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We evaluated the prevalence of 25-hydroxyvitamin D (25-(OH)D) deficiency in our setting according to season, sex, and age. We also studied the association with parathyroid hormone (PTH) levels.

Rationale and Objectives: The goal of achieving clinical remission in patients with spondyloarthritis does not necessarily include the resolution of entheseal inflammation from a histological perspective. However, enthesis not clinically inflamed, under mechanical stress, may behave differently from healthy subjects considering the physiopathology of SpA. Our goal was to determine whether ultrasound changes in entheses differ between SpA patients in clinical remission and healthy subjects., Methods: SpA patients in clinical remission and matched healthy controls were recruited. At baseline, the following variables were measured on the dominant side by ultrasound: thickness of the distal patellar enthesis (hDP), the deep infrapatellar bursa (hDIB), the Achilles enthesis (hA), the preachilleal bursa (hPAB), effusion in the preachileal bursa (hePAB), and the presence of power Doppler signal in both enthesis. All measurements except hDP and hA were collected again after exercise (post-stress ultrasound)., Results: 30 patients and 30 controls were enrolled. In all subjects, hDIB, hPAB, and the preachileal bursa occupancy index increased significantly after the exercise. The increase was significantly greater in patients for all variables. At baseline, in patients, hyperemia was detected in one patellar tendon (3.3%) and in two Achilles tendons (6.7%). After exercise, the number of tendons with hyperemia increased to 11/30 (36.7%) and 12/30 (40%), respectively. Among controls, there was no detectable basal hyperemia, but after exercise, it was detected in 1/30 patellar tendons (3.3%) and 2/30 Achilles tendons (6.7%)., Conclusion: Exercise triggers a greater effusive and hyperemic synovial response in patients in remission than in healthy controls. These findings suggest that the definition of remission should also include an assessment of the synovial response to mechanical stress., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the effect of subclinical synovitis on the progression of joint disease in a cohort of patients with systemic lupus erythematosus over a mean follow-up of 10 years., Methods: A longitudinal follow-up of 96 patients diagnosed with lupus was performed. All patients were considered clinically free of joint disease or with minimal joint impairment at baseline and were studied through ultrasound study of their dominant hand to assess the prevalence of subclinical synovitis. Now, over 10 years after we contacted them and reviewed their evolution to determine the impact of had or had not been diagnosed with subclinical synovitis in their current joint condition., Results: Thirty-one of the 91 reached patients developed clinical progression in their joint manifestations (at least one ordinal degree of worsening). Of these, 23 (74,9%) had demonstrated subclinical synovitis at baseline. In the group of patients who did not progress clinically, 46 (76,6%) did not have this finding at the start of follow-up ( p < .01, OR 9,44 95%CI 3,46-25,74). The patients in whom clinical progression was demonstrated had worse combined ultrasound scores than the rest of the patients: 6,41 SD 1,45 vs. 1,15 SD 0,97 ( p < .01)., Conclusions: The finding of subclinical synovitis in patients with systemic lupus erythematosus is associated with the development of joint disease progression both clinically and ultrasonographically., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Objective: Trigger finger is a frequent complaint in which corticosteroid infiltrations play a relevant therapeutic role in intermediate degrees of severity when conservative treatment has not worked. However, there are no criteria to select which patients will benefit most from this procedure. The present study aimed to identify the factors leading to the therapeutic success of corticosteroid infiltration in these patients., Materials and Methods: We designed a prospective longitudinal study based on routine clinical practice with adult patients with a clinical diagnosis of trigger finger grade II or III on the Quinnell scale, who underwent an infiltration of 20 mg of triamcinolone acetate. The outcome variables were to achieve a Quinnell grade I or reduce the severity of the symptoms by at least one category two months after the procedure. To identify the determinants of complete or partial therapeutic success, binary logistic regression predictive modelling was performed using those variables that had a satisfactory univariate correlation., Results: 74 patients were included over three years, 42 of whom (61.8%) were classified as Quinnell grade III. After infiltration, 22 (32.4%) achieved complete resolution and 50 (73.5%) partial resolution. The variables tendon thickening (HR 10.72; 95%CI 2.88-39.93; P < .001) and progression time (HR 1.23; 95%CI 1.02-1.49; P = .027) proved to be predictors of therapeutic success in complete resolution. For the modelling for partial resolution, the same variables proved to be determining predictors (HR 5.57; 95%CI 1.38-22.41; P = .016 and HR 1.18; 95%CI .99-1.41; P = .051, respectively). Pulley thickening did not demonstrate predictive ability in either model., Discussion and Conclusions: Our results indicate that the demonstration of finger flexor apparatus thickening is the main determining factor for the success of corticosteroid infiltrations in this pathology. This is in agreement with the histological findings of specimens obtained from both tenosynovial and pulley tissue. In the former, in addition to an infiltrate of inflammatory characteristics, the presence of chondrocytoid cells producing hyaluronic acid is demonstrated. Although the therapeutic success of infiltrations in previous studies reaches 70%, the recurrence rate is similar after 12 months. The selection of patients with tendon thickening ensures therapeutic success in the short term, could reduce recurrence in the long term, and avoid delay in release surgery., (Copyright © 2021 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objective: The physiological response of the synovium to acute mechanical stress has not been extensively studied. This response is interesting in terms of the morphological changes it can cause as any such changes should be taken into account during ultrasound examinations. The purpose of this study was to assess the extent of changes in ultrasound images of the synovial joint in the hands of healthy individuals after controlled mechanical stress., Method: We included 110 healthy volunteers on whom we carried out two ultrasound examinations of the non-dominant hand: one at baseline and the other after controlled handgrip exercise at 70% of the maximum voluntary contraction., Results: The synovitis scores at baseline and after exercise were 0.472±0.798 and 0.772±1.162 t(109)=-3.791, respectively; p < 0.001. We observed no tenosynovitis in 88.2% of the participants at baseline, while after exercise the percentage fell to 70.9%; x2 (1, N=110) =10.0851, p = 0.0014., Conclusion: We conclude that synovitis and tenosynovitis are inducible by physical exercise and are detectable on ultrasound. This should be taken into account during ultrasound examinations for suspicion or follow-up of inflammatory rheumatism.

Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disorder that causes chronic pain, primarily in the spine and sacroiliac joints. It is characterized by the presence of type 1 major histocompatibility complex HLA-B27 genetic marker, arthritis in peripheral joints, enthesitis and/or dactylitis and extra-articular manifestations. Current guidelines recommend biological therapy when first-line therapy is not sufficiently effective. The finding that the interleukin (IL)-17 axis is vital for the pathogenesis of axSpA propelled the development of secukinumab, a fully human monoclonal antibody directed against IL-17A. The present review provides evidence on the efficacy and safety of secukinumab in the treatment of radiographic and non-radiographic axSpA from nine randomized controlled phase III trials, as well as evidence from real-world observational analyses. The primary endpoint in six clinical trials was the proportion of patients meeting the Assessment of SpondyloArthritis international Society criteria for either 20% or 40% improvement (ASAS20, ASAS40) at week 16. Significantly more patients achieved the primary endpoint with secukinumab compared with placebo in all the studies except MEASURE 4. Both clinical trials and real-world studies showed significant improvements in the secondary endpoints of disease activity, quality of life, and pain and fatigue relative to placebo. The benefits of secukinumab were generally sustained during longer-term (up to 5 years) treatment. Overall, secukinumab was well tolerated with a low frequency of adverse events and treatment persistence was high in the real-world setting. Although indirect comparisons suggest that secukinumab and adalimumab have comparable efficacy and safety, they are being directly compared in the ongoing SURPASS study. During the current coronavirus disease 2019 (COVID-19) pandemic, it is advisable to continue biological therapy in patients who do not have severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, but interrupt treatment during an infection, reinitiating once the patient has recovered from the infection. In conclusion, secukinumab is a largely safe and effective treatment for radiographic and non-radiographic axSpA., (© 2021. The Author(s).)

Competing Interests: The authors declare no conflict of interest.

Objective: The health crisis caused by COVID-19 has had an economic impact at all levels and the labor market has been shaken by the pandemic. Companies have had to adapt to new work models and have had to decide between face-to-face, teleworking, or mixed models without conclusive scientific evidence on the impact on transmission. To determine the change in the risk of SARS-CoV-2 infection and the development of disease associated with the performance of blended work with respect to remote work and the general population in a non-healthcare company while respecting the measures of social distancing, use of masks and hand hygiene., Methods: Observational ecological study followed by a retrospective cohort study. Data were collected on the total daily cases and incidence of COVID-19 between September 1, 2020 and April 30, 2021 from the population of a non-healthcare company and the reference population of the Community of Madrid. Analysis was also performed in two 30-day periods on the same population differentiated by the existence of fully remote or blended work. The statistical analysis was performed by determining the Chi 2 distribution (χ 2 ) and calculating the Odds Ratio (OR)., Results: The average number of employees during the study period was 642 (30.55% women). The reference population was 6,745,591 people (52.16% women). The number of people aged between 20 and 69 years was 4,520,116 (51.67% women). The incidence in the period (Ip) in the study population was 9.5%. The Ip in the Community of Madrid was 7.81%. No statistical differences were found OR 1.23 (95% CI 0.95-1.61) χ 2 =2.55 p-value 0.11. Ip in the population of the Community between 20 and 69 years was 8.84% OR 1.08 (95% CI 0.83-1.41) χ 2 =0.35 p-value 0.556. In the comparison performed in the study population, no statistically significant differences were found between both periods OR 0.59 (IC95% 0.26-1.37) χ 2 =1.53 p-value 0.216., Conclusions: Based on the data analyzed, we found no statistically significant evidence to show that performing semi-distance work with security measures in a non-healthcare company increases the risk of SARS-CoV-2 infection and the development of disease., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

To assess whether smoking and obesity are predictors of poor treatment response in patients with axial spondyloarthritis (axSpA). A systematic literature review was performed by searching in MEDLINE and EMBASE up to June 2019 with a strategy based on the PICO approach: Population: patients with axSpA; Intervention or exposure: smoking or obesity; Comparison: non-smokers (for smoking) and normal-weight individuals (for obesity); and Outcome: any response criteria currently validated for axSpA. The 2009 Oxford Centre for Evidence-based Medicine levels were used for assessing the studies quality. Out of 1873 references retrieved, 46 studies were selected for full-text review and 12 for data extraction: six stratified patients by smoking and six by obesity. All were longitudinal observational studies, except one, which was cross-sectional. Overall, these studies included 5291 patients (3917 for smoking and 1333 for obesity), and all these patients were on anti-tumor necrosis factor (anti-TNF) therapy. The quality of evidence was graded as level 2b except that from the cross-sectional study which was graded level 4. For smoking, the evidence found is inconsistent: two studies finding negative effects in response to anti-TNF while the other four found no differences in clinical response to this therapy. Regarding obesity, the evidence is more consistent: five of the six studies describing a negative influence in response to anti-TNF. According to the scientific evidence in patients with axSpA, obesity is associated with a more unsatisfactory response to anti-TNF therapy. A poorer response in smokers has yet to be demonstrated. Key Points • Identifying predictors of treatment response in axSpA, especially those that are modifiable, is relevant. • Obesity increases the risk of poorer response to anti-TNF agents in patients with axSpA. • Scientific evidence for smoking habit as a predictor of treatment response in axSpA is inconclusive.

Objectives: To determine the prevalence of subclinical synovitis in Lupus patients without peripheral joint symptoms, in those with arthralgias without arthritis and those with episodic arthritis but without radiological structural damage., Methods: We conducted a multicentre cross-sectional study. Patients with lupus from those three categories were recruited to take part in a greyscale ultrasound scan performed by an expert blinded rheumatologist. Data from a historical control group from a previous study was also included for comparisons. Images were assessed separately in order to determine the presence and level of synovitis following Eular recommendations., Results: Ninety-six patients (88.5% female) with an average age of 40 ± 6.2 years old, were included. SLICC/ACR score was 0.6 ± 0.3 in the group without joint symptoms (group 0), 0.8 ± 0.3 in the group with arthralgias (group I) and 1.1 ± 0.4 in the group with episodic arthritis. The global prevalence of subclinical synovitis was 38.5%. In group 0, that prevalence was 30%. The time since onset of symptoms of patients with subclinical synovitis was longer than the rest of the patients (9.4 ± 2.2 vs 6.5 ± 4.0 years, P  < 0.001). No other remarkable association was founded with clinical features of the disease., Conclusions: This is the first study focused on subclinical synovitis in patients with lupus. Other previous studies had included patients with different levels of arthropathy. Subclinical synovitis does exist in lupus patients in over a third of patients. Its meaning remains unclear and must be a topic of further studies.

Nontraumatic musculoskeletal disorders are the main reason for presentation to the emergency department (ED), with rachialgia (back pain) being the most common reason to request medical assessment among them. This also generates the highest demand for reassessments due to poor pain control or onset of adverse reactions to the treatment prescribed in the initial assessment.A retrospective observational study based on usual clinical practice was conducted in patients attending the ED due to low back pain during a period of 24 months. The primary objective was to determine the demand for reassessments in the ED by these patients in the following 30 days, according to the type of therapeutic approach used in the initial assessment.A total of 732 patients who requested medical assessment due to back pain in the ED of our hospital were analyzed, 91 of whom were treated with tapentadol whereas 641 received another treatment. In the first month after the initial assessment, reassessments were less common in the tapentadol group; this difference was significant from days 8 to 15 (P = 0.001, odds ratio [OR] 0.252 with 95% confidence interval [CI] 0.100-0.635) and days 15 to 30 (P < 10, OR 0.277 with 95% CI 0.136-0.563). Patients who received tapentadol also had a better clinical evolution of pain compared to those who did not receive it (P < 10) and to those who received tramadol (P < 10).In this study in patients with back pain, tapentadol shows clear advantages over the other analgesics analyzed, in terms of pain control and less need for reassessments.

Background: In October 2013, the emergency department of our hospital started up a rheumatology and musculoskeletal emergencies clinic (RMSEC) with the participation of three specialists in Rheumatology. The purpose of this study was to describe the experience gained in the first year since the beginning of our activity., Method: A descriptive study of healthcare activity of the RMSEC throughout its first year of operation was performed., Results: 1788 assessments on 1663 patients were performed. The range of age was 7 to 67 years. 1530 (85.57%) assessments were performed in patients of the healthcare area of our hospital. Of all the assessments made, 633 (35.4%) were related to inflammatory processes and the remaining 1155 (64.6%) to mechanical or degenerative joint or soft tissue processes. According to the topography of the complaint, 435 (24.3%) patients consulted for a process related to the knee, 362 (20.3%) with axial lumbar region and 336 (18.8%) with the shoulder., Conclusion: Our results denote an intense clinical activity that could have a positive impact on the management of rheumatic and musculoskeletal general emergency., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objectives: To compare the results of emergency department management of spinal pain from vertebral fractures (in terms of revisits, adverse effects at 90 days, or need for hospitalization because of poor pain control at 6 months) in patients treated with transdermal buprenorphine or another analgesic., Material and Methods: Retrospective observational study of cohorts in an emergency department database compiled prospectively over a period of 18 months. We included all patients over the age of 60 with a radiologic diagnosis of vertebral fracture or compression causing pain for more than 3 months. Records were stratified according to the World Health Organization (WHO) analgesic scale, which was used when the patients were treated. Variables related to effectiveness were revisits at 1 month, time between visits in days, and the need for hospitalization., Results: A total of 180 patients were included; 39 were treated with drugs on the first step of the WHO's analgesic ladder, 74 with second-step drugs (mainly tramadol), and 67 with transdermal buprenorphine, a third-step drug. Half the patients treated with buprenorphine had revisited at 50 days or later (interquartile range [IQR, 41-60 days); half those treated with first-step analgesics had revisited by 19 days IQR, 10-37 days), and half those on second-step drugs had revisited by 28 days (IQR, 21-53 days) (P<.001). After adjustment for other variables, patients treated with first-step drugs revisited 4.19-fold more (95% CI, 2.57-6.80; P<.001) and those treated with second-step drugs revisited 1.91-fold more (95% CI, 1.22-2.99; P=.005) more than patients treated with transdermal buprenorphine., Conclusion: Transdermal buprenorphine used to manage spinal pain seems to significantly reduce the need for revisits in comparison with treatments with first- or second-step analgesics.

Objectives: To describe an experience with the evaluation of resident physicians doing rotations in a tertiary-care hospital emergency department and to analyze the correlation between results on the various assessment tools and the resident's rank on Spain's standardized selection examination for admission to residency programs., Material and Methods: The residents took 2 written examinations in 2013 and 2014, and rotation supervisors wrote subjective evaluations of the residents' clinical performance in the workplace. The residents also provided self-assessments of theoretical and practical knowledge and their aptitude for emergency department work. The results on these assessment tools were tabulated independently, and it was investigated if there were correlations between them., Results: We observed an inverse correlation between the residents' rank on the standardized selection examination and their scores on the written examinations of knowledge and the supervisors' workplace assessments. The written examination scores after the rotation correlated positively with workplace assessments. Self-assessments were distributed normally, suggesting they were of scarce value, and they did not correlate with the results of the other assessment tools., Conclusion: Written examinations are acceptably correlated with subjective workplace assessments of practical competencies, whereas ranking on the residency program admissions examination is not acceptably correlated with emergency department workplace performance. We believe that efforts to prepare ways to evaluate residents' emergency department performance will be of interest in the future, once a specialization in emergency medicine is approved.

Objectives: To analyze the benefits of using a cooperative learning (CL) model to teach hospital residents doing rotations in the emergency department and to compare the CL approach to traditional training., Material and Methods: Two training sessions on the same content were given by 2 expert instructors. A traditional method of instruction was used in one of the sessions and the CL model was used in the other. Immediately after the sessions and 3 months later, the residents took a multiple-choice test that was developed by a third expert. A control group of residents who had not attended either session also took the test., Results: Twenty-one residents were in the CL group and 17 were in the traditional-training group. The mean (SD) scores on the examinations immediately after training were 8.81 (1.40) and 7.88 (1.26), in the CL and traditional groups, respectively (P=.0414). Three months later, the mean scores of these same residents retaking the examination and 32 control residents were as follows: CL group, 8.19 (1.12); traditional group, 7.00 (1.22); and control group, 6.37 (1.37) (P<.05, CL vs traditional; P>.05, traditional vs control)., Conclusion: The CL approach proved superior to traditional training in terms of short- and medium-term retention of information. Although this is the first analysis of CL in this type of specialized medical training, extending its use in preparing medical residents working in emergency departments would seem to be justified.

We present the fatal outcome in a 31-year-old woman of Latin-American origin diagnosed with dermatomyositis. There were three months between death and the onset of symptoms. The initial presentation was normal dermatological symptoms to which were shortly added clinical signs of effects on the lungs, as was shown radiologically and through pulmonary function tests which were subsequently identified histologically as Hamman-Rich syndrome. The patient was treated with high doses of corticosteroids, intravenous (IV) immunoglobulin, cyclophosphamide and cyclosporin. We carried out a review of the literature on pulmonary compromise in dermatomyositis, clinical and anatomopathological forms and treatment alternatives.

Arthritis associated with Behçet's disease is typically nonerosive and nondeforming, and most patients respond to colchicine treatment. However, destructive arthritis and refractory arthritis have also been reported on occasion. Elevated white blood cell counts may occur in synovial fluid in BD, but pseudoseptic arthritis is a very rare event in this disease. We report a patient with BD and rapidly progressive deforming pseudoseptic arthritis refractory to colchicine, corticosteroids, and methotrexate, who entered remission after infliximab treatment.

Objective: To compare the proportion of synovitis detected by ultrasonographic study (USS) of the hands, in subjects with no rheumatologic known disease according to self-reported level of overexertion performed the day before., Methods: 407 consecutive volunteers were enrolled in a twelve-month period and underwent an ultrasound assessment of the hand. All studies were performed on Monday or Friday. Subjects were grouped according to their self-reported overexertion carried out the day before. Presence or absence of ultrasonographic findings compatible with synovitis was compared between groups., Results: 95.8% of those tested on Friday had made no overexertion the day before the study, while 30.2% of those assessed on Monday declared to have carried out an overexertion. Presence of carpal synovial hypertrophy, synovial fluid/effusion, and power-Doppler signal was statistically higher in subjects who carried out an overexertion the day before the study than the rest of subjects when the dominant hand was assessed. Globally, presence of any synovitis ultrasonographic finding was statistically higher in subjects who were studied on Monday than Friday (34.9% versus 12.1%) and in subjects who self-reported an overexertion the day before compared to the rest of subjects (47.7 versus 11.5%)., Conclusions: In general, we recommend performing the USS as many days as possible after the most recent overexertion.