A positive HLA-B27 was found in 55% of the AS group and 25% of the USpA group (p < 0.01 for the difference between groups). The frequency of positive HLA-B27 was significantly higher in individuals with a family history of SpA (p = 0.022). A positive Anti-CCP was found in 56% of the RA group, a significantly higher frequency compared with other groups (p < 0.001). The frequency of positive Anti-CCP in patients in AS (9%) and USpA (6%) was significantly higher than in healthy controls (p < 0.001). CONCLUSIONS: The frequency of anti-CCP positivity was higher in SpA patients than in healthy controls.

INTRODUCCIÓN: Los términos espondiloartritis y espondiloatropatia (Spa) se usan para definir un grupo de enfermedades con características y genética relacionadas. OBJETIVO: Informar las características clínicas y demográficas de la espondilitis anquilosante (EA) y espondiloartritis indiferenciada (USpA) - y para evaluar la frecuencia de positividad del anticuerpo péptido citrulinado cíclico (anti-CCP). MATERIAL Y MÉTODOS: En este estudio observacional se incluyeron doscientos pacientes con USpA y EA, 100 pacientes control con diagnóstico de artritis reumatoide (AR) y 100 voluntarios sanos. Se evaluó la historia clínica, exámen físico, recuentos sanguíneos completos, velocidad de sedimentación globular (ESR), proteína C reactiva (PCR), anti-CCP, pruebas bioquímicas de rutina y resultados de la prueba HLA-B27. Para evaluar la actividad de la enfermedad se utilizaron las puntuaciones ASDAS y BASDAI y la rigidez matutina. RESULTADOS: El síntoma inicial de 73 (73%) pacientes en el grupo de EA y 58 (58%) pacientes en el grupo de USpA fue dolor en las articulaciones axiales. Treinta y dos pacientes de cada grupo (32%) tenían antecedentes familiares de SPA. HLA-B27 fue positivo en el 55% del grupo AS y el 25% del grupo USpA con una diferencia significativa entre los dos grupos (p < 0.001). La frecuencia de positividad HLA-B27 fue mayor en individuos con historia familiar de SpA (p = 0,02). Se encontraron anti-CCP positivos en el 56% del grupo con AR, una frecuencia significativamente mayor en comparación con otros grupos (p < 0,01). La frecuencia de anti-CCP positivo fue mayor los pacientes con AS (9%) y USpA (6%) que en el grupo sano (p < 0,001). CONCLUSIONES: La frecuencia de positividad anti-CCP fue mayor en los grupos de SpA en comparación con los grupos control sanos.

Mobile health technologies for the management of rheumatic diseases: a systematic review of online stores in Brazil.

Rheumatic diseases are serious conditions with a low uptake of conservative treatments. Mobile health (mHealth) applications (apps) offer potential to assist the self-management of rheumatic diseases. Our goal was to perform a systematic review of available mHealth apps for rheumatic diseases in Brazil. We focused on the most prevalent rheumatic diseases: osteoarthritis, rheumatoid arthritis, fibromyalgia, systemic lupus erythematosus, osteoporosis, and axial spondylarthritis. Google Play Store and AppStore in Brazil were queried by two independent reviewers on September 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS). Of the 3173 mHealth apps found, five were eligible for inclusion. Two for fibromyalgia and two for axial spondylarthritis offered exercise, educational content, and tools to track patient-reported symptoms; and one for osteoporosis offered educational content and tracking tools only. The included apps scored moderately on the MARS quality scale, with a mean score (SD) of 3.1 (0.7) on a 0-5 scale. Most apps scored poorly based on credibility, user interface and experience, and engagement. There is growing interest in the development of mHealth technologies to support rheumatic diseases patients. Although the majority of the included apps came from non-profit organizations, they are still of poor quality and limited functionality. This study is a call for to the development of new user-centered mHealth apps that can empower rheumatic diseases patients in Brazil, especially in the area of osteoarthritis, rheumatoid arthritis, and lupus, since no apps were found.

Free Area of the Spinal Canal and Torg's Ratio in Acute Cervical Trauma and Degenerative Disease: MANCOVA and Correlational Analyses.

BACKGROUND: The two of the most common indications for magnetic resonance (MR) imaging of the cervical spine include acute spine trauma and degenerative disease. OBJECTIVE: We aimed to correlate the measurements of the free area of the spinal canal (FASC), a new approach to the cervical spinal canal compromise, with the Torg´s ratio quantification of the cervical spine. METHODS: A cross-sectional study including 50 cervical-spine MR evaluations of patients with acute cervical trauma or degenerative disease was performed. We used multivariate analysis of covariance (MANCOVA) to identify the type of lesion, intervertebral level and gender differences between FASC and Torg´s ratio quantification of the cervical spine; age was the controlled covariate. Correlates between FASC and Torg´s ratio were obtained at each intervertebral level. RESULTS: There was a non-significant interaction between the type of lesion, gender and intervertebral levels between FASC and Torg´s ratio measurements, F (8, 456) 0.260, p = .978; Wilks' Lambda 0.991; with a small effect size (partial η2 = .005). Among the main effects, only the gender was statistically significant: F (2, 228) = 3.682, p = .027. The age (controlled covariate) was non-significantly related to FASC and Torg´s ratio quantification: F (2, 228) = .098, p = .907. The Pearson´s correlation coefficient depicted a poor, non-significant agreement between FASC and Torg´s ratio. CONCLUSION: FASC provides an integrative evaluation of the cervical spinal canal compromise in acute, cervical spine trauma and degenerative disease. Further observations and correlation with specific neurological symptoms, surgical findings and clinical outcomes are necessary to assess the usefulness of FASC in clinical settings.

Recognition of spondyloarthritis lesions on magnetic resonance imaging: Results of an educational intervention.

BACKGROUND: Magnetic resonance imaging (MRI) is a fundamental diagnostic tool in axial spondyloarthritis (SpA), allowing us an earlier diagnosis of the disease compared to radiography. OBJECTIVE: To compare the performance of a recognition test on SpA MRI lesions and theoretical knowledge, before and after carrying out an educational intervention (hands-on workshop). We also evaluated whether the successes in the tests were associated with the individual characteristics of the participants. METHODS: A test was carried out involving 10 questions (seven for image recognition and three for theoretical knowledge) before and after the attendance to an MRI workshop in SpA performed in different cities in Argentina. The number of correct answers was assessed before and after the workshop; good performance was defined as the achievement of 6 correct answers on average between the pre- and post-test. Participants' characteristics were collected. RESULTS: A total of 106 participants were evaluated. Average of correct answers before and after the workshop were 5.3 and 6.8, respectively (P = .0001); 65% of participants achieved good performance. Performance is not associated with the characteristics of trained physicians. CONCLUSION: MRI training workshops in SpA allow rheumatologists to improve recognition of acute inflammatory and structural lesions. The long-term effects of such training need further evaluation.

Doença de Whipple - uma condição não rara que pode mimetizar espondiloartrite e piora com o uso de imunobiológico anti-TNF / Whipple's Disease - an uncommon condition that can mimic spondyloarthritis and worsens with the use of anti-TNF immunobiological

A doença de Whipple é uma condição rara causada pela Tropheryma whipplei. Sua apresentação articular mais comum é a artralgia migratória de grandes articulações. Mais raramente cursa com oligoartrite ou poliartrite, que podem preceder as manifestações gastrointestinais em vários anos. Cursa com diarréia e má absorção, podendo também causar derrame pleural e linfonodomegalias. Alguns pacientes podem apresentar sacroiliite, uveíte e confundir com espondiloartrite, e neste contexto o uso de anti-TNF pode ser iniciado. Os autores relatam o caso de um paciente masculino, 50 anos, com quadro compatível com espondiloartrite em que o início do infliximabe determinou piora clínica e após reavaliação confirmou tratar-se de doença de Whipple.

Whipple's disease is a rare condition caused by Tropheryma whipplei. Its most common articular presentation is migratory arthralgia of large joints. More rarely it courses with oligoarthritis or polyarthritis, which can precede the gastrointestinal manifestations in several years. It causes diarrhea and malabsorption, and may also cause pleural effusion and lymphadenopathy. Some patients may present with sacroiliitis, uveitis and confuse with spondyloarthritis, and in this context the use of anti-TNF may be initiated. The authors report the case of a 50-year-old male patient with a spondyloarthritis-compatible condition in which the onset of infliximab caused clinical worsening and after reassessment confirmed that it was Whipple's disease.

Ultrasound of sacroiliac joints in spondyloarthritis: a systematic review.

Ultrasound (US) is an accessible imaging technique with a possible role to diagnose active sacroiliitis, so this technique is projected as a promising diagnostic tool for the diagnosis of SpA. We analyse the available evidence about the use of US as a diagnostic tool in sacroiliitis in patients with SpA, by a systemic review of the literature fulfilling OMERACT criteria. A systematic literature search for original articles was carried out using four databases (Medline, Embase, Scopus and Web of Science). Data from studies were included only if participants had SpA and a US examination of sacroiliac joint (SIJ) was performed. The methodological quality of the studies was assessed using QUADAS-2 tool. Thirteen studies were included. All studies were observational, prospective and cross-sectional. In most articles (76.9%), the main US finding compatible with sacroiliitis evaluated was the presence of vascularisation (Doppler signals) with measurements of the resistive index (RI). The sensitivity and specificity analysis were performed in seven studies (58.8%) and were good, with a median of 90 and 89.2%, respectively. The studies showed a positive to moderate a strong correlation between the US and the gold standard but this was optimal only in four studies. In general, the agreement was good in all studies (≥ 0.80). The methods of evaluation of sacroiliitis vary between the studies included. To date, there is not enough evidence to support the use of ultrasound as a diagnostic method for sacroiliitis but it has potential to identify structural lesions at SIJ's level.

MRI assessment of bone marrow oedema in the sacroiliac joints of patients with spondyloarthritis: is the SPAIR T2w technique comparable to STIR?

OBJECTIVE: To compare short tau inversion-recovery (STIR) with another fat saturation method in the assessment of sacroiliac joint inflammation. METHODS: This prospective cross-sectional study comprised 76 spondyloarthritis (SpA) patients who underwent magnetic resonance imaging of the sacroiliac joints in a 1.5-T scanner, using STIR, spectral attenuated inversion recovery (SPAIR) T2w and spectral presaturation with inversion recovery (SPIR) T1w post-contrast sequences. Two independent readers (R1 and R2) assessed the images using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. We assessed agreement of the SPARCC scores for SPAIR T2w and STIR with that for T1 SPIR post-contrast (reference standard) using the St. Laurent coefficient. We evaluated each sequence using the concordance correlation coefficient (CCC). RESULTS: We observed a strong agreement between STIR and SPAIR T2w sequences. Lin's CCC was 0.94 for R1 and 0.84 for R2 for STIR and 0.94 for R1 and 0.84 for R2 for SPAIR. The interobserver evaluation revealed a good CCC of 0.79 for SPAIR and 0.78 for STIR. CONCLUSION: STIR technique and SPAIR T2w sequence showed high agreement in the evaluation of sacroiliac joint subchondral bone marrow oedema in patients with SpA. SPAIR T2w may be an alternative to the STIR sequence for this purpose. KEY POINTS: • There are no studies evaluating which fat saturation technique should be used. • SPAIR T2w may be an alternative to STIR for sacroiliac joint evaluation. • The study will lead to changes in guidelines for spondyloarthritis.

Mortality in patients with ankylosing spondylitis in Argentina.

Some reports describe an increased mortality in patients with ankylosing spondylitis (AS) compared to the general population. The aims of this study were to evaluate the cumulative survival in patients with AS and to establish possible factors associated with mortality. In cross-sectional retrospective study, AS patients were included according to 1984 modified NY criteria, in the 2000-2010 period, the prevalence of mortality was determined by review of medical records, telephone contact, family reports, and death certificates, and it was compared with mortality in Argentina's general population. One hundred twenty-seven patients were studied, 96 (75.6 %) were male, median age 49 years (interquartile range (IQR) 34-60) and median disease duration 8 years (IQR 4-17). During the follow-up period, 9 patients died (7.1 %). The median estimated survival from diagnosis of AS was 39 years (IQR 34-50) and median cumulative survival was 76 years (IQR 74-85). Cardiovascular disease was the most frequent cause of death (5/9 patients). Deceased patients had a mean age and a mean AS disease duration significantly higher than living patients (68.1 ± 12.4 years vs 46.4 ± 15.09 years, p = 0.0001 and 33 ± 13.7 years vs 12 ± 10.7 years, p = 0.001, respectively), higher frequency of total surgeries [3/5 (60 %) vs 5/105 (4.76 %), p = 0.002] and cauda equina syndrome [3/6 (50 %) vs 2/116 (1.72 %), p = 0.001], respectively. Frequency of mortality in AS patients was higher than the crude mortality rate of Argentina's general population in the same period, with cardiovascular cause being the most frequent one.

Frecuencia de alelos HLA de clase I y II en una cohorte de pacientes con espondiloartritis provenientes del noroccidente colombiano / Frequency of HLA alleles class I and II in a cohort of northwestern Colombian patients with spondyloarthritis

Introducción. Las espondiloartritis son enfermedades reumatológicas crónicas que afectan el esqueleto axial y las articulaciones periféricas, con varias manifestaciones extraarticulares. La asociación con el HLA-B27 sigue siendo uno de los vínculos más fuertes conocidos entre estas entidades y el complejo mayor de histocompatibilidad; sin embargo, la distribución mundial del HLA-B27 varía considerablemente y se han descrito asociaciones con genes no HLA-B27. Objetivo. Conocer la frecuencia de alelos HLA de clase I y II en pacientes con espondiloartritis provenientes del noroccidente colombiano y su frecuencia en las manifestaciones clínicas y radiológicas específicas. Materiales y métodos. Se condujo un estudio descriptivo, observacional, de corte transversal, retrospectivo y prospectivo entre 2005 y 2008 de 56 pacientes colombianos con espondiloartritis. Se identificaron los alelos correspondientes a los loci HLA de clase I y II (HLA-B, HLADQB1 y HLADRB). Se analizó su frecuencia con las manifestaciones clínicas axiales, periféricas, extraarticulares y radiológicas. Resultados. Se encontró una baja frecuencia de HLA-B27 en la población total (50 %), aunque fue el alelo más frecuente, junto con HLA-DRB4*01 (35,7 %) y HLA-DQB1*0501 (28,6 %), en todos los pacientes en general y en cada una de las manifestaciones clínicas y radiológicas. Se resalta la alta frecuencia de HLA-B27 y HLA-DRB4*01 (64,3 %) en pacientes con dactilitis, hallazgo novedoso sin previa descripción. Conclusión. Los alelos HLA-B27, HLA-DRB4*01 y HLA-DQB1*0501 fueron frecuentes en los diferentes subtipos de espondiloartritis y en las manifestaciones clínicas axiales, periféricas y extraarticulares específicas, además de la sacroiliítis radiológica.

Introduction. Spondyloarthritis is a chronic rheumatic disease that affect the axial skeleton and peripheral joints, along with several extra-articular manifestations. The association with HLA-B27 remains one of the strongest known links between these entities and the major histocompatibility complex. However, the global distribution of HLA-B27 varies considerably and furthermore, associations with non-HLA-B27 genes have been described. Objective. The frequency of HLA class I and II was determined in a population of patients with spondyloarthritis with respect to detection in the clinical setting and by radiology. Materials and methods. A descriptive, observational, cross-sectional, retrospective and prospective study was conducted in 56 patients from northwestern Colombia. Each was diagnosed with spondyloarthritis between 2005 and 2008. In each case, alleles were identified for the loci HLA class I and II (HLA-B; HLADQB1 and HLADRB). The frequency of these alleles in the axial, peripheral, extraarticular and radiological manifestations. Results.The frequency of HLA-B27 was 50% overall, and it was the most frequent allele. The two other alleles were HLA.DRB4*01 at 35.7% and HLA-DQB1*0501 at 28.6%, as detected in each of the clinical and radiological manifestations. A high frequency of HLA-B27 and HLA-DRB4*01 (64.3%) was noted in patients with dactylitis. Conclusion. The alleles HLA-B27, HLA-DRB4*01 and HLA-DQB1*0501 were common in the different subtypes of spondyloarthritis and were frequent in the specific clinical axial, peripheral and extraarticular clinical manifestations, as well as radiological sacroiliitis.