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Objectives To characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world.Methods Cross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated.Results A total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%).Conclusion These results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.

Aims: The aim was to translate and cross-culturally adapt the modified Short Questionnaire to Assess Health-enhancing physical activity (mSQUASH) into Turkish. Methods: The mSQUASH was translated into Turkish and backward-translation into Dutch was performed afterwards using the Beaton method. After the Turkish version was reviewed and revised by an expert committee that included translators, two patients and the research team a pre-final version was produced. The-pre final version then entered a field-test with cognitive debriefing in 10 patients with axSpA. The final result was the Turkish mSQUASH version. Results: The translation process went without difficulties. Small discrepancies were either resolved during the synthesis or expert consensus meetings. Mean (SD) time to complete the mSQUASH was 6.1 (2.4) minutes in field-test procedure. The cognitive debriefing showed that the items of the Turkish mSQUASH were clear, relevant, easy to understand and easy to complete. None of the patients reported that an important aspect of physical activity was missing from the questionnaire items. Patients raised the concern that not all sport examples were culturally suitable; tennis was replaced by volleyball and basketball after the cognitive debriefing, to make it more appropriate to the Turkish culture. Conclusion: The final Turkish version of the mSQUASH showed acceptable linguistic and field validity for use in both clinical practice and research. However, further assessment of the psychometric properties (validity and reliability) of the Turkish version of the mSQUASH is needed before it can be implemented. [ABSTRACT FROM AUTHOR]

Aim: To collect and summarize the available scientific evidence that evaluates the effects of physical exercise interventions on axial spondyloarthritis (axSpA). Methods: A systematic review was conducted in accordance to the guidance of Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) to collect randomized controlled trials on the PubMed, Embase and Web of Science Core Collection databases. The search strategy included terms regarding physical exercise interventions targeted to axSpA participants and all of its variants in multiple combinations adapted to each one of the databases regarding its own special requirements. Several outcomes were defined: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), ASDAS (Ankylosing Spondylitis Disease Activity Score), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), the 36-item short form health survey (SF-36) and the Ankylosing Spondylitis Quality of Life questionnaire (ASQoL). Two independent researchers screened the titles and abstracts followed by full-text analysis when suitable, using EndnoteTM online. Selected articles, according to exclusion/inclusion criteria defined, were submitted to data extraction and bias assessment was performed for each study's outcomes using the Cochrane risk-of-bias tool for randomized trials. Results: A total of 2063 articles were identified through the electronic databases search. After removal of duplicates, 1435 were eligible for screening, of which 45 articles went through full text evaluation. Only 24 articles met the inclusion/exclusion criteria. Physical exercise contributes for a statistically significant improvement of BASDAI in 13 studies, BASFI in 10, BASMI in 6, ASDAS in 3, CRP in 2, ESR in 1, SF-36 in 2 and ASQoL in 3.No major adverse effects were reported and an overall benefit was noted with the implementation of physical exercise as a treatment modality for axSpA. Conclusion: Physical exercise seems to be an effective non-pharmacological therapy for axSpA, with positive effects in disease activity, physical function, and quality of life. [ABSTRACT FROM AUTHOR]

Objective: The human resting myofascial tone maintains the body tone in a neutral posture, the assessment of this and other muscle physical properties (MPP) is relevant, since, it is altered in many pathological states. Patients and methods: Seventeen healthy subjects (8 males), between 18-50 years old, were assessed. The MPP of lower lumbar muscles was evaluated on right and left sides during prone resting position using two devices; myotonometry (stiffness, elasticity and tone) and ultrasound-based shear-wave elastography (SWE) (shear modulus). MTM measurements were performed at two anatomic points (ANp), selected by an experienced reader and at an adjacent ultra-sound determined point (USp). Myotonometry measurements of the erector spinae and SWE measurements of multifidus muscles at the L3-4 level were compared between genders and sides. The intra-reader reliability (IRR) for each device and correlations between techniques were analysed. MTM measurements performed at ANp and USp were compared. The intraclass correlation coefficient (ICC) was assessed for both devices. Correlations between stiffness (myotonometry) and shear modulus (SWE) at the respective muscle depths were assessed with Spearman correlation. Results: Males had greater stiffness and tone than females, particularly on the dominant side. MPP assessed by myotonometry were not different between ANp and USp. Good/Excellent IRR was documented for measurements by MTM (ICC=0.90) and SWE (ICC=0.85). No correlation in myotonometry stiffness and SWE shear modulus was found. For myotonometry assessments, the addition of ultrasonography was not different from anatomic localizations. No correlation of measurements was found between devices assessing respective L3-4 level muscles. Conclusions: Gender and side differences must be considered when assessing MPP in axial muscles. For MTM assessments, the addition of ultrasonography was not different to anatomic references. No correlation was found between devices. [ABSTRACT FROM AUTHOR]

Background: Psoriatic arthritis (PsA) is a chronic inflammatory disease commonly managed by rheumatologists. Switching between biologic therapies is a re - commended strategy for PsA patients that show insufficient response or adverse events with a biologic agent. Although the choice of the subsequent biologic may be dependent on many factors (accessibility, clinical aspects, patient's preference), assessing the quality of the switch decision is of utmost relevance. Objectives: To develop and validate two outcomes measurement tools to evaluate the quality of biologic therapies switch in PsA patients with axial and peri - pheral phenotypes in clinical practice. Methods: A Task Force and an Expert Panel were specifically assembled for this purpose. The tool development comprised a modified-Delphi method in a four-step procedure: 1) literature search and experts' opinion collection about quality indicators for PsA management; 2) Delphi design to address the deve - lopment of the measurement tool; 3) three Delphi questionnaire rounds; 4) consensus meeting to discuss the results and reach a decision regarding outcomes measurement tools' components. This phase resulted in the definition of two measurement tools to evaluate the quality of biologic switch in peripheral and axial PsA. For the validation of these tools, 12 experienced rheumatologists were asked to evaluate and classify the biologic switch of 80 patient profiles (40 with peri - pheral PsA and 40 with axial PsA phenotypes). Clinical judgement was defined as the "gold standard" against which, tools' output was compared. Each patient profile was evaluated by 3 experts and only those with consensual clinical judgment (agreement between at least 2 of 3 rheumatologists) were included in the validation analysis. The results were used to assess the validity (by sensitivity/specificity analysis) and the reliability, more specifically inter-rater reliability, (by Cohen's kappa) of both tools. Results: The developed tools consisted of 6 domains (disease activity, dactylitis, enthesitis, skin and nail manifestations, physical function and quality of life), their respective instruments and thresholds. The classification of the biologic switch was divided into three quality levels: "Good", based on treat-to-target thresholds; "Moderate", based on improvement from baseline thresholds; and the remaining as "Insufficient". In the validation phase, an agreement (i.e. clinical judgement versus tools' output) of 75% was obtained for peripheral PsA and 63% for axial PsA. The peripheral PsA tool was found to be more sensitive (92%) with the "Good" quality level and more specific (97%) with the "Insufficient" quality level. Regarding the axial PsA tool, higher sensitivity and specificity was obtained for all quality levels, as well as a higher Cohen's kappa than Peripheral PsA tool (0.94 vs 0.71). Conclusion: The two developed outcomes measurement tools address the quality of treatment decisions regarding biologics' switch in PsA clinical practice. The data in the validation part support the tools' reliability for both peripheral and axial PsA and could complement clinical judgment too. Therefore, these fully developed and validated tools are expected to support rheumatologists in making better and more informed therapeutic decisions. Disclosure of Interest: This publication was deve - loped under the project "Switch to Quality: Psoriatic Arthritis biologic switching consensus" that was sponsored by Novartis and executed with the collaboration of IQVIA. Acknowledgments: To all rheumatologists who collaborated in the clinical judgement. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia as well as abnormalities in body composition are common features in several chronic diseases and have been shown to lead to increased morbidity and mortality. However, their assessment in young patients with axial spondyloarthritis (axSpA) has not been performed thus far. Objectives: To assess the skeletal muscle mass, strength and performance as well as body composition in patients with axSpA compared to healthy controls. Methods: Patients between 18 and 50 years of age with the diagnosis of axSpA and short disease duration (under 10 years) and classified according to the ASAS criteria were included. Healthy individuals matched by gender and age (1:1) were used as control group. Muscle strength (MS) was assessed by resisted flexion of the dominant forearm using a hand dynamometer. Muscle performance was assessed with the 60 second sit-to-stand test (STS60) and with 5 times sit-to-stand test (STS5). Body composition was assessed with octapolar multifrequency bioelectrical impedance analysis (InBody 770). The level of physical activity was measured by the IPAQ questionnaire. BASDAI and BASFI were used to evaluated disease activity and function, res pectively. All measures (except age and disease duration) are reported as median and 25th and 75th percentiles. Non-parametric tests were used to compare groups. Results: A total of 27 patients and 27 controls were included [mean age (36.5 ± SD 1.0), 66% males]. AxSpA patients had symptom duration of 7.0 ± SD 0.9 years, BASDAI 2.7 (1.4-3.6) and BASFI 0.9 (0.3-3.2). Compared to controls, axSpA patients had less MS in the dominant upper limb (DUL) (46.0 (37.5-70.6) vs 71.2 (54.1-83.4) kg, p=0.006) and worse performance on the STS60 test (48.0 (27.5-64.3) vs 63.0 (53.0-68.0) repetitions, p=0.010). These differences were maintained after normalization for lean mass (LM) (MS_DUL/LM_DUL and STS60/Total_LM). In addition, compared to controls, axSpA patients had higher body fat (BF) (19.8 (12.1-29.1) vs 15.7 (10.1-22.2) kg, p=0.041), torso fat (TF) (10.3 (6.3-15.9) vs 8.1 (5.1-11.1) kg, p=0.450) and visceral fat (VF) (87.3 (52.7-145.1) vs 65.4 (41.8-96.4) cm2, p=0.034). No differences were registered for weight, body mass index, total body water, extracellular water, fat free mass, LM and bone mineral content between groups. The level of physical activity, measured by the IPAQ questionnaire, was identical between patients and healthy controls (p=0.500). Conclusion: Compared to healthy controls, young axSpA patients have a reduction in muscle strength and muscle performance with maintenance of muscle mass and levels of physical activity. These preliminary results underline the relevance of further investigations. [ABSTRACT FROM AUTHOR]

Background: Ankylosing Spondylitis (AS) is the prototypic disease of the seronegative spondyloarthritis. Inflammatory back pain is a characteristic symptom, and new bone formation with syndesmophytes and ankylosis is the hallmark of this condition, which. typically affects young people and leads to deterioration of physical function and quality of life. The introduction of biological therapies has changed clinical practice impacted significant improvement in quality of life and prognosis. However, about 40% of patients do not present an adequate response. The identification of biomarkers of treatment response would greatly benefit clinical management by targeting these treatments to those most likely to respond. Methods: Bioefficacy SpA is an investigator-initiated prospective, single-arm, open-label, multicentric trial, involving 7 national Rheumatology departments. Patients older than 18 years, with the diagnosis of Ankylosing Spondylitis (AS) (1984 modified New York Criteria, allowing the diagnosis of sacroiliitis by magnetic resonance imaging (MRI) and active disease despite optimal conventional treatment (Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis - December 2011 update), were included. All patients started a tumor necrosis factor inhibitor (TNFi), adalimumab, and were follow-up for a period of 14 weeks. The primary outcome of this trial was to identify new candidate genes/proteins that are differentially expressed in responders vs non-responders to TNFi, using transcriptomic and proteomic approaches, and explore their ability to predict TNFi response. Key secondary outcomes included: composite indexes for disease activity-Assessment of Spondyloarthritis International Society (ASAS) and Ankylosing Spondylitis Disease Activity Score (ASDAS); Disease function-Bath Disease Ankylosing Spondylitis Functional Index (BASFI) and severity-Bath Ankylosing Metrology Spondylitis Index (BASMI) and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS); general quality of life (QoL) assessment-36-Item Short Form Survey (SF-36) and EuroQoL 5 dimensions Questionnaire (EQ-5D); disease specific QoL assessment-Health Assessment Questionnaire for AS (HAQ-AS) and Ankylosing Spondylitis Quality of Life Questionnaire (ASQOL), psychological impact-Hospital Anxiety and Depression Scale (HADS); MRI changes under TNFi. At week 14, patients were classified as responder vs nonresponder according to ASAS20 achievement. Results/Conclusions: The results from Bioefficacy SpA are expected to have implications in clinical practice, allowing the development of an algorithm to identify the best candidates to TNFi therapy. Bioefficacy SpA will also contribute to understand the impact of TNFi therapy on axial spine and muscle through MRI assessment. This trial was registered in the clinical trials. gov database (https://www.clinicaltrials.gov/NCT02492217). [ABSTRACT FROM AUTHOR]

Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease characterized by a progressive mobility reduction of the rachis. The postural changes may cause balance problems with gait repercussions. However, we lack information during the early years of the disease regarding gait pattern and the possible variables that may influence gait parameters. Objectives: In order to gain insight into the gait patterns in patients at early stages of axSpA and the potential influence of some patient-specific features, the aim of this study was therefore to evaluate: (i) the 3D gait signature in patients at early years of axSpA; and (ii) the relation between gait parameters, and body composition and muscle performance variables. Methods: A cross-sectional study was conducted on 46 participants (18-50 years old), 23 patients with axSpA (according to ASAS criteria, with less than 10 years since symptoms onset) and 23 healthy controls, matched by gender and age, with a mean age of 37±7.5 years, predominantly males (60%). The patients with axSpA had 5±3.2 years of disease duration, with BASDAI and BASFI of 3±2.2 and 2±2.9, respectively. Subjects' movement was reconstructed using a 3D fullbody kinematic model (Kinetikos, Coimbra, Portugal) fed by 15 inertial sensors placed in the head, arms, trunk, pelvis, thighs, shanks and feet. The primary outcomes comprise the general gait parameters such as gait deviation index, speed, cadence, stance duration, body vertical regularity (sample entropy), step length, range of movement and peak velocity of the different joints. Body composition was assessed by performing octapolar multifrequency bioelectrical impedance analysis (BIA; InBody 770). Muscle performance was assessed with a 60 second sit-to-stand test (STS60), while physical activity was controlled by the international physical activity questionnaire (IPAQ). Variables (except age, disease duration, BASDAI, BASFI) are presented as median. Non-parametric tests were used to compare groups. Correlations between gait, body composition and skeletal muscle function parameters, were performed. Results: Gait analysis showed statistically significant differences between axSpA and healthy control groups on gait deviation index (median 83 vs 87%, p=0.022, with higher score values representing similar performance to normal movement), speed (median 0.79 vs 0.85m/s, p=0.015), stance duration at the left side (median 68 vs 67s, p=0.027), left step length (median 0.47 vs 0.49m, p=0.008), and vertical regularity (median 0.39 vs 0.33, p=0.029, with higher values representing a less regular and predictable movement pattern). At the sagittal plane, patients showed higher values of left arm maximum flexion (median 14 vs 10°, p=0.011), lower lumbar extension peak velocity (median 45 vs 60°/s, p=0.016) and higher ankle angular peak velocity on right side (median 330 vs 299°/s, p=0.020). However, no statistically significant differences between groups were found for physical activity. In addition, no statistically significant correlation was found between the gait parameters and weight, body fat, torso fat, visceral fat, body mass index, total body water, extracellular water, fat free mass, lean mass, bone mineral content and STS60. Conclusion: These results provide evidence that although young axSpA patients at early years of the disease display a particular gait pattern and this behavior does not seem to be influenced by the body composition and muscle performance. The main determinant for this gait pattern remains an open question. [ABSTRACT FROM AUTHOR]

Background: Inflammatory rheumatic diseases (IRDs) are thought to be multifactorial diseases. Female-male ratio in IRDs differs according to the disease. In Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE) female prevalence is higher opposing to Ankylosing Spondylitis (AS). Until recently, differences on gender-bias observed in predisposition to IRDs, and to their pathophysiologies have been understudied and neglected. Recent research using omics approaches shows that genderbias is outspread in a diversity of pathologies. The integration of omics results, spite the extremely complex crosstalk among the several biomolecules involved, places these methods at the lead of medical research, overcoming limitations and increasing the forecasts of targeted methodologies. Objectives: The purpose of this systematic review is to aggregate existing omics results on biomarkers for RA, SLE and AS to raise awareness about whether gender can actually play a role on their profiles. Methods: Two searches were conducted on PUBMED database (22nd November 2018) with a final output of 81268 articles. Both searches were sorted by best matches and for the second thousandth articles ranked no relevance was found for the aim of this review. The first 1000 articles were further analyzed based on the title, abstract and content. Three articles having relevant results were selected from the first thousand publications. Ten more were identified from the cross-references of both searches. The PICO (P, population; I, intervention; C, comparison; O, outcome) concept was used to perform the analysis according to: Patients: adults (>18 years old) with RA, SLE or AS (SpA); Intervention: any - omic study; Comparison: gender information regarding results; Outcomes: identified genes, proteins or metabolites. Results: Dectin-2, MCP-1 and DC-SIGN polymorphisms where proposed as possible accounts for gender associated differences in susceptibility to RA. Sexdifferentiated and sex-interaction analyses of a GWA study revealed strong evidence of association in both sexes, highlighting links with RA only in one of the genders. Several transcriptomic studies pointed to gender differences on biomarkers profiles for the three diseases. For instance, different expression levels of TNFα, IL-6, IL-17, IL-18, IFNα as well as X or Y chromosome-linked genes were found in SLE and/or AS. In AS, male patients with syndesmophytes showed higher levels of TNFα and men without syndesmophytes presented higher levels of VEGF, IL-6, TNFα and IL-18 both compared to females-matched. In RA patients, microRNAs 222, 532, 98, and 92a were found significantly down regulated in PBMC of female versus male13. Six genes displayed a gender-biased expression among male and female SLE patients. Conclusion: Blood biomarkers signatures for the IRDs analyzed in this study have been shown gender-biased. These will contribute for a better understanding of these diseases pathophysiology and probably to different gender approaches regarding diagnosis, monitoring and therapeutic approach. [ABSTRACT FROM AUTHOR]