Power Doppler signal at the enthesis and bone erosions are the most discriminative OMERACT ultrasound lesions for SpA: results from the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) multicentre study.

OBJECTIVES: To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population. METHODS: In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas). RESULTS: In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses. CONCLUSIONS: This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.

Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study.

Objectives: To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. Methods: Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients. Results: The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). Conclusion: The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.

From A Formal Training Program In Musculoskeletal Ultrasound (MSUS) To A High Reproducibility for MSUS Ultrasound In Rheumatoid Arthritis.

OBJECTIVE: To assess the intra- and inter-observer reliability of Ultrasound (US) in scoring B-mode, Doppler synovitis and combined B-mode and Doppler synovitis scores in different peripheral joints of Rheumatoid Arthritis (RA) patients. METHODS: Four rheumatologists with a formal training in Musculoskeletal US (MSKUS) particularly focus on definitions and scoring synovitis on B-mode and Doppler mode participated in a patient- based reliability exercise on 16 active RA patients. The four rheumatologists independently and consecutively performed a B-mode and Power Doppler (PD) US assessment of 7 joints of each patient in two rounds in a blinded fashion. Each joint was semi quantitatively scored from 0 to 3 for B-mode Synovitis (BS), Doppler Synovitis (DS), and combined B-mode/Doppler synovitis (CS). Intraobserver reliability was assessed by Cohen's κ. Interobserver reliability was assessed by unweight Light's κ. RESULTS: The mean prevalence of synovitis on B-mode was 83% of joints; scores ranging from grade 1 in 18% of joints, to grade 3 in 33%. In 55% of joints synovial PD signal was detected and the distribution of scores range from 14% of joints for grade 3, to 26% for grade 2. After a total of 448 joints scanned with 896 adquired images our intraobserver and interobserver reliability was good to excellent for most of the joints. CONCLUSION: Formal, structured and continuous training in musculoskeletal ultrasound would bring a good to excellent reproducibility in rheumatological hands with a high reliability in real time acquisition BS, DS and CS modalities for scoring synovitis in patients with active rheumatoid arthritis.

Report from the Latin American Spondyloarthritis Society for Education and Research in Immunology and Medicine organization 2012 workshop.

The first annual meeting of the Latin American Spondyloarthritis Society for Education and Research in Immunology and Medicine (LASSERIM) was held in Bogotá, Colombia, in September 2012 and was attended by key opinion leaders, researchers, and rheumatologists. The meeting included presentations and discussions from renowned speakers during 2 days and a coaching leadership exercise led by an expert in the field followed by an open forum. Two groups defined a priori discussed the establishment of a professional network and organization to be involved in the identification, assessment, and effective resolution of health care issues in Latin America.A broad spectrum of topics were discussed but focused on the following: pharmacoeconomics in general rheumatology, spondyloarthritis and chronic back pain, therapeutic interventions in rheumatoid arthritis, ultrasonography in spondyloarthritis, impact of social media in medicine and global trends in leadership, quality of life, and innovation. A special workshop on coaching in health care and coaching as a tool to implement LASSERIM goals was part of the 2-day conference.LASSERIM will be working in the future on education, research, and innovation in the field of rheumatology and immunology. A special focus will be on spondyloarthritis, by promoting research, open discussions, and by conducting carefully planned research studies to impact on the quality of life of patients and doctors from Latin American countries.

Normatización para la administración y el seguimiento de los agentes bilógicos y de quimioterapia usados en reumatología / Guidelines for use of biologic agents and quimiotherapy in Rheumatology

El desarrollo de las ciencias básicas como la inmunología, la genética y la biología molecular ha permitido implementar nuevas alternativas de tratamiento en enfermedades que tradicionalmente contaban con pocas opciones terapéuticas. La reumatología en los últimos años ha adoptado y extendido el uso de agentes biológicos y la quimioterapia en la mayoría de las enfermedades reumáticas. Para ello es necesario establecer guías para la utilización de estos agentes. El uso inapropiado de estos agentes puede llevar a consecuencias catastróficas. Los nuevos medicamentos deben ser usados sólo por personas expertas en el tratamiento de las enfermedades reumáticas y su administración debería realizarse en condiciones ideales para minimizar el riesgo. La Asociación Colombiana de Reumatología pretende con este documento establecer las guías locales para utilizar estos agentes