Global mapping survey research on physiotherapeutic interventions for osteoarthritis: a scoping review protocol.

INTRODUCTION: Physiotherapists provide non-pharmacological conservative treatment for osteoarthritis (OA) using a wide spectrum of interventions. Previous surveys have identified global physiotherapy OA management practices. However, no review to date summarises the scope and findings of these studies. This article describes a scoping review protocol to map the surveys investigating physiotherapeutic interventions offered to patients with OA to identify the treatment interventions currently used for OA, the physiotherapists' attributes and organisational practice factors potentially associated with the choice of these interventions and to detect knowledge-practice gaps in the provision of physiotherapeutic interventions in OA treatment, contributing to guiding future research on this topic. METHODS AND ANALYSIS: This is a protocol for a scoping review that will be based on Arksey and O'Malley scoping review methodology and the methodological guidance for conducting scoping reviews published by the Joanna Briggs Institute (JBI). Relevant articles will be searched using the following databases: Medline (PubMed), Embase, Web of Science and Google Scholar. Surveys studies addressing physiotherapeutic interventions offered to patients with OA will be included. Study will be selected through title/abstract and full-text screening stages and data will be extracted using an instrument based on the model available in the JBI Manual. The findings will be summarised using descriptive statistics according to our research questions. This review will be reported in accordance with the Preferred Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. ETHICS AND DISSEMINATION: Ethical approval is not required for this scoping review. Review findings will be disseminated through peer-reviewed publications, scientific conference presentations and scientific meetings. STUDY REGISTRATION: This protocol has been registered with the Open Science Framework (DOI 10.17605/OSF.IO/J3RBT).

Epidural blood patching in an anticoagulated patient with intracranial hypotension.

A middle-aged man had classical clinical and radiographical features of spontaneous intracranial hypotension, refractory to conservative management. His medical history included antiphospholipid syndrome, autoimmune thrombocytopenia and recurrent thrombotic events. To reduce his risk from epidural blood patching, we stopped his anticoagulation, but he developed thrombosis. Despite therapeutic challenges, we performed a fluoroscopically guided epidural blood patch successfully at multiple levels, with significant symptom and radiological improvement maintained at 9 months. We review the place of epidural blood patching in people with spontaneous intracranial hypotension who either take anticoagulants or have coexisting blood disorders.

Discordant Perception of Disease Activity Between Providers and Adolescents with Systemic Lupus Erythematosus: A Cohort Study.

Discordance in perception of disease activity between adolescent patients with lupus and their providers may influence disease outcomes. We found that patients endorsed higher perceptions of disease activity than providers. Discordance was present at all levels of disease activity, particularly in patients with high activity, nephritis, and/or taking corticosteroids or mycophenolate mofetil.

Analysis of the image and corporate identity of the Colegio Mexicano de Reumatologia: Is it time to redefine it?

INTRODUCTION AND OBJECTIVES: The Colegio Mexicano de Reumatología (CMR) is a corporation whose brand has two elements-image and identity-that differentiate it from other corporations. We evaluated aspects of CMR's corporate image and identity. SUBJECTS AND METHODS: To assess corporate image, we designed a survey using proof-of-concept and discrete-choice-experiments approaches. It assessed which definition (orthopedist, rheumatologist, or rehabilitator) was most meaningful in four pain scenarios in healthy adults from the country's Western region. We used discourse analysis and five readability indices of the CMR website to assess corporate identity. RESULTS: In total, 700 respondents were included. For every rheumatologist chosen in the hand scenario, respondents chose 1.13 orthopedists and 0.70 rehabilitators. For every rheumatologist chosen in the knee scenario, respondents chose 2.36 orthopedists and 0.64 rehabilitators, whereas 0.85 orthopedists and 0.58 rehabilitators were chosen in the arthritis scenario. Only 38% of the respondents preferred the CMR's definition of a rheumatologist to describe a rheumatologist. The younger age group preferred orthopedists to rheumatologists (50% vs. 31%, p<0.001). In the arthritis scenario, the choice of rheumatologist increased from 27% in the elementary school group to 49% in the university group (p<0.001). Mother was the most influential in healthcare seeking. The discursive analysis revealed that the CMR is positioned as a "we" restricted to "colleagues;" the patient did not have agentive representation. The semiotic structure of the CMR's mission/vision was deemed imprecise and lacking in statements of value and purpose; the readability scores indicated that the text was challenging and dry. CONCLUSIONS: The CMR's corporate image does not differentiate it from other health providers. CMR's identity seems ambiguous with restricted directionality. It seems pertinent to redefine the CMR.

Referrals for rheumatologic evaluation following a positive antinuclear antibody test result. A cross-sectional single center Brazilian study.

BACKGROUND: In general, patients are referred for rheumatological evaluation due to isolated laboratory abnormalities, especially antinuclear antibody (ANA) positivity, with the risk of more severe patients remaining on the waiting list for longer than desired. The aim of this study was to analyze the demographic, clinical, and laboratory information of patients referred to a specialized rheumatological care unit because of positive antinuclear antibody. METHODS: This is a retrospective study of 99 out of 1670 patients seen by the same rheumatologist between 01/01/2011 and 01/01/2019. Patients whose referrals were exclusively due to the ANA test result and the specialist's final diagnosis being "abnormal finding of serum immunological test" (ICD-10 R769) were included. Sociodemographic, clinical, and laboratory information were extracted from the consulting rheumatologist's chart. Descriptive statistics were used for data analysis. RESULTS: A total of 99 patients were included, most of whom were female (84.8%) with a median age of 49 years. At the moment of specialist's appointment, 97 patients (97.9%) repeated the ANA test, and 77 patients remained positive. Of these, only 35 (35.35%) were in a high titer range (greater than or equal to 1:320). Complete blood count for cytopenia's investigation was not performed in a high percentage of patients (22.2%), as well as urinalysis (31.3%). In addition, more than 70% of patients score 0 to 1 classification criteria for Systemic Lupus Erythematosus, according to SLE - ACR 1987 (American College of Rheumatology) and SLICC 2012 (Systemic Lupus International Collaborating Clinics). CONCLUSIONS: Most patients are still referred for specialized evaluation due to the misinterpretation of laboratory tests that were inappropriately requested in patients without clinical evidence of autoimmune rheumatic disease.

Three-dimensional kinematics of the trunk, pelvis, hip, and knee during the single-leg squat and hip torque in subjects with isolated patellofemoral osteoarthritis compared to individually matched controls: Preliminary results.

Objectives: This study aimed to compare three-dimensional kinematic of the trunk, pelvis, hip, and knee during the single-leg squat and hip torque in individuals with and without isolated patellofemoral osteoarthritis (PFOA). Patients and methods: This cross-sectional study evaluated trunk, pelvis, hip, and knee kinematics at 30°, 45°, and 60° knee flexion during the single-leg squat using the Vicon motion capture and analysis system, the Nexus System 2.1.1, and 3D Motion Monitor software. Sixteen individuals (8 males, 8 females; mean age: 49.3±6.2 years; range 40 to 61 years) participated in the study, of which eight were PFOA patients and eight were healthy controls. Isometric hip abductor, extensor, and external rotator torques were evaluated using a handheld dynamometer. Results: The PFOA group exhibited greater hip adduction at 30° (p=0.008), 45° (p=0.005), and 60° (p=0.008) knee flexion in the descending phase of the single-leg squat, as well as at 60° (p=0.009) and 45° (p=0.03) knee flexion in the ascending phase. No significant differences were found between groups for other kinematic variables (p>0.05). The PFOA group exhibited lower isometric hip abductor (p=0.02), extensor (p <0.001), and external rotator (p=0.007) torques. Conclusion: Individuals with PFOA exhibited excessive hip adduction that could increase stress on the lateral patellofemoral joint at 30°, 45°, and 60° knee flexion during the single-leg squat and exhibited weakness of the hip abductors, extensors, and external rotators in comparison to healthy controls.

An update on the study of synovial fluid in the geriatric patient.

BACKGROUND: The characteristics of synovial fluid (SF) in geriatric patients differ from those in younger patients. In Mexico, epidemiologic data on the incidence of different rheumatic diseases in geriatric patients are scarce. OBJECTIVE: To describe the physical characteristics of geriatric SF and the prevalence of crystals in knee and other joint aspirates from patients with previously diagnosed joint disease. MATERIALS AND METHODS: A retrospective study was performed with a baseline of 517 SF samples between 2011 and 2023. White blood cell count was performed by Neubauer chamber and crystals were identified by polarized light microscopy. Descriptive statistical analysis was performed and prevalence was reported as a percentage. RESULTS: The mean age of the adults was 73.5±5.0 years, 54.4% were women and 45.6% were men. The mean SF volume was 6.3±9.5mL in older adults and 15.3±24.9mL in those younger than 65 years. The mean viscosity in older adults was 9.5±4.5mm and the mean leukocyte count was 7352±16,402leukocytes/mm3. Seventy percent of the older adults' SFs were referred to the laboratory for osteoarthritis (OA), with lower proportions for rheumatoid arthritis (RA) (14.6%) and gout (5.1%). Of the crystals observed in the geriatric population, 14.6% corresponded to monosodium urate crystals (CUM) and 18.9% to calcium pyrophosphate crystals (CPP). CONCLUSIONS: The characteristics of LS in older adults were smaller volume, increased viscosity, and non-inflammatory. The main diagnoses were OA, RA, and gout. The crystal content of the SF of the geriatric population corresponded mainly to CPP.

The power of us: breaking barriers and bridging the gap of ultrasound in rheumatology to empower a new generation.

OBJECTIVE: This study assesses musculoskeletal ultrasound (MSUS) knowledge, attitudes, and practices among young rheumatologists in Mexico, aiming to identify barriers and facilitators to its clinical use. METHODS: An online survey distributed to a network of young rheumatologists captured demographics, institutional, and personal MSUS information. Multivariable analysis identified factors associated with positive MSUS attitudes. RESULTS: Ninety-six rheumatologists (39.18% national response rate) completed the survey. Of respondents (54.2% females, median age 35.1 years), 81.2% deemed MSUS necessary in clinical rheumatology. The main barriers included limited training access (56.2%) and required training time (54.1%). Lack of scientific evidence was not a major barrier (60.4%). Positive MSUS attitudes were associated with learning from conferences (p = 0.029) and colleagues (p = 0.005), formal (p = 0.043), and in-person training (p = 0.020), MSUS use in practice (p = 0.027), and use by radiologists in their institute (p < 0.001). Interest in learning MSUS (88.5%) was significantly higher in those with positive attitudes (94.4%, p < 0.001). Elastic net analysis identified key drivers, including learning MSUS from conferences, colleagues, and in residency; using MSUS in practice; respondent-performed MSUS; and MSUS use by radiologists. Statistically significant associations were found with using MSUS for synovitis/inflammatory joint disease (OR = 1.43, 95% CI 1.00-2.05) and MSUS use by radiologists in respondent's institutes (OR = 1.70, 95% CI 1.20-2.90). CONCLUSION: Most young rheumatologists in Mexico recognize the necessity of MSUS in clinical practice. By addressing identified barriers, encouraging rheumatologist-radiologist collaboration, and establishing a regulatory body to certify rheumatologist's MSUS experience, there is an opportunity to empower them with the necessary skills for effective MSUS use, ultimately benefiting patient care.

Valores de referencia para el 1-minute sit-to-stand test en pacientes pediátricos con artritis idiopática juvenil / Reference values for the 1-minute sit-to-stand test in pediatric patients with juvenile idiopathic arthritis

Introducción: los niños con artritis idiopática juvenil (AIJ) experimentan períodos de dolor e inmovilidad que afectan sus capacidades condicionales. Objetivos: describir los valores de referencia para el 1-minute Sit-to-Stand Test(1-STS; test de 1 minuto de sentarse y pararse) en niños con AIJ como evaluación de la capacidad aeróbico-funcional y de la fuerza muscular de los miembros inferiores (MMII).Materiales y métodos: se realizó un estudio observacional que incluyó a 15 niños con AIJ de entre 5 y 16 años. Se evaluó su rendimiento en el 1-STS. Resultados: se encontró una correlación positiva significativa entre el 1-STS y el test de la marcha de 6 minutos (r=0,56; p=0,03), como con el índice de capacidad funcional (CAPFUN) (r=0,54; p=0,03). No se observaron correlaciones significati-vas entre el Childhood Health Assessment Questionnaire (CHAQ) y el 1-STS (r=-0,21; p=0,44), tampoco con el Juvenile Arthritis Disease Activity Score (JADAS-10) (p=0,83). Conclusiones: el 1-STS parece prometedor para medir la capacidad aeróbi-co-funcional y la fuerza muscular de los miembros inferiores en niños con AIJ oligoarticular.

Introduction: children with juvenile idiopathic arthritis (JIA) experience periods of pain and immobility that affect their physical capacities. Objectives: to describe reference values for the 1-minute sit to stand test (1-STS) in children with JIA as an assessment of aerobic-functional capacity and lower limb muscle strength.Materials and methods: an observational study was conducted, including 15 children with JIA aged between 5 and 16 years. Their performance in the 1-STS was assessed. Results: a significant positive correlation was found between the 1-STS and the 6-Minute Walk Test (r=0,56; p=0,03), as well as with the Functional Capacity Index (CAPFUN) (r=0,54; p=0,03). No significant correlations were observed between the Childhood Health Assessment Questionnaire (CHAQ) and the 1-STS (r=-0,21; p=0,44), nor with the Juvenile Arthritis Disease Activity Score (JADAS-10) (p=0,83). Conclusions: the 1-STS appears promising for assessing aerobic-functional capacity and lower limb muscle strength in children with oligoarticular JIA.

Características del empleo y la remuneración económica en el ejercicio de la Reumatología en diferentes distritos de Argentina / Characteristics of employment and economic remuneration in the practice of Rheumatology in different districts of Argentina

Introducción: la Reumatología es una especialidad clínica con elevada de-manda y gran desigualdad en su ejercicio en Latinoamérica y el país. Objetivos: describir el estado del ejercicio de la Reumatología en nuestro país. Materiales y métodos: estudio observacional de corte transversal que recabó información a través de una encuesta online difundida por e-mail y de un código QR en el 54º Congreso Argentino de Reumatología. Resultados: se recibieron 127 respuestas; 86 (67,7%) fueron del sexo femenino, con una mediana de edad de 45 años. Ciento trece (113; 89%) encuestados eran especialistas en Reumatología, con 20 años (RIC 14-28) de ejercicio de la medicina y 13 años (RIC 6,5-20) de la especialidad. El 55,5% ejercía tanto en el ámbito público como privado, el 38,6% solo en el privado y el 7,6% únicamente en el público. Del total, el 84,3% trabajaba en dos o más lugares y el 21,2% en cuatro o más. Sesenta de los encuestados (60; 59,8%) recibía una remuneración mensual de entre 100.000 a 249.000 pesos (U$S: 501,68-1249,18) y 27 (23,1%) de menos de 100.000 pesos (U$S 501,68). Conclusiones: nuestro estudio muestra un alto porcentaje de profesionales que se desempeña en múltiples lugares de trabajo. Una quinta parte de ellos tenía remuneración baja.

Introduction: Rheumatology is a clinical specialty with high demand and great inequality in its practice throughout Latin America and our country. Objectives: to describe the state of the practice of Rheumatology in our country. Materials and methods: cross-sectional observational study that collected information through an online survey distributed by email and through a QR code in the 54thArgentine Congress of Rheumatology. Results: 127 responses were received. Eighty-six (67.7%) were women, with a median age of 45 years. One hundred thirteen (89%) were specialists in Rheumatology, with 20 years (IQR 14-28) in the practice of medicine and 13 years (IQR 6.5-20) in the specialty.The 55.5% worked in both the public and private spheres, 38.6% only in the private sphere and 7.6% only in the public sphere. Of the total, 84.3% worked in 2 or more locations, with 21.2% working in 4 or more. In 60 (59.8%), the monthly remuneration was between 100,000 to 249,000 pesos (U$S: 501.68-1249.18) and in 27 (23.1%) it was less than 100,000 pesos (US$ 501.68). Conclusions: Our study shows that a high percentage of professionals who work in multiple places. One-fifth of respondents had low pay

Ocular cicatricial pemphigoid: is there an association with autoimmune diseases?

PURPOSE: To assess the prevalence of autoimmune diseases (ADs) associated with ocular cicatricial pemphigoid (OCP) and analyze clinical, laboratory, and treatment associations between these entities. METHODS: A multicentre cross-sectional study of patients with an OCP diagnosis. The population was divided into two groups according to their association with other ADs or not. Clinical, laboratory and treatment variables were described and compared between groups. A multivariable logistic regression analysis was performed to identify variables that could suggest the association between OCP and ADs. RESULTS: Eighty-eight patients were recruited, with a mean age at diagnosis of 64.3 years (SD 11.9). Biopsy was performed in 86.8% of the patients. There was a median delay of 2 years from the onset of symptoms to diagnosis. Extraocular involvement was evidenced in 11.5%. The group associated with ADs included 24 patients (27.3%). The most prevalent diagnosis was Sjögren´s syndrome. Hypergammaglobulinemia was associated with ADs and OCP, adjusted for age, sex, smoking, skin and mucosal involvement, and erythrocyte sedimentation rate (OR 8.7; 95%CI 1.6-46.8; p = 0.012). CONCLUSIONS: Due to OCP's autoimmune nature, it could coexist with other ADs. This study observed that more than a quarter of the population presented with this association, and hypergammaglobulinemia could suggest it.

Safety of Upadacitinib in Immune-Mediated Inflammatory Diseases: Systematic Literature Review of Indirect and Direct Treatment Comparisons of Randomized Controlled Trials.

INTRODUCTION: Immune-mediated inflammatory diseases including rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), non-radiographic axial spondylarthritis (nr-axSpA), atopic dermatitis (AD), ulcerative colitis (UC), and Crohn's disease (CD) pose a substantial burden on patients and their quality of life. Upadacitinib is an orally administered, selective, and reversible Janus kinase inhibitor indicated for seven conditions, but data on its safety versus other active treatments are limited. A systematic literature review of indirect and direct treatment comparisons of randomized controlled trials (RCTs) was conducted to assess the safety profile of upadacitinib. METHODS: MEDLINE, Embase, and Cochrane Library databases were searched for indirect and direct treatment comparisons of RCTs that (1) included licensed upadacitinib dosages; (2) studied any of the seven conditions; (3) reported any adverse events (AEs), serious AEs (SAEs), AEs leading to discontinuation, major adverse cardiovascular event, venous thromboembolism, malignancies, infections or serious infections, and death; and (4) were published between January 2018 and August 2022. RESULTS: A total of 25 studies were eligible for inclusion. SAEs, AEs leading to discontinuation, and any AEs were commonly studied. RA was the most studied condition, followed by AD and UC. Most studies (16/25, 64%) reported no statistically significant difference in the studied safety outcomes between upadacitinib and other active treatments (e.g., tumor necrosis factor blockers, interleukin receptor antagonists, integrin receptor antagonists, T cell co-stimulation modulator), or placebo (placebo ± methotrexate or topical corticosteroids). Other studies (9/25, 36%) reported mixed results of no statistically significant difference and either statistically higher (8/25, 32%) or lower rates (1/25, 4%) on upadacitinib. CONCLUSION: Most studies suggested that upadacitinib has no statistically significant difference in the studied safety outcomes compared to active treatments or placebo in patients with RA, PsA, AS, AD, UC, and CD. A few studies reported higher rates, but findings were inconsistent with limited interpretation.

Valores de referencia para el 1-minute sit-to-stand test en pacientes pediátricos con artritis idiopática juvenil / Reference values for the 1-minute sit-to-stand test in pediatric patients with juvenile idiopathic arthritis

Resumen Introducción: los niños con artritis idiopática juvenil (AIJ) experimentan períodos de dolor e inmovilidad que afectan sus capacidades condicionales. Objetivos: describir los valores de referencia para el 1-minute Sit-to-Stand Test (1-STS; test de 1 minuto de sentarse y pararse) en niños con AIJ como evaluación de la capacidad aeróbico-funcional y de la fuerza muscular de los miembros inferiores (MMII). Materiales y métodos: se realizó un estudio observacional que incluyó a 15 niños con AIJ de entre 5 y 16 años. Se evaluó su rendimiento en el 1-STS. Resultados: se encontró una correlación positiva significativa entre el 1-STS y el test de la marcha de 6 minutos (r=0,56; p=0,03), como con el índice de capacidad funcional (CAPFUN) (r=0,54; p=0,03). No se observaron correlaciones significativas entre el Childhood Health Assessment Questionnaire (CHAQ) y el 1-STS (r=-0,21; p=0,44), tampoco con el Juvenile Arthritis Disease Activity Score (JADAS-10) (p=0,83). Conclusiones: el 1-STS parece prometedor para medir la capacidad aeróbico-funcional y la fuerza muscular de los miembros inferiores en niños con AIJ oligoarticular.

Abstract Introduction: children with juvenile idiopathic arthritis (JIA) experience periods of pain and immobility that affect their physical capacities. Objectives: to describe reference values for the 1-minute sit to stand test (1-STS) in children with JIA as an assessment of aerobic-functional capacity and lower limb muscle strength. Materials and methods: an observational study was conducted, including 15 children with JIA aged between 5 and 16 years. Their performance in the 1-STS was assessed. Results: a significant positive correlation was found between the 1-STS and the 6-Minute Walk Test (r=0,56; p=0,03), as well as with the Functional Capacity Index (CAPFUN) (r=0,54; p=0,03). No significant correlations were observed between the Childhood Health Assessment Questionnaire (CHAQ) and the 1-STS (r=-0,21; p=0,44), nor with the Juvenile Arthritis Disease Activity Score (JADAS-10) (p=0,83). Conclusions: the 1-STS appears promising for assessing aerobic-functional capacity and lower limb muscle strength in children with oligoarticular JIA.

Características del empleo y la remuneración económica en el ejercicio de la Reumatología en diferentes distritos de Argentina / Characteristics of employment and economic remuneration in the practice of Rheumatology in different districts of Argentina

Resumen Introducción: la Reumatología es una especialidad clínica con elevada demanda y gran desigualdad en su ejercicio en Latinoamérica y el país. Objetivos: describir el estado del ejercicio de la Reumatología en nuestro país. Materiales y métodos: estudio observacional de corte transversal que recabó información a través de una encuesta online difundida por e-mail y de un código QR en el 54º Congreso Argentino de Reumatología. Resultados: se recibieron 127 respuestas; 86 (67,7%) fueron del sexo femenino, con una mediana de edad de 45 años. Ciento trece (113; 89%) encuestados eran especialistas en Reumatología, con 20 años (RIC 14-28) de ejercicio de la medicina y 13 años (RIC 6,5-20) de la especialidad. El 55,5% ejercía tanto en el ámbito público como privado, el 38,6% solo en el privado y el 7,6% únicamente en el público. Del total, el 84,3% trabajaba en dos o más lugares y el 21,2% en cuatro o más. Sesenta de los encuestados (60; 59,8%) recibía una remuneración mensual de entre 100.000 a 249.000 pesos (U$S: 501,68-1249,18) y 27 (23,1%) de menos de 100.000 pesos (U$S 501,68). Conclusiones: nuestro estudio muestra un alto porcentaje de profesionales que se desempeña en múltiples lugares de trabajo. Una quinta parte de ellos tenía remuneración baja.

Abstract Introduction: Rheumatology is a clinical specialty with high demand and great inequality in its practice throughout Latin America and our country. Objectives: to describe the state of the practice of Rheumatology in our country. Materials and methods: cross-sectional observational study that collected information through an online survey distributed by e-mail and through a QR code in the 54th Argentine Congress of Rheumatology. Results: 127 responses were received. Eighty-six (67.7%) were women, with a median age of 45 years. One hundred thirteen (89%) were specialists in Rheumatology, with 20 years (IQR 14-28) in the practice of medicine and 13 years (IQR 6.5-20) in the specialty. The 55.5% worked in both the public and private spheres, 38.6% only in the private sphere and 7.6% only in the public sphere. Of the total, 84.3% worked in 2 or more locations, with 21.2% working in 4 or more. In 60 (59.8%), the monthly remuneration was between 100,000 to 249,000 pesos (U$S: 501.68-1249.18) and in 27 (23.1%) it was less than 100,000 pesos (US$ 501.68). Conclusions: Our study shows that a high percentage of professionals who work in multiple places. One-fifth of respondents had low pay.

Compared efficacy of rituximab, abatacept, and tocilizumab in patients with rheumatoid arthritis refractory to methotrexate or TNF inhibitors agents: a systematic review and network meta-analysis.

BACKGROUND: Our aim was to compare the efficacy of rituximab, tocilizumab, and abatacept in individuals with rheumatoid arthritis (RA) refractory to treatments with MTX or TNFi agents. METHODS: We searched 6 databases until January 2023 for phase 2-4 RCTs evaluating patients with RA refractory to MTX or TNFi therapy treated with rituximab, abatacept, and tocilizumab (intervention arm) compared to controls. Study data were independently assessed by two investigators. The primary outcome was considered as achieving ACR70 response. RESULTS: The meta-analysis included 19 RCTs, with 7,835 patients and a mean study duration of 1.2 years. Hazard ratios for achieving an ACR70 response at six months were not different among the bDMARDs, however, we found high heterogeneity. Three factors showing a critical imbalance among the bDMARD classes were identified: baseline HAQ score, study duration, and frequency of TNFi treatment in control arm. Multivariate meta-regression adjusted to these three factors were conducted for the relative risk (RR) for ACR70. Thus, heterogeneity was attenuated (I2 = 24%) and the explanatory power of the model increased (R2 = 85%). In this model, rituximab did not modify the chance of achieving an ACR70 response compared to abatacept (RR = 1.773, 95%CI 0.113-10.21, p = 0.765). In contrast, abatacept was associated with RR = 2.217 (95%CI 1.554-3.161, p < 0.001) for ACR70 compared to tocilizumab. CONCLUSION: We found high heterogeneity among studies comparing rituximab, abatacept, and tocilizumab. On multivariate metaregressions, if the conditions of the RCTs were similar, we estimate that abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab.

Takayasu's arteritis as an incidental finding in a patient with celiac disease: the importance of positron emission computed tomography.

BACKGROUND: Takayasu arteritis is a large-vessel vasculitis which affects large-caliber elastic arteries, primarily the aorta and its main branches. It mainly affects women between 20-30 years, so it is rare in children. CASE REPORT: We describe the case of a 15-year-old female who was followed up since she was 9 years old due to celiac disease. At the age of 13, anaemia of chronic disorders associated to elevated C-reactive protein and erythrocyte sedimentation were detected. The patient remained asymptomatic. After excluding other diseases, we requested a positron emission computed tomography (PET-CT); lesions compatible with large-vessel vasculitis were detected. Cardiology evaluation showed an aneurysm in the right coronary artery. Angio-CT suggested Takayasu type III arteritis. CONCLUSIONS: The delay in the diagnosis of Takayasu arteritis in pediatric patients is quite common. In this case, we have found phase II lesions, with no previous phase I symptoms. However, PET-CT allowed the diagnosis of vasculitis, key to the diagnosis of the patient.

INTRODUCCIÓN: La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a las arterias elásticas de gran calibre, fundamentalmente la aorta y sus ramas principales. Ocurre frecuentemente en mujeres entre los 20-30 años, por lo que es muy infrecuente en la edad pediátrica. CASO CLÍNICO: Se presenta el caso de una paciente de 15 años en seguimiento desde los 9 años por enfermedad celiaca. A los 13 años se detectó anemia de trastornos crónicos, elevación de proteína C reactiva y velocidad de sedimentación globular. La paciente permaneció en todo momento asintomática. Tras descartar otros procesos, se solicitó tomografía computarizada por emisión de positrones (PET-TC), donde se detectaron lesiones compatibles con vasculitis de grandes vasos. La valoración por Cardiología evidenció un aneurisma en coronaria derecha. Se realizó angio-TC, que sugirió arteritis de Takayasu tipo III. CONCLUSIONES: Es frecuente un retraso en el diagnóstico de la arteritis de Takayasu en los pacientes pediátricos. En este caso se encontraron lesiones de la fase II sin la presencia de síntomas correspondientes a la fase I. El PET-TC permitió el diagnóstico de vasculitis, clave para el diagnóstico de la paciente.

Publication outcomes of abstracts presented at the Argentine Congress of Rheumatology.

OBJECTIVE: To analyse the outcome of scientific abstracts submitted to the Argentine Congress of Rheumatology (ACOR) in 2000, 2005, 2010, and 2015. METHODS: Every abstract submitted to the ACOR was analysed. The number of these manuscripts published was determined through Google Scholar and PubMed searches. The impact of the scientific journals was established through the SCImago Journal (SJR) indicator. RESULTS: Considering the 727 abstracts evaluated, 10.2% of the articles were found in journals indexed by Google Scholar, and 6.6% in PubMed: 4.7% were published in 2000, 9.4% in 2005, 14.6% in 2010, and 11.9% in 2015 (Log Rank test 0.008), with a statistically significant increase between 2010 and 2015 compared to 2000 (HR 3.3; 95% CI 1.5-7; p 0.002 and HR 2.9; CI 1.4-6.3; p 0.005 respectively). The median SJR of the journals was 0.46 and 67.6% had SJR available. CONCLUSIONS: The publication rate was low, and only a few articles were published in the most prestigious journals within the speciality.

Do the instruments used to assess fibromyalgia symptoms according to American College of Rheumatology criteria generate similar scores in other chronic musculoskeletal pain?

BACKGROUND: As with fibromyalgia, several musculoskeletal disorders are characterized by chronic pain, raising a clinical question - do the instruments used to assess fibromyalgia symptoms according to ACR criteria (ACR criteria) generate similar scores in other chronic musculoskeletal pain? OBJECTIVE: To compare the symptoms among fibromyalgia and other chronic musculoskeletal pain. Additionally, we also compared the most researched outcomes in fibromyalgia (i.e., present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptom). METHODS: A cross-sectional study. Participants over 18 years old were included if they presented report of chronic musculoskeletal pain (≥ 3 months) and after that, they were divided into two groups (fibromyalgia and chronic pain). They answered the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), Brief Pain Inventory (BPI), Numerical Pain Rating Scale (NPRS) for pain and fatigue, WPI, and SSS. RESULTS: A total of 166 participants were included in this study into two independent groups (chronic pain, n = 83; fibromyalgia, n = 83). We observed significant differences (p < 0.05) and large effect sizes (Cohen's d, ≥ 0.7) in clinical outcomes comparisons between groups (i.e., widespread pain; symptom severity; present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptoms). CONCLUSION: Fibromyalgia patients (2016 ACR criteria) compared to other chronic musculoskeletal pain patients have higher levels of pain (at rest or after movement) and fatigue, greater impairment in both functionality and global impact, and worse symptoms. Therefore, the WPI and SSS instruments should be used exclusively to assess fibromyalgia symptoms.

Pattern of prescription drugs used for patients diagnosed with systemic vasculitis / Patrón de prescripción de medicamentos utilizados en pacientes con diagnóstico de vasculitis sistémicas

ABSTRACT Introduction: Vasculitis is a heterogeneous group of diseases characterized by inflammation of the blood vessel wall, which can cause thrombosis, stenosis, or occlusion. Its pharmacological management involves corticosteroids and conventional and biological disease-modifying antirheumatic drugs. Objectives: The objective was to determine the different types of systemic vasculitis and their pharmacological treatment in a group of patients from Colombia, 2019-2020. Materials and methods: This was a cross-sectional study that identified different types of systemic vasculitis and their pharmacological management in a group of patients from a drug-dispensing database of approximately 8.5 million people. Sociodemographic, comorbidity and pharmacological variables were considered. A descriptive analysis was performed. Results: A total of 621 patients with a diagnosis of systemic vasculitis were identified. The patients had a median age of 55.0 years, and 74.4% were women. The most common vasculitis types were those limited to the skin (30.1%), granulomatosis with polyangiitis (17.6%), and necrotizing vasculopathy (10.8%). A total of 81.0% of cases received corticosteroid prescriptions, 44.0% received azathioprine, and 24.0% received methotrexate; only 1.6% were prescribed biological antirheumatic drugs. Cardiovascular diseases were the most common comorbidity. Conclusions: The pattern of prescription medications used for patients diagnosed with systemic vasculitis is heterogeneous. Much of this population has associated comorbidities, which increases the use of medications according to the current management guidelines.

RESUMEN Introducción: Las vasculitis son un grupo heterogéneo de enfermedades caracterizadas por la inflamación de la pared de los vasos sanguíneos, lo cual puede llegar a ocasionar trombosis, estenosis u oclusión. Su manejo farmacológico incluye corticoesteroides, antirreumáticos modificadores de enfermedad convencionales y biológicos. Objetivos: El objetivo de este estudio fue determinar los diferentes tipos de vasculitis sistémicas y su tratamiento farmacológico en un grupo de pacientes de Colombia. Materiales y métodos: Se trató de un estudio de corte transversal que identificó los diferentes tipos de vasculitis sistémicas y su manejo farmacológico en un grupo de pacientes, a partir de una base de datos de dispensación de medicamentos de aproximadamente 8,5 millones de personas. Se consideraron variables sociodemográficas, comorbilidades y variables farmacológicas, y se hizo un análisis descriptivo. Resultados: Se identificaron 621 pacientes con diagnóstico de vasculitis sistémicas, con una mediana de edad de 55,0 anos, el 74,4% mujeres, siendo las vasculitis más frecuentes las limitadas a la piel (30,1%), la granulomatosis con poliangeitis (17,6%) y la vasculopatía necrosante (10,8%). El 81,0% de los casos recibió corticoesteroides, el 44,0% azatioprina y el 24,0 metotrexate, mientras que solo el 1,6% tenía prescritos antirreumáticos biológicos. Las comorbilidades cardiovasculares fueron las más comunes. Conclusiones: El patrón de prescripción de medicamentos utilizados en pacientes con diagnóstico de vasculitis sistémicas es heterogéneo y acorde con las guías actuales de manejo. Gran parte de esta población cursa con comorbilidades asociadas, lo cual incrementa el uso de medicamentos.

Short communication: Differences in clinical outcomes according to the healthcare regime in Colombian patients with rheumatoid arthritis / Comunicación corta: diferencias en los desenlaces clínicos según el régimen de salud en pacientes colombianos con artritis reumatoide

ABSTRACT Introduction/Objectives: Rheumatoid arthritis (RA) is a burdensome disease from both individual and societal perspectives, in which access to a rheumatologist plays a pivotal role in disease activity and reduction of its impact. We describe preliminary results of our study aimed at exploring whether healthcare regime affiliation influences disease outcomes of Colombian patients with RA. Materials and methods: We performed a retrospective observational study of RA patients (2010 ACR/EULAR classification criteria) with at least 3 assessments in rheumatology clinics from different healthcare regimes: Contributory (CR), Subsidized (SR), a centre of clinical excellence (C3) that follows CR patients. We retrieved data from clinical charts including a follow-up period of 2 years. Results: We included one hundred and sixty patients (C3: 79 [49.4%], CR: 26 [16.2%], SR: 55 [34.2%]). Median initial age was 54 years (IQR 48-62) and most patients were women (77.8%). Of the patients, 79% had established RA and 70% had high disease activity at the beginning of the follow-up. We observed statistical differences between groups with regards to (1) median time to scheduled visits, (2) percentage of visits accomplished in scheduled time, (3) median time to real visit, (4) adherence, (5) median percentage of time in high disease activity, and (6) percentage of patients in high disease activity at the end of follow-up. The best outcomes were observed in the C3 cohort. Conclusions: Access opportunity and clinical outcomes of Colombian patients with RA appear to differ between healthcare regimes. Although systematic bias may be present due to sample size, these data imply the healthcare regime is a major determinant of disease outcomes.

RESUMEN Introducción/Objetivos: La artritis reumatoide (AR) presenta una alta carga de enfermedad tanto desde una perspectiva individual como social. La posibilidad de acceder a un reumatólogo desempeña un papel fundamental en la actividad de la enfermedad y la reducción de su impacto. Se describen los resultados preliminares de un estudio que tiene por objetivo explorar la influencia del régimen de afiliación en salud en los desenlaces de la enfermedad en pacientes colombianos con AR. Materiales y métodos: Se realizó un estudio observacional retrospectivo en pacientes colombianos con AR (criterios de clasificación ACR/EULAR 2010), con al menos 3 consultas por reumatología, en 3 servicios ambulatorios de diferentes regímenes de atención: contributivo (RC), subsidiado (RS) y un centro de cuidado clínico de excelencia (C3). Se recogieron datos de las historias clínicas, incluyendo un periodo de seguimiento de 2 años. Resultados: Se incluyó un total de 160 pacientes (C3: 79 [49,4%], RC: 26 [16,2%], RS: 55 [34,2%]). La mediana de la edad inicial fue de 54 años (RIC 48-62) y la mayoría fueron mujeres (77,8%). El 79% de los pacientes tenía AR establecida y el 70% presentaba una alta actividad de la enfermedad al inicio del seguimiento. Se encontraron diferencias estadísticas entre los grupos en: 1) la mediana del tiempo programado para la siguiente consulta; 2) el porcentaje de las consultas cumplidas en el tiempo previsto; 3) la mediana del tiempo real en consulta; 4) la mediana de la adherencia a la toma de laboratorios; 5) la mediana del porcentaje de tiempo durante el seguimiento en alta actividad, y 6) el porcentaje de pacientes con alta actividad al final del seguimiento. Los mejores desenlaces se observaron en el grupo C3. Conclusiones: La oportunidad de acceso y los desenlaces clínicos de pacientes colombianos con AR parecen diferir según el régimen de afiliación en salud. Aunque puede existir un sesgo sistemático debido al tamaño de la muestra, estos datos apuntan a que el régimen de afiliación en salud es un determinante mayor en los desenlaces de la enfermedad.