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Panicum coloratum L. (Mijo Perenne cv Verde) es una gramínea perenne de crecimiento primavera-estival originada de África, que se introdujo para evaluar su respuesta en la Región Pampeana Semiárida. Debido a la calidad forrajera ofrecida sin perder sus características de perennidad y productividad ha logrado una amplia difusión en esta Región. El consumo de forraje por animales en pastoreo es de difícil cuantificación. Para tal fin se han desarrollado varios métodos de estimación, entre ellos las técnicas de índice fecal (Método 1) y la diferencia de biomasa en pie pre y post-pastoreo (Método 2); ambos métodos se evalúan en el presente estudio. En la técnica de Índice Fecal se determinó, sobre las muestras de heces, la concentración del nitrógeno fecal (cNF), variable que se utilizó como índice fecal para calcular la digestibilidad de la materia orgánica (DM0). El método del pre y post-pastoreo consistió en cuantificar la diferencia de biomasa forrajera en pie, a través del pesaje diario de muestras de forraje antes y después del pastoreo de los animales. El trabajo se dividió en dos ensayos: alimentación en confinamiento (10 animales) y alimentación en pastoreo (8 animales). La alimentación era en base a Panicum coloratum L. Se utilizaron ovinos machos castrados raza Pampinta, los que portaron arneses para la recolección diaria de heces en bolsas. En laboratorio se analizó y cuantificó el forraje ofrecido, rechazado y heces de ambos ensayos. Con estos resultados se obtuvieron los siguientes valores de consumo: Método 1:67,3 g MO/kg PV0,75=/día y método 2: 62,5 g MO/kg PV0,75/día. Aun cuando, en la situación de pastoreo, no se dispone de una medida directa del valor de consumo efectivo de forraje por el animal, la escasa discrepancia (7%) entre los valores promedio de consumo de materia orgánica, de los dos métodos ensayados, lleva a inferir que la cNF, como índice fecal, puede ser un estimador útil del consumo de forraje.

Background Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO). Early diagnosis and prompt therapeutic intervention are crucial for limiting PsA progression and prevention of disability. Dermatologists are in a privileged position to detect early PsA. The management of patients with PsA in the dermatology setting is widely variable. Objective To provide practical recommendations for the management of patients with PsA in the dermatology setting including early diagnosis and treatment. Methods A consensus document was written by an expert panel composed by dermatologists (n = 12) and rheumatologists (n = 6). Eleven highly relevant questions were selected and elaborated with answers/statements based on a narrative literature review. The resulting document was discussed in a face-to-face meeting adopting a nominal group technique to reach consensus (i.e. 100% agreement) using the Delphi method. Results A consensus was achieved in defining the following: the clinical characteristics differentiating inflammatory and non-inflammatory signs and symptoms of joint disease; the most important differential diagnoses of PsA in clinical practice; the most useful screening questionnaires, serum laboratory tests and imaging techniques for the detection of early PsA; the criteria for dermatologist to refer patients with PsO to rheumatologist; the criteria for the diagnosis of PsA; the selection of the indices that the dermatologist could use for measuring the activity and severity of PsA in clinical practice; when systemic steroids and/or intra-articular steroid injections are indicated in the treatment of PsA. Finally, systemic treatments including synthetic and biologic disease-modifying antirheumatic drugs to be considered for the treatment of PsA have been reported. Conclusions The implementations of these practical recommendations could be very helpful for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

The progressive miniaturization of electronic devices and their exponential increase in processing, storage and transmission capabilities, is leading to unprecedented scenarios as the Internet of Things (IoT). Although most of the recent biomedical research applications of pervasive technology focused on remote monitoring and diagnostics, Smart Objects may enable novel quantitative approaches in rehabilitation too. In this paper, we present some preliminary results regarding a pediatric rehabilitation protocol based on Smart Objects and biofeedback, administered to a small group of hemiplegic children. Despite the very limited number of treatments, all children enjoyed participating in the study, and the preliminary results represent an interesting starting point to fuel the scientific and clinical discussion towards what could be defined “Pediatric Rehabilitation 2.0”.

This cross-sectional investigation examined the prevalence and severity of dysphonia, globus pharyngeus, and dysphagia in patients affected by immunomediated (IM) diseases. Seventy subjects were administered the Voice Handicap Index (VHI) (scale 0–4), Glasgow-Edinburgh Throat Scale (GETS) (scale from 0 to 7) for globus pharyngeus assessment, and modified Swallowing Outcomes After Revised Laryngectomy (SOAL) (scale 0, 1, 2) to test swallowing symptoms. VHI: the mean percentage of answers with a score greater than 1 (corresponding to a frequency of situation’s occurrence “sometimes,” “almost always,” or “always”) was 25.7, 26.7, and 44.1% for functional, emotional, and physical groups of sub-items respectively. GETS: the mean percentage of answers with a score ≥ 3 was 60.85%, significantly higher if compared with that of answers with a score

International audience; The bean beetle Callosobruchus maculatus is a worldwide generalist legume seed pest, present in the tropics and subtropics. Despite its economic importance, little is known about the population structure and migration patterns of this bruchid beetle in its continent of origin, both at local and regional scales. Gaining knowledge in the demographic processes experienced by C. maculatus, in particular in its native area, might give clues to understand evolutionary forces that have driven its expansion in traditional agroecosystems. Here, we analyze the genetic structure of 23 African populations of C. maculatus located in eleven different countries, using nuclear (28S) and mitochondrial (CytB) markers, and further apply phylogenetic and demographic analyses. The 28S sequences showed low genetic variability. In contrast, the analysis of CytB indicated significant genetic differentiation between most populations, suggesting low levels of gene flow, even at a reduced spatial scale. The results obtained from the estimation of various demographic parameters suggest evidence of recent population expansion, in agreement with a scenario of long-distance dispersal through trade of legume seeds for human consumption and population growth related to its pest nature. Overall, our results show that biogeography, isolation processes and human-mediated dispersal events drive the genetic structure of this pest in Africa.Key message:. This study was conducted to examine the population structure and migration patterns of Callosobruchus maculatus in Africa, its continent of origin.. The combination of biogeographic processes, isolation by distance and human-mediated dispersal events explain the genetic structuring of C. maculatus in Africa.. Our findings provide important baseline information for new approaches of biological control against this pest.

The genetic predisposition to a long-term efficacy of anti-tumor necrosis factor (TNF)α treatment in seronegative spondyloarthritis (SpA) was investigated by analysing the possible correlation between several single nucleotide gene polymorphisms and the retention rate of anti-TNFα therapies. We compared patients needing to switch the first anti-TNFα (Sw, No. 64) within at least 12 months of follow-up with patients not needing to switch (NSw, No. 123), observing at least 6 months of treatment to establish anti-TNFα failure, leading to treatment change. Response to treatment was evaluated by standardised criteria (BASDAI for axial involvement, DAS28-EULAR for peripheral involvement). The TNFα -308 A allele and the interleukin (IL)-6 -174GG homozygosis resulted as independent biomarkers predicting survival of the first anti-TNFα therapy in SpA patients (P=0.007, odds ratio (OR): 4.4, 95% confidence interval (CI)=1.5-13.1 and P=0.035, OR: 2.1, 95% CI=1.1-4.4). Also, the male gender (P=0.001, OR: 3.4, 95% CI=1.6-7.1) associated with the NSw phenotype, whereas no association was found either with the specific diagnosis or the predominant joint involvement.

Background Rheumatic diseases (RD) predominantly affect young women during reproductive age. Pregnancy, contraception and family planning (FP) are crucial for the quality of life of these patients. Objectives We aimed to investigate 9women9s health9 through a self-reported questionnaire. Answers from patients with connective tissue diseases (CTD) vs chronic arthritis (CA) were compared. Methods 24 centres distributed the questionnaire (65 multiple-choice and 12 open-answer questions) to women with RD (18–45years) regularly attending their outpatient clinics. Results Answers were collected from 249 CTD vs 149 CA patients. Their desire to have children was influenced by RD in 40% of cases: half of them reduced the number of children they wanted (Table 1). 39% CA vs 29% CTD were afraid of being mother because of disability. 24% CTD vs. 18% CA had at least one miscarriage; 21% CTD vs. 2% CA had more than one. 31% CTD and 34% CA were never asked about their desire to have children. 61% CTD vs 70% CA received counselling about contraception, given by a gynaecologist (G) (58% vs 64%), rheumatologist (R) (22% vs 14%) or both (7% vs 9%). 60% in both groups received a counselling before pregnancy: 34% vs 39% from R and G, 14% vs 22% by R. This positively changed family planning in 64% vs 59%. We created a Knowledge Index (based on the average of the normalized performed scores on 6 key questions for different sections): 55% CTD patients vs 44% CA had a medium-high score. A higher score directly correlated with the desire to became pregnant and with a multidisciplinary counselling. Conclusions This survey suggested that CTD have a major impact on FP and family size, possibly mediated by the increased rate of miscarriages as compared to CA. Concerns about reproductive issues could be positively overcome by adequate counselling. Rheumatologists should implement the discussion about FP and the compatibility of drugs with pregnancy in the management of young women with RD, especially those with CTD for whom contraception and pregnancy have particular implications. Acknowledgements Statistical analysis supported by an unrestricted grant by UCB Pharma Thanks to Patients9 Associations and Participants Disclosure of Interest None declared

Background Chronic rheumatic conditions such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) are associated with severe morbidity and significant impairment of patients9 health related quality of life (HRQoL). Several treatments are available but not all the patients respond positively to them. Biologic therapies such as anti-TNFα agents are shown to benefit who fail or have partial responses to standard DMARD therapy. Objectives Within a multicenter stated preferences study (CARA Study), we assessed HRQoL in patients with RA, AS and PsA, and estimated relationship of HRQOL with the different diagnoses, clinical characteristics and biological treatment experience. Methods Patients with RA, AS, or PsA, who at the time of enrollment were following a treatment (experienced) or received a first prescription (naive) of treatment with biological drugs were enrolled. Together with preferences data, clinical and HRQOL information was reported. HRQoL was assessed with the recently developed and successfully validated version of the EQ-5D-5L, which allows to obtain a description of health (in 5 domains and 5 levels of severity each), a measure (EQ-VAS) and a valuation (utility) of health. Multiple linear regression analyses were conducted to assess the association between EQ-5D VAS score and the utility with age, sex, diagnosis, treatment experience, years from symptoms onset and years from diagnosis. Results 513 patients were enrolled (mean±SD =50.0±13.6, 42.5% female). As regards the diagnosis, 33.9% had RA, 34.9% PsA and 31.2% AS. The mean±SD time from the symptoms onset was 10.8±9.4 and from the diagnosis was 8.0±8.2 years. Almost half of the patients (47.4%) were naive to the biological treatment. Patients reporting severe or extreme problems were: 7.1% in mobility, 3.6% in self-care, 10.3% in usual activities, 18.6% in pain/discomfort, 5.5% in anxiety/depression. The mean±SD of the VAS was 60.4±20.5 and of the utility was 0.773±0.116. From the regression model the VAS and utility are significantly (p Conclusions Patients naive to biological treatment have significat lower levels of HRQoL, suggesting that their current situation is not satisfactory and need to start with a more effective treatment. Disclosure of Interest L. Sinigaglia: None declared, L. Scalone: None declared, P. Sarzi-Puttini: None declared, C. Montecucco: None declared, R. Giacomelli Grant/research support from: MSD, G. Lapadula: None declared, I. Olivieri: None declared, A. Giardino Employee of: MSD Italia, G. Didoni Employee of: MSD Italia, P. Cortesi Grant/research support from: Gilead, L. Mantovani: None declared, M. Mecchia Employee of: MSD Italia

Background Rheumatic diseases (RD) affect women during reproductive age. Children9s outcome is a major topic for counselling on family planning, but no large studies are available. Objectives We aimed at assessing the long-term health conditions of children born to mothers with RD through a self-reported questionnaire. Methods 24 Rheumatology Centers distributed the questionnaire (65 multiple choice and 12 open-answer questions) to consecutive women with RD attending their outpatient clinic during September 2015. Data were compared according to maternal diagnosis (MD) -chronic arthritis (CA) or connective tissue disease (CTD)- and to the timing of pregnancy (before or after MD of RD). Results The survey yielded data about 269 children born to 184 mothers (63 CA, 121 CTD). According to MD, children had a mean age of 17.1 (±9.6 SD) and 14.4 (±9.0 SD) years at the time of interview, and male children were 52/93 (56%) and 91/176 (52%), respectively. Twenty-nine children in the CA group (31.2%) and 64 in the CTDs group (36.4%) were born after MD of RD. Pre-term delivery (before 37 weeks) was observed in 48 cases (17.8%), mostly children born to mothers with CTD (37/48, 77%). Regarding school performance, 12 children (4.5%) repeated one year of school, in 7 cases for indolence, in 3 for learning disabilities (LD)/health problems (HP), in 2 for family problems. Eleven of these children were born before MD. Overall, 9 children (3.3%) were diagnosed with a LD and 53 children were affected by HP requiring either hospitalization or evaluation by a Specialist (Table). Three children (1%) were affected by autoimmune disease. Conclusions The long-term follow-up of children born to women with RD is reassuring of an outcome similar to that of the general pediatric population (GPP). Autoimmune diseases are not frequent. Problems seem to cluster in children born to CTD, especially after MD, with a higher frequency of LD (6.3% vs 2.5–3.5% of GPP), but no particular pattern of exposure to maternal autoantibodies nor drugs was observed. Acknowledgements Statistical analysis supported by an unrestricted grant by UCB Pharma Thanks to Patients Associations and Participants to the survey Disclosure of Interest None declared

Background Extra-articular manifestations (EAMs), such as uveitis, inflammatory bowel diseases (IBD) and psoriasis (PsO), frequently complicate the disease course of patients with axial spondyloarthritis (axSpA), although prevalence data on this regard are still controversial. The occurrence of EAMs might also contribute to the decision of introducing a biologic therapy and even influence the choice between the available TNF inhibitors (TNFis). Objectives The aim of this study is to retrospectively evaluate the prevalence of EAMs in a multicentre cohort of axSpA patients treated with TNFi, investigating how these influenced the choice of treatment. Methods Clinical data from axSpA patients treated with a TNFi between May 2003 and May 2016 where obtained from a multicentre registry. Prevalence of EAMs (uveitis, IBD and PsO) was calculated at the time of TNFi prescription, evaluating their distribution according to drug subgroup. Results The study included 503 patients with axSpA (172 [34.2%] women, mean age [±SD] 40.5 [±13.2] years, mean disease duration 9.7 [±14.7] years), receiving a total of 675 lines of treatment (I-line n=503, II-line n=118, ≥ III-line n=54) with a TNFi (272 infliximab [IFX], 173 adalimumab [ADA], 89 golimumab [GOL], 141 etanercept [ETN]). At the time of TNFi introduction, 28.6% patients claimed at least one EAM (IBD 11.3%, uveitis 10.9%, and PsO 8.8%). The baseline presence of at least one EAM was associated with a more frequent prescription of an anti-TNF monoclonal antibody rather than etanercept (34.1% versus 21.9%, respectively; p=0.005). In detail, EAMs were found in 41.6, 36.9, 29.8, and 21.9% patients treated with GOL, ADA, IFX, or ETN, respectively. The prevalence of IBD was significantly higher (p=0.004) in patients treated with ADA (12.7%), IFX (14.3%), or GOL (11.2%) compared with ETN (4.9%). Uveitis was numerically more frequent in GOL (20.2%) and ADA (13.3%) rather than IFX (9.5%) and ETN (9.9%) groups. Finally, PsO prevalence was similar in patients treated with ADA (10.9%) and GOL (10.1%), and numerically lower in the ETN (7.1%) and IFX (5.9%) groups. Conclusions In our cohort of axSpA patients treated with TNFis, EAMs were highly represented. The presence of extra-articular involvement has been carefully taken into account when a TNFi was required to better control the disease. In particular, IBD and uveitis drove more frequently the choice toward an anti-TNF monoclonal antibody instead of the receptor. Disclosure of Interest None declared

Background The development of biologic therapies has created a more complex decision-making process to select the treatment option for patients. In order to optimize the appropriateness of the decisions, it is necessary to be informed and aware of the preferences of the interested parties and the influence of their experiences on their preferences for the different treatments. Objectives To estimate preferences of relevant treatment characteristics valued by the different subjects involved in the management of patients with rheumatic diseases. This abstract focuses on patients9 preferences. Methods We involved patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) or psoriatic arthritis (PsA), who according to clinical practice, at the time of data collection had for the first time a prescription of (naive), or received treatment with (experienced) biological drugs for at least 3 months in the last 12 months. Through a Discrete-Choice-Experiment, the participants valued 16 possible scenarios in which pairs of similarly effective treatments were described with 6 characteristics including 2–4 possible levels each: (1) frequency of administration; (2) mode and place of administration; (3) hospitality, service, efficiency and courtesy of health personnel; (4) frequency of reactions at the site of drug administration; (5) generalized undesired reactions or allergic reactions involving the whole body; (6) additional contribution added as healthcare taxes to be paid by all the citizens to make available the treatment to target patients. Results 513 patients from 30 centres through Italy participated, balanced for diagnosis and treatment experience (around 20% of each subgroup). Characteristics 4, 3 and 6 were the first, second and third most important ones for every subgroup, the fourth most important characteristic was 1 (experienced RA), 5 (naive AS), and 2 for the other subgroups. Across all the subgroups, patients generally preferred very satisfactory levels of (3), infrequent (4), mild (5), and no (6). Instead, for characteristics (1) and (2) the patients generally preferred the frequency, mode and place of administration that were closer to those actually experienced or prescribed. Conclusions Taking into account the different opinions of patients on at least some treatment characteristics could guide the conduction of good choices aimed to optimize benefits and to allocate efficiently resources. Disclosure of Interest L. Sinigaglia: None declared, P. Sarzi-Puttini: None declared, L. Scalone: None declared, C. Montecucco: None declared, R. Giacomelli Grant/research support from: MSD, G. Lapadula: None declared, I. Olivieri: None declared, A. Giardino Employee of: MSD Italia, P. Cortesi Grant/research support from: Gilead, L. Mantovani: None declared, M. Mecchia Employee of: MSD Italia

Background The management of patients with rheumatologic diseases (RDs) involves a complex interaction between different parties such as patients, physicians, pharmacists. The development of biologic therapies has created a more complex decision-making process to select the treatment option for patients. To optimize the appropriateness of the decisions, it is necessary to be informed and aware of the preferences of the interested parties. Objectives To estimate preferences of relevant treatment characteristics with biological agents valued by the different subjects involved in the management of patients with rheumatic diseases. Methods We involved patients with RDs, rheumatologists, nurses and pharmacists with experience in the treatment with/provision of biological drugs of these patients. Through a Discrete-Choice-Experiment, the participants valued 16 possible scenarios in which pairs of similarly effective treatments were described with 6 characteristics including 2–4 possible levels each: (1) frequency of administration; (2) mode and place of administration; (3) hospitality, service, efficiency and courtesy of health personnel; (4) frequency of reactions at the site of drug administration; (5) generalized undesired/allergic reactions; (6) additional cost: since the Italian NHS pays treatment costs, we included possible additional cost as monthly healthcare taxes for all the citizens, to make available the treatment to all target patients. relative importance of each characteristic was estimated through a random-effects conditional logistic regression model. Results 513 patients, 110 rheumatologists, 51 nurses and 46 pharmacists from 30 centres through Italy participated. Characteristics (3), (4) and (6) were the most important for every subgroup, while (1) was the least important for patients and rheumatologists, (2) the least important for the pharmacists, (2) and (5) the least important for the nurses. The four subgroups were consistent in preferences towards the specified levels of characteristics (1) and (3) to (6). However, as for characteristic (2), pharmacists preferred autonomous subcutaneous injection with syringe, nurses preferred assisted infusion at an infusional center close to patient9s place, patients and rheumatologists preferred autonomous subcutaneous injection with pen. Conclusions Different subjects show different preferences for some treatment characteristics, which together with pure clinical aspects can play an important role in the choice and consequent success of treatments. Disclosure of Interest P. Sarzi-Puttini: None declared, P. Cortesi Grant/research support from: Gilead, L. Sinigaglia: None declared, C. Montecucco: None declared, R. Giacomelli Grant/research support from: MSD, G. Lapadula: None declared, I. Olivieri: None declared, A. Giardino Employee of: MSD Italia, G. DIdoni Employee of: MSD Italia, L. Scalone: None declared, L. Mantovani: None declared, M. Mecchia Employee of: MSD Italia

Objective Behcet's disease (BD) is a chronic, relapsing, inflammatory vascular disease with no pathognomonic test. Low sensitivity of the currently applied International Study Group (ISG) clinical diagnostic criteria led to their reassessment. Methods An International Team for the Revision of the International Criteria for BD (from 27 countries) submitted data from 2556 clinically diagnosed BD patients and 1163 controls with BD-mimicking diseases or presenting at least one major BD sign. These were randomly divided into training and validation sets. Logistic regression, ‘leave-one-country-out’ cross-validation and clinical judgement were employed to develop new International Criteria for BD (ICBD) with the training data. Existing and new criteria were tested for their performance in the validation set. Results For the ICBD, ocular lesions, oral aphthosis and genital aphthosis are each assigned 2 points, while skin lesions, central nervous system involvement and vascular manifestations 1 point each. The pathergy test, when used, was assigned 1 point. A patient scoring ≥4 points is classified as having BD. In the training set, 93.9% sensitivity and 92.1% specificity were assessed compared with 81.2% sensitivity and 95.9% specificity for the ISG criteria. In the validation set, ICBD demonstrated an unbiased estimate of sensitivity of 94.8% (95% CI: 93.4–95.9%), considerably higher than that of the ISG criteria (85.0%). Specificity (90.5%, 95% CI: 87.9–92.8%) was lower than that of the ISG-criteria (96.0%), yet still reasonably high. For countries with at least 90%-of-cases and controls having a pathergy test, adding 1 point for pathergy test increased the estimate of sensitivity from 95.5% to 98.5%, while barely reducing specificity from 92.1% to 91.6%. Conclusion The new proposed criteria derived from multinational data exhibits much improved sensitivity over the ISG criteria while maintaining reasonable specificity. It is proposed that the ICBD criteria to be adopted both as a guide for diagnosis and classification of BD.

BackgroundSince the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations.MethodsA systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated.ResultsThe updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used.ConclusionsThese recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion.

Background As psoriatic disease (PD) is a condition characterized by the combination of inflammatory skin (psoriasis) and osteo-articular manifestations (psoriatic arthritis), its treatment should cover both its clinical components. Objective The objective of this study was to propose a flexible framework for the use of biological agents in PD. Methods The proposal was drawn up by a group of dermatologists and rheumatologist expert in PD and was based on existing evidence and personal opinion. Results The three TNF-a inhibitors (adalimumab, etanercept, infliximab) are effective in all of the psoriatic manifestations and should be used in the case of moderate/severe disease refractory to systemic treatment with non-biological drugs. We propose the following definitions of moderate/severe disease: PASI > 10 or BSA > 10 or DLQI > 10 for plaque-psoriasis; BSA ‡ 10 or DLQI ‡ 10 for the other psoriatic skin lesions; DLQI ‡ 10 or meaningful values of the NAPSI or mNAPSI for psoriatic nail involvement; ‡ 1 inflamed joint + patient global VAS 3 4 + physician’s judgement or arthritic joint deformities or radiographic joint damage plus ‡ 5 inflamed small joints or ‡ 1 large joints for peripheral joint involvement; ‡ 1 digit with dactylitis and ‡ 1 enthesitic sites + patient global VAS 3 4 + physician’s judgement for dactylitis and enthesitis. BASDAI ‡ 4 + physician’s judgement for spondylitis; recurrent flares or risk of developing irreversible damage for uveitis. Other assessment instruments can be used if the physician is more familiar with them and if they have been validated. Conclusion We provide a shared dermatological and rheumatological proposal for the use of biological agents in PD.

Objectives: To develop evidence-based European League Against Rheumatism (EULAR) recommendations for the management of Behcet disease (BD) supplemented where necessary by expert opinion. Methods: The multidisciplinary expert committee, a task force of the EULAR Standing Committee for Clinical Affairs (ESCCA), consisted of nine rheumatologists (one who was also a clinical epidemiologist and one also a Rehabilitation Medicine doctor), three ophthalmologists, one internist, one dermatologist and one neurologist, representing six European countries plus Tunisia and Korea. A patient representative was also present. Problem areas and related keywords for systematic literature research were identified. Systematic literature research was performed using Medline and the Cochrane Library databases from 1966 through to December 2006. A total of 40 initial statements were generated based on the systematic literature research. These yielded the final recommendations devel- oped from two blind Delphi rounds of voting. Results: Nine recommendations were developed for the management of different aspects of BD. The strength of each recommendation was determined by the level of evidence and the experts' opinions. The level of agreement for each recommendation was determined using a visual analogue scale for the whole committee and for each individual aspect by the subgroups, who consider themselves experts in that field of BD. There was excellent concordance between the level of agreement of the whole group and the ''experts in the field''. Conclusion: Recommendations related to the eye, skin- mucosa disease and arthritis are mainly evidence based, but recommendations on vascular disease, neurological and gastrointestinal involvement are based largely on expert opinion and uncontrolled evidence from open trials and observational studies. The need for further properly designed controlled clinical trials is apparent.

Objectives: To present and analyse the literature sources regarding the management of Behcet disease (BD) identified during the systematic literature research, which formed the basis for the European League Against Rheumatism (EULAR) evidence-based recommendations for the management of BD. Methods: Problem areas and related keywords regarding the management of BD were determined by the multidisciplinary expert committee commissioned by EULAR for developing the recommendations. A systematic literature research was performed using MedLine and Cochrane Library resources through to December 2006. Meta-analyses, systematic reviews, randomised controlled trials (RCTs), open studies, observational studies, case control studies and case series’ involving ⩾5 patients were included. For each intervention the effect size and number needed to treat were calculated for efficacy. Odds ratios and numbers needed to harm were calculated for safety issues of different treatment modalities where possible. Results: The literature research yielded 137 articles that met the inclusion criteria; 20 of these were RCTs. There was good evidence supporting the use of azathioprine and ciclosporin A in eye involvement and interferon (IFN)α in mucocutaneous involvement. There were no RCTs with IFNα or tumour necrosis factor (TNF)α antagonists in eye involvement. Similarly controlled data for the management of vascular, gastrointestinal and neurological involvement is lacking. Conclusion: Properly designed, controlled studies (new and confirmatory) are still needed to guide us in managing BD.

Objectives: To determine the type and proportion of patients with ankylosing spondylitis who rheumatologists consider to be candidates for treatment with tumour necrosis factor (TNF)-blocking agents, and to what extent this is in agreement with the ASsessment in Ankylosing Spondylitis (ASAS) international working group recommendations on initiation of treatment with anti-TNF agents. Methods: Participants were rheumatologists from 10 different countries, who were considered to be experts in treating patients with ankylosing spondylitis and in the use of anti-TNF treatment, but were unaware of the ASAS recommendations (unpublished at the time of study in 2003). The first 10 consecutive patients with ankylosing spondylitis seen by the rheumatologist were evaluated as to whether the patient was a candidate for anti-TNF treatment. Thereafter, a metrologist assessed the patient for disease activity and severity, and collected data on demographics and treatment. Results: Complete data were available for 1207 of the 1284 patients and were used for analysis. Overall, the rheumatologists indicated that they would initiate TNF-blocking agents in 49.3% of patients, ranging from 37.2% patients in Canada to 78.3% in Australia. These candidates had higher disease activity, higher levels of acute-phase reactants, worse spinal mobility, worse function, more often hip involvement and a higher prevalence of sick leave. Of all patients considered to be candidates, 40% did not fulfil ASAS recommendations with respect to previous use of non-steroidal anti-inflammatory drugs (NSAIDs; at least two NSAIDs) or Bath Ankylosing Spondylitis Disease Activity Index (⩾4). Conversely, 36% of patients who did not fulfil the NSAID or BASDAI recommendations were still considered to be candidates for TNF-blocking treatment. Objective variables, such as C reactive protein, erythrocyte sedimentation rate or magnetic resonance activity, were considered less important than disease activity in the decision on starting TNF-blocking drugs. The only important objective criterion was rapid radiographic progression. Conclusion: Rheumatologists wanted to initiate TNF-blocking drugs in roughly half of the patients with ankylosing spondylitis. However, there was a wide variation across countries and doctors. Rheumatologists considered both disease activity and severity to be determinants of starting TNF blockers, but their decision was often in disagreement with ASAS recommendations.

The spondyloarthritis (SpA) complex includes ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, arthritis related to inflammatory bowel disease and forms that do not meet established criteria for these definite categories which are designated as undifferentiated SpA. In the early 1990s, two sets of classification criteria were suggested with the purpose to cover the whole clinical spectrum of SpA: the Amor criteria and the European Spondylarthropathy Study Group (ESSG) criteria...

Background Current recommendations for the management of axial spondyloarthritis (SpA) and psoriatic arthritis are to monitor disease activity and adjust therapy accordingly. However, treatment targets and timeframes of change have not been defined. An international expert panel has been convened to develop ‘treat-to-target’ recommendations, based on published evidence and expert opinion. Objective To review evidence on targeted treatment for axial and peripheral SpA, as well as for psoriatic skin disease. Methods We performed a systematic literature search covering Medline, Embase and Cochrane, conference abstracts and studies in http://www.clinicaltrials.gov. Results Randomised comparisons of targeted versus routine treatment are lacking. Some studies implemented treatment targets before escalating therapy: in ankylosing spondylitis, most trials used a decrease in Bath Ankylosing Spondylitis Disease Activity Index; in psoriatic arthritis, protocols primarily considered a reduction in swollen and tender joints; in psoriasis, the Modified Psoriasis Severity Score and the Psoriasis Area and Severity Index were used. Complementary evidence correlating these factors with function and radiographic damage at follow-up is sparse and equivocal. Conclusions There is a need for randomised trials that investigate the value of treat-to-target recommendations in SpA and psoriasis. Several trials have used thresholds of disease activity measures to guide treatment decisions. However, evidence on the effect of these data on long-term outcome is scarce. The search data informed the expert committee regarding the formulation of recommendations and a research agenda.

The objective of this study was to evaluate the predictive factors for achieving partial remission (PR) in patients with ankylosing spondylitis (AS) treated with anti-TNFα. We longitudinally enrolled in a multi-center study 214 AS patients, classified according to New York criteria, treated with anti-TNFα drugs adalimumab (ADA), etanercept (ETA) and infliximab (INF) with at least 12 months of follow up. PR was reached when the score was

Musculoskeletal manifestations in a population-based cohort of inflammatory bowel disease patients.Salvarani C, Vlachonikolis IG, van der Heijde DM, Fornaciari G, Macchioni P, Beltrami M, Olivieri I, Di Gennaro F, Politi P, Stockbrugger RW, Russel MG; European Collaborative IBD Study Group.Dept. of Rheumatology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy. salvarani.carlo@asmn.re.itBACKGROUND: Musculoskeletal disorders are the most common extra-intestinal manifestation of inflammatory bowel disease (IBD). Wide ranges of prevalence have been reported depending on the criteria used to define spondylarthropathy and on the selection of patients. We aimed to evaluate the prevalence and clinical spectrum of musculoskeletal manifestations in an inception cohort of European IBD patients. METHODS: From 1 October 1991 to 30 September 1993, 202 IBD patients were diagnosed in three centres of two countries (Italy and The Netherlands) by means of a population-based inception cohort study. Of this group of patients, 160 (79%) were interviewed and examined by a rheumatologist and a gastroenterologist in the period June-September 1996. A total of 139/160 patients had an antero-posterior radiograph of the pelvis, and in 140/160 HLA-B27 was determined. RESULTS: 53 (33.1%) of the 160 patients had experienced at least one musculoskeletal manifestation, 29 (18.1%) satisfied the European Spondylarthropathy Study Group (ESSG) criteria for spondylarthropathy and 5 (3.1%) satisfied the modified New York criteria for ankylosing spondylitis. However, 23 (14.4%) patients developed one or more spondylarthropathy-related manifestations without fulfilling any of the classification criteria. In patients satisfying ESSG criteria a significantly higher frequency of women (P = 0.03), of ocular and liver involvement (P = 0.01 and P = 0.03, respectively), and use of immunosuppressive drugs (P = 0.02) was observed. CONCLUSION: Our study shows a high prevalence of musculoskeletal manifestations in an inception cohort of IBD patients. The clinical spectrum is broader than that defined by spondylarthropathy criteria.

Objectives. To describe a case-series of patients who presented with the typical postural abnormalities of long-standing advanced ankylosing spondylitis (AS) but were instead found to suffer from diffuse idiopathic skeletal hyperostosis (DISH). Methods. We enrolled consecutive patients who showed postural abnormalities, which at first suggested to us the diagnosis of long-standing advanced AS, although the diagnostic process led us to the correct diagnosis of DISH. Each patient had a complete physical examination and radiographs of the spine and pelvis, and was investigated for HLA-B27 locus typing. Results. From 15 June 1998 to 15 June 2006, 15 patients with DISH were seen who presented with the typical postural abnormalities of long-standing advanced AS. All patients were males with a median age of 69yrs (range 51-91). All lacked HLA-B27 and denied personal or family history of spondyloarthritis. All measurements assessing cervical, thoracic and lumbar spinal movement were abnormal. Conclusions. Patients suffering from DISH can occasionally have severe limitations of spinal mobility, along with postural abnormalities that resemble long-standing advanced AS. Thus, the differential diagnosis between DISH and advanced AS is not limited to the radiological findings and can also extend to the clinical findings in the two diseases, as is highlighted by our report.

We evaluated the prevalence of hepatitis C virus (HCV) infection in Italian patients suffering from fibromyalgia (FM), in comparison with patients affected by non-HCV related rheumatic degenerative disorders. Consecutive patients with FM and a statistically comparable group of patients suffering from peripheral osteoarthritis (OA) or sciatica due to L4-L5 or L5-S1 herniated disc were tested for HCV infection with a third-generation microparticle enzyme immunoassay (MEIA). In the positive cases, a third-generation recombinant immunoblot assay (RIBA) confirmatory test and serum HCV-RNA test were performed. Fisher's exact test was performed to compare the prevalence of HCV infection (MEIA- and RIBA-positive results) obtained in the two enrolled groups. Enrolled were 152 subjects suffering from FM and 152 patients with peripheral OA or sciatica. Anti-HCV antibodies were found in 7/152 (4.6%) patients suffering from FM and in 5/152 (3.3%) of control subjects. No statistically significant differences in HCV prevalence were detected between cases and controls. Our present report does not confirm previous data indicating an increased prevalence of HCV in FM patients and does not seem to support a significant pathogenetic role of HCV under this condition.

The case of a patient with seronegative spondyloarthropathy showing oligoarthritis of the hand together with large pitting oedema is reported. Unlike the patients with late on set peripheral spondyloarthropathy described by Dubost and Sauvezie who show minimal involvement of the axial skeleton, the patient has been suffering from AS for about twenty years.

NTRODUCTION:The Assessments of SpondyloArthritis international society Health Index (ASAS HI) measures functioning and health in patients with spondyloarthritis (SpA) across 17 aspects of health and 9 environmental factors (EF). The objective was to translate and adapt the original English version of the ASAS HI, including the EF Item Set, cross-culturally into 15 languages.METHODS:Translation and cross-cultural adaptation has been carried out following the forward-backward procedure. In the cognitive debriefing, 10 patients/country across a broad spectrum of sociodemographic background, were included.RESULTS:The ASAS HI and the EF Item Set were translated into Arabic, Chinese, Croatian, Dutch, French, German, Greek, Hungarian, Italian, Korean, Portuguese, Russian, Spanish, Thai and Turkish. Some difficulties were experienced with translation of the contextual factors indicating that these concepts may be more culturally-dependent. A total of 215 patients with axial SpA across 23 countries (62.3% men, mean (SD) age 42.4 (13.9) years) participated in the field test. Cognitive debriefing showed that items of the ASAS HI and EF Item Set are clear, relevant and comprehensive. All versions were accepted with minor modifications with respect to item wording and response option. The wording of three items had to be adapted to improve clarity. As a result of cognitive debriefing, a new response option 'not applicable' was added to two items of the ASAS HI to improve appropriateness.DISCUSSION:This study showed that the items of the ASAS HI including the EFs were readily adaptable throughout all countries, indicating that the concepts covered were comprehensive, clear and meaningful in different cultures.

Background Quality of Life (QoL) is reduced in patients (pts) with axial spondyloarthritis (axSpA) who suffer from pain, stiffness and fatigue in their most productive years of life. Currently, data on QoL and impact on daily activities in axSpA pts classified according to the ASAS criteria are limited. No medical research in Italy has been conducted in AxSpA pts Objectives To assess the evolution of QoL in pts suffering from axSpA over a 12-month period and disease impact on daily life activities Methods QUASAR is a multicenter, longitudinal, observational study on adult axSpA pts in Italy. This interim analysis reports baseline data. Inclusion criteria were diagnosis of axSpA (either non radiographic [nr-axSpA] or ankylosing spondylitis [AS]) based on the ASAS classification criteria and ability to understand and complete the questionnaires. The following clinical parameters were recorded: CRP, HLA-B27, pain, stiffness, disease activity (BASDAI and ASDAS), Patient and Physician Global Assessment (PtGA/PGA), comorbidities and treatment. Subjects were asked to complete the ASQoL, WPAI, MARS, EQ-5D questionnaires and a VAS on satisfaction with the treatment during routine visits. Descriptive statistics (mean±Standard Deviation [SD] or frequencies) are presented for baseline clinical characteristics, disease activity and QoL. Mann-Whitney test, t-test, χ 2 were used to calculate differences between pts groups Results A total of 512 pts (mean age 47.8±13.1 years; males 62.1%) were enrolled. 19% had a family history of SpA and 21% of psoriasis. 97 pts (18.9%) had a diagnosis of nr-axSpA. 246 (61.5%) subjects out of the 400 typed were HLA-B27 positive (48.7% and 62.7% of nr-axSpA and AS pts, respectively). Time to diagnosis since symptom onset was 5.4±2.9yrs for all pts, 3.8±3.1yrs for nr-axSpA and 5.8±2.8yrs for AS pts. 59.8% of nr-axSpA and 58.3% of AS pts had pain at the first visit. Low back pain was the most frequent type (73.3% of all pts) followed by cervical pain (35%) and dorsal pain (23.3%). 52.6% of nr-axSpA and 56.1% AS pts had morning stiffness. The following table shows the baseline demographic and characteristics of the pts involved in QUASAR: Extra Articular Manifestations (EAM) were as follows: psoriasis 17.6%, uveitis 15.8%, ulcerative colitis (UC) 4.1% and Crohn9s disease 6.5%. EAMs were present in 24.7% and 15.9% (psoriasis), 15.5% and 15.9% (uveitis), 5.2% and 3.9% (UC), 4.1% and 7.0% (Crohn9s disease) of nr-axSpA and AS pts Conclusions QUASAR is the first prospective Italian study with a large sample size that reports an overall similar burden of disease in nr-axSpA and AS patients, documented by pain, CRP, PGA/PtGA, BASDAI, ASDAS, ASQOL, and EQ-5D VAS. Our data support the importance of early diagnosis and treatment of axSpA Acknowledgement AbbVie funded the study, participated in its design/data collection/analysis/interpretation/writing publication Disclosure of Interest I. Olivieri Grant/research support from: Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, UCB, Consultant for: Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, UCB, Speakers bureau: Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, UCB, R. M. D9Attino Employee of: Abbvie, G. Gualberti Employee of: Abbvie, R. Merolla Shareholder of: Abbvie, Employee of: Abbvie

Background Psoriatic arthritis (PsA) is a systemic inflammatory disease mainly characterised by arthritis, dactylitis, enthesitis and skin involvement. Recently issued therapeutic guidelines (1) suggest that treatment decisions should be driven by as many manifestations of disease as possible. Objectives The aim of this study was to determine, in a multicentre Italian cohort of PsA patients, which clinical or patient reported disease outcome influence physician decision to change DMARD or biologic treatment. Methods 173 consecutive patients with PsA (103 males and 70 females, mean age 52±12 years) were enrolled in a longitudinal observational study. Seven tertiary referral clinics with expertise in PsA and SpA were involved. Detailed clinical examination, including ACR joint count, presence or absence of dactylitis and enthesitis, PASI, were recorded. Patient perception of disease was evaluated by means of global, joint and skin specific VAS scales. Detailed treatment information were also recorded. According to study protocol clinical assessment was performed at baseline and after twelve weeks in order to identify two distinct groups: changed and unchanged DMARD or biologic therapy. Results A higher number of tender joints (p Conclusions The results of this study, performed in an Italian cohort of PsA patients, suggest that rheumatologists, when they decide to change DMARD or biological treatment in PsA patients, are influenced by both objective evidence of musculoskeletal involvement and by patient reported global and joint outcomes. They do not seem to be influenced by the extent of skin dermatitis, possibly because of the generally low extent of skin involvement in PsA patient and/or because of a musculoskeletal orientated approach of rheumatologists. References Coates LC, Kavanaugh A, Mease PJ et al. Group for research and assessment of psoriasis and psoriatic arthritis: Treatment recommendations for psoriatic arthritis 2015. Arthritis Rheumatol. 2016 Jan 8. doi: 10.1002/art.39573. [Epub ahead of print] Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is characterized by an excess of cardiovascular diseases (CVD) risk, similar to type 2 diabetes (T2DM). A recent meta-analysis confirmed an elevated prevalence and incidence of T2DM in RA [1]. In this context, the necessity to recognize early T2DM in RA is driven by the evidence that CVD risk factors tends to act synergistically, thus increasing the risk conferred by each single factor [2]. However, it9s still difficult to select patients that need to underwent extensive diabetes investigation in the rheumatology setting. Objectives Aim of our work was to identify useful predictors of impaired glucose tolerance (IGT) and T2DM in RA patients with normal fasting glucose values in the rheumatology outpatient setting. Methods 100 RA patients satisfying ACR/EULAR 2010 criteria [3] were screened with FPG. Of these, 78 had normal ( ln (TG [mg/dL] x glucose [mg/dL]/2). The lipid accumulation product (LAP)[6] was calculated with the formula [WC (cm) – 58 for women or 65 for men] x TG (mmol/L). The visceral adiposity index (VAI) was calculated with the formula proposed by Amato et al [7]. Results Of the 78 RA patients recruited 57 were NGT, 18 were IGT and 3 were T2DM. After correction for age, sex, BMI, and systolic blood pressure, 2h-pG correlated with diseases duration (R=0.25, p=0.04), ESR (R=0.27, p=0.02), lnTG/HDLc (R=0.24, p=0.04), HOMA-IR (R=0.29, p=0.01), LAP (R=0.28, p=0.02) but not with lnCRP, lnTG, fasting glucose, uric acid, TyG index or VAI. In addition 2h-pG category correlated only with LAP (R=0.33, p=0.005). When A1c% was set as dependent variable, it correlated with lnTG (R=0.26, p=0.03), fasting glucose (R=0.29, p=0.0), uric acid (R=0.26, p=0.03), TyG index (R=0.25, p=0.04), LAP (R=0.30, p=0.01). Conclusions In RA patients with normal fasting glucose, LAP correlates significantly with 2hPG and predicts abnormal glucose tolerance. References Jiang, P., H. Li, and X. Li. Clin Exp Rheumatol, 2015. 33(1): p. 115–21. Baghdadi, L.R., et al. PLoS One, 2015. 10(2): p. e0117952. Aletaha, D., et al. Ann Rheum Dis, 2010. 69(9): p. 1580–8. Wallace, T.M., J.C. Levy, and D.R. Matthews. Diabetes Care, 2004. 27(6): p. 1487–95. Unger, G., et al. Endocrinol Nutr, 2014. 61(10): p. 533–40. Kahn, H.S. BMC Cardiovasc Disord, 2005. 5: p. 26. Amato, M.C., et al. Diabetes Care, 2010. 33(4): p. 920–2. Disclosure of Interest None declared

Background The first EULAR recommendation for the management of Behcet9s syndrome (BS) was published in 2008 and since then new data including biologic agents have appeared. Objectives To review the evidence for efficacy and safety of management strategies in BS patients with eye, vascular, gastrointestinal (GI) and neurologic involvement. Methods We used the GRADE methodology as framework for guidelines development. For the systematic literature review, we searched The Cochrane Library, Database of Abstracts of Reviews of Effects, Health Technology Assessments, MEDLINE, EMBASE and International Pharmaceutical Abstracts Database. Randomized controlled trials (RCT), controlled clinical trials, or open label trials comparing an active drug in patients with BS with other agents or placebo were included. If controlled trials were not available for answering a specific research question, uncontrolled evidence from prospective or retrospective studies or case series about a minimum of 5 patients were also included. Results We reviewed the titles and abstracts of 3927 references, followed by the full texts of 397. A total of 166 studies related with major organ involvement met our inclusion criteria. Three RCTs with cyclosporine-A (CycA) and 1 with azathioprine (AZA) showed beneficial results in BS patients with eye involvement. There were several observational studies with interferon-α and TNF-α antagonists in patients with eye involvement, including those among patients refractory to conventional treatment modalities. Decreases in the frequency of ocular attacks, remission and improvement in visual acuity were observed in the majority of patients treated with these agents. As for vascular involvement, retrospective studies showed that immunosuppressives (IS) significantly decreased the frequency of recurrences in BS patients with deep vein thrombosis (RR 95%CI: 5.8, 2.8–11.8). A similar effect was not observed with anticoagulants+IS compared with IS alone (RR 95%CI: 1.5, 0.8–2.6). Observational studies showed that cyclophosphamide and high dose glucocorticoids (GC) decreased mortality in patients with arterial aneurysms. Treatment with IS and GC decreased postoperative complications in patients who had surgery for arterial aneurysms. Observational studies showed beneficial results with 5-ASA derivatives and AZA in the initial management of BS patients with GI involvement. Remission could be obtained with thalidomide and/or TNF- α antagonists in the majority of patients with refractory GI involvement. Retrospective studies also showed IS decreased postoperative recurrences in patients operated for intestinal perforations or major bleeding (RR 95%CI: 0.56, 0.33–0.95). Observational studies in BS patients with neurologic involvement showed IS and GC improved the outcome. CycA should be avoided in such patients since retrospective studies showed that CycA had increased the risk of development of neurologic involvement (RR 95%CI: 12.6, 4.7–33.7). Conclusions It is sobering to note that the majority of the studies forming the basis for the recommendations related to major organ involvement in the updated EULAR recommendations for the management of BS come from observational studies. Disclosure of Interest None declared

The traditional management of psoriatic arthritis (PsA) includes NSAIDs, corticosteroids and DMARDs. Advancement in the knowledge of the immunopathogenesis of PsA has been associated with the development of biologic agents which have revolutionized the management of the disease. Among biologics drugs, there are the 4 currently availablee anti-TNFα blocking agents (etanercept, infliximab, adalimumab and golimumab) which are more effective than traditional DMARDs on symptoms/signs of inflammation, quality of life, function, and in inhibiting the progression of the structural joint damage. Despite of the high cost, TNF inhibitors are costeffective on both the musculoskeletal and skin manifestations of psoriatic disease.

Detecting adaptation involves comparing the performance of populations evolving in different environments. This detection may be confounded by effects due to the environment experienced by organisms prior to the test. We tested whether such confounding effects occur, using spider-mite selection lines on two novel hosts and one ancestral host, after 15 generations of selection. Mites were either sampled directly from the selection lines or subjected to a common juvenile or to a common maternal environment, mimicking the most frequent environmental manipulations. These environments strongly affected all life-history traits. Moreover, the detection of adaptation and correlated responses on the ancestral host was inconsistent among environments in almost 20% of the cases. Indeed, we did not detect responses unambiguously for any life-history trait. This inconsistency was due to differential environmental effects on lines from different selection regimes. Therefore, the detection of adaptation requires a careful control of these environmental effects.

Although theory established the necessary conditions for diversification in temporally heterogeneous environments, empirical evidence remains controversial. One possible explanation is the difficulty of designing experiments including the relevant range of temporal grains and the appropriate environmental trade-offs. Here, we experimentally explore the impact of the grain on the diversification of the bacterium Pseudomonas fluorescens SBW25 in a temporally fluctuating environment by including 20 different pairs of environments and four temporal grains. In general, higher levels of diversity were observed at intermediate temporal grains. This resulted in part from the enhanced capacity of disruptive selection to generate negative genotypic correlations in performance at intermediate grains. However, the evolution of reciprocal specialization was an uncommon outcome. Although the temporal heterogeneity is in theory less powerful than the spatial heterogeneity to generate and maintain the diversity, our results show that diversification under temporal heterogeneity is possible provided appropriate environmental grains.

The case of a 49-year-old man affected by Behçet's syndrome (BS) without any clinical or radiological evidence of ankylosing spondylitis, exhibiting a peripheral enthesitis typical of seronegative spondyloarthropathy (SpA) is reported. The diagnosis of SpA is supported by computed tomographic evidence of sacroiliitis. This case confirms our hypothesis that patients with BS may have other forms of SpA than AS.

Nine polymorphic microsatellite loci for the pied flycatcher (Ficedula hypoleuca),from a wild population in Spain are isolated and their variability escribed on 70 individuals. The number of alleles per locus ranged from 6 to 41 and observed heterozygosity ranged from 0.75 to 0.98. These markers are being used to study mating strategies in Ficedula hypoleuca iberiae.

Objective: Non-radiographic axial spondyloarthritis (SpA) is characterised by a lack of definitive radiographic sacroiliitis and is considered an early stage of ankylosing spondylitis. The objective of this study was to develop candidate classification criteria for axial SpA that include patients with but also without radiographic sacroiliitis. Methods: Seventy-one patients with possible axial SpA, most of whom were lacking definite radiographic sacroiliitis, were reviewed as "paper patients" by 20 experts from the Assessment of SpondyloArthritis international Society (ASAS). Unequivocally classifiable patients were identified based on the aggregate expert opinion in conjunction with the expert-reported level of certainty of their judgement. Draft criteria for axial SpA were formulated and tested using classifiable patients. Results: Active sacroiliitis on magnetic resonance imaging (MRI) (odds ratio 45, 95% CI 5.3 to 383; p

Objectives: To present and analyse the literature sources regarding the management of Behçet disease (BD) identified during the systematic literature research, which formed the basis for the European League Against Rheumatism (EULAR) evidence-based recommendations for the management of BD. Methods: Problem areas and related keywords regarding the management of BD were determined by the multidisciplinary expert committee commissioned by EULAR for developing the recommendations. A systematic literature research was performed using MedLine and Cochrane Library resources through to December 2006. Meta-analyses, systematic reviews, randomised controlled trials (RCTs), open studies, observational studies, case control studies and case series' involving ≥5 patients were included. For each intervention the effect size and number needed to treat were calculated for efficacy. Odds ratios and numbers needed to harm were calculated for safety issues of different treatment modalities where possible. Results: The literature research yielded 137 articles that met the inclusion criteria; 20 of these were RCTs. There was good evidence supporting the use of azathioprine and ciclosporin A in eye involvement and interferon (IFN) in mucocutaneous involvement. There were no RCTs with IFNa or tumour necrosis factor (TNF)a antagonists in eye involvement. Similarly controlled data for the management of vascular, gastrointestinal and neurological involvement is lacking. Conclusion: Properly designed, controlled studies (new and confirmatory) are still needed to guide us in managing BD.

Objective: Inflammatory back pain (IBP) is an important clinical symptom in patients with axial spondyloarthritis (SpA), and relevant for classification and diagnosis. In the present report, a new approach for the development of IBP classification criteria is discussed. Methods: Rheumatologists (n = 13) who are experts in SpA took part in a 2-day international workshop to investigate 20 patients with back pain and possible SpA. Each expert documented the presence/absence of clinical parameters typical for IBP, and judged whether IBP was considered present or absent based on the received information. This expert judgement was used as the dependent variable in a logistic regression analysis in order to identify those individual IBP parameters that contributed best to a diagnosis of IBP. The new set of IBP criteria was validated in a separate cohort of patients (n = 648). Results: Five parameters best explained IBP according to the experts. These were: (1) improvement with exercise (odds ratio (OR) 23.1); (2) pain at night (OR 20.4); (3) insidious onset (OR 12.7); (4) age at onset

Patients with ankylosing spondylitis (AS) may develop cardiovascular manifestations ranging from asymptomatic forms to life threatening conditions. The most important cardiovascular manifestation of AS is aortitis, which frequently involves the aortic root and the ascending aorta leading to valvular insufficiency. The extension of the subaortic fibrotic process into the interventricular septum may cause conduction abnormalities that represent the second common cardiovascular manifestations occurring in AS patients. More rarely, an involvement of coronary arteries and of thoracic and abdominal aorta could be present. Rheumatologists managing AS patients should carefully consider, both in late and in early phases of the disease, the occurrence of an aortic involvement in order to promptly administer adequate treatment.

BACKGROUND: Ten ASAS/EULAR recommendations for the management of ankylosing spondylitis (AS) were published in 2006. OBJECTIVES: (a) To disseminate and (b) to evaluate conceptual agreement with, and (c) application of, these recommendations as well as (d) potential barriers to the application. METHODS: A questionnaire was sent to rheumatologists in 10 countries. It included (a) the text of the recommendations; (b) rheumatologists' demographic variables; (c) two numerical rating scales from 1 to 10 for each recommendation: conceptual agreement with, and application of, the recommendation (10 indicates maximal agreement and maximal application); and (d) a list of potential barriers to the application of the recommendation. Statistical analysis included descriptive and multivariate analyses. RESULTS: 7206 questionnaires were sent out; 1507 (21%) were returned. Of the 1507 answering rheumatologists, 62% were men, mean (SD) age 49 (9) years, and 34% had an academic position. Conceptual agreement with the recommendations was high (mean (SD) for all recommendations 8.9 (0.9)). Self-reported application was also high (8.2 (1.0)). The difference between agreement and application varied across recommendations and countries. The most pronounced discrepancies were reported for use of anti-tumour necrosis factor drugs in a few countries, with funding as the most commonly reported barrier for application of this recommendation. CONCLUSION: This large project has helped the dissemination of the ASAS/EULAR recommendations for the management of AS and shows that conceptual agreement with the recommendations is very high. The project also highlights inequalities in access to healthcare for European citizens with AS. researcherid-numbers: Pavelka, Karel/E-6578-2017 orcid-numbers: Pavelka, Karel/0000-0003-1952-8422 Collantes Estevez, Eduardo/0000-0002-7647-6289 unique-id: ISI:000255774400009 ispartof: ANNALS OF THE RHEUMATIC DISEASES vol:67 issue:6 pages:782-788 ispartof: location:England status: published

To evaluate the frequency and duration of clinical remission in patients with PsA.All consecutive new outpatients with peripheral PsA requiring second-line drugs and RA observed between January 2000 and December 2005 were included in a prospective, case-control study. Primary end point was to assess the frequency of remission in peripheral PsA compared with RA. Secondary end points were to compare the duration of clinical remission during treatment and after therapy interruption, ACR 20, 50, 70 response rates and to detect any remission predictor at diagnosis. Treatment regimen was standardized in both groups. From January 2003 to December 2005, therapy was suspended in PsA patients and controls if achieving remission.One or more episodes of remission occurred in 57/236 (24.1%) PsA patients and in 20/268 (7.5%) controls (P0.001). The mean duration of remission was of 13 +/- 9.4 months in PsA patients and 4 +/- 3.7 in controls (P0.001). Remission episodes were more frequent in PsA patients treated with anti-TNF compared with those receiving traditional DMARDs (P0.001), with no differences regarding the duration. After therapy interruption, the remission duration was 12 +/- 2.4 months in PsA and 3 +/- 1.5 in RA (P0.001). No remission predictor at diagnosis resulted by multivariate analysis.Remission is possible in up to 24% of patients with peripheral PsA. It is significantly more frequent, but not longer, in patients receiving anti-TNF drugs compared with those treated with traditional DMARDs. Patients remain in remission for a long period after therapy interruption, thus suggesting an intermittent therapeutic strategy.

Objective. Recommendations and/or guidelines represent a popular way of integrating evidence-based medicine into clinical practice. The 3E Initiatives is a multi-national effort to develop recommendations for the management of rheumatic diseases, which involves a large number of experts combined with practising rheumatologists addressing specific questions relevant to clinical practice. Methods. Ten countries participated in three rounds of discussions and votes concerning the management of AS. A set of nine questions was formulated in the domains of diagnosis, monitoring and treatment, after a Delphi procedure. A literature search in MedLine was conducted. Predefined outcome parameters for the domains of diagnosis, monitoring and treatment were assessed. The evidence to support each proposition was evaluated and scored. After discussion and votes, the final recommendations were presented using brief statements by each national group, following which the final international recommendations were formulated. Results. A total of 2699 papers were found and 467 were selected for analysis. Twelve key recommendations were developed: three in the domain of diagnosis addressing general diagnostic considerations, early AS diagnosis and general practitioners' referral recommendations; three concerning monitoring of AS disease activity, severity and prognosis; six concerning pharmacological treatment (except biologics): non-steroidal anti-inflammatory drugs/COX-II inhibitors, bisphosphonates and treatment of enthesitis. The compiled agreement among experts ranged from 72% to 93%. Conclusion. Recommendations for the management of AS were developed using an evidence-based approach followed by expert/physician consensus with high level of agreement. Involvement of a larger and more representative group of rheumatologists may improve their dissemination and implementation in daily clinical practice.