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Background and objectives Influenza vaccine is recommended for patients with autoimmune inflammatory rheumatic diseases who receive biological therapy. To evaluate if biological therapy impairs immunization after seasonal influenza vaccine. Material and methods Patients with inflammatory arthopathies, psoriasis, inflammatory bowel disease or connective tissue diseases who were receiving or were going to initiate biological therapy were included and vaccinated during 2014–2015 influenza season. ELISA was used to measure influenza antigen A and B antibodies, before and after vaccination. Demographic parameters, diagnosis and kind of treatment were recorded and their influence on the final serological status against influenza was studied. Results 253 subjects were analyzed. After vaccination, 77% of participants presented detectable antibodies against antigen A and 50.6% of them had detectable antibodies against antigen B. Final seropositivity rate against antigen B antibodies increased from baseline (50.6% vs 43.5%, p

Patients with different autoimmune inflammatory diseases (AIID) on biological therapy are at risk of pneumococcal disease. Adults with inflammatory arthropathies, connective tissue diseases, psoriasis, or inflammatory bowel disease on biological therapy such as anti-TNFα, rituximab, tocilizumab, abatacept, or anakinra were included in this study. Patients completed a protocol combining the pneumococcal vaccines PCV13 and PPV23. Immune response against pneumococcal serotypes 1, 3, 7F, 14, 19A, and 19F were assessed evaluating functional antibodies by an opsonophagocytosis killing assay (OPKA). In this study, 182 patients with AIID completed the sequential vaccination protocol. Patients on etanercept tended to achieve OPKA titers against a larger number of serotypes than the rest of patients on other biological therapies, while adalimumab was associated to a lower number of serotypes with OPKA titers. Rituximab was not associated with a worse response when compared with the rest of biological agents. Not glucocorticoids, nor synthetic disease-modifying antirheumatic drugs, interfered with the immune response. OPKA titers against serotype 3 which is one of the most prevalent, was obtained in 44% of patients, increasing up to 58% in those on etanercept. Hence, almost 50% of patients on biological therapy achieved functional antibodies after the administration of a complete pneumococcal vaccination protocol. Ministerio de Economía, Industria y Competitividad, Gobierno de España (SAF2017-83388) Sociedad de Reumatología de la Comunidad de Madrid (SORCOM)/ MSD (204151) Pfizer (14151) 4.961 JCR (2021) Q2, 77/161 Immunology 1.004 SJR (2021) Q1, 26/153 Drug Discovery No data IDR 2021 UEM

To evaluate the response to hepatitis B virus (HBV) vaccine in patients on biological therapy. Adults with autoimmune inflammatory diseases on biological therapy such as anti-TNFα, rituximab, tocilizumab, abatacept, or anakinra were included. Hepatitis B surface antibody (anti-HBs) was measured by ELISA before and after vaccination. Seroconversion was considered when an anti-HBs titer 10 mIU/mL was achieved. The effect of treatment on the immunoprotective state was studied. The response was compared with that obtained in patients on synthetic disease modifying anti-rheumatic drugs (DMARDs) and healthy controls. A total of 187 patients on biologicals, 48 on synthetic DMARDs, and 49 on healthy controls were analyzed. More than 80% of patients on biologics responded to the vaccine but required more boosters and second vaccine series. Patients who achieved seroconversion were younger than those who did not (47.10 ± 12.99 vs. 53.18 ± 10.54 years, p = 0.012). Being on etanercept or golimumab was associated with seroconversion, while being on rituximab was not. Seroconversion was achieved in 93.75% of patients on synthetic DMARDs and 97.96% of healthy controls. The seroconversion rate in the biologics group was lower than in the synthetic DMARD group (p = 0.043) and tended to be lower than in the healthy group (p = 0.056). In patients on biological therapy, a high rate of HBV vaccine response can be achieved when a complete vaccination schedule is administered. Vaccination while not on biological agents reduces the requirement for boosters and revaccination. Key points: • Patients on biological therapy can achieve high rates of immune response to HBV vaccine when complete vaccination schedules are administered. • However, to achieve such a high seroconversion rate, more boosters and second vaccination series are required. • This supports the proposal already made to provide HBV vaccination to all patients with an autoimmune inflammatory disease after the diagnosis is made and not when the use of a biological treatment is under consideration.

The National Commission of Rheumatology has developed a satisfaction survey for residents concerning their training period. 37% of the 176 invited to participate answered the survey. 71% said they were satisfied or very satisfied with the influence of the assistance activities during their training. 38% were dissatisfied or very dissatisfied with supervision by staff. 39% were dissatisfied or very dissatisfied with their training in polarized light microscopy. 52% said no regular meetings were structured to monitor their training. 66% said that there had been no effective evaluation of their training. 39% were dissatisfied or very dissatisfied on the tools they were given to publish at their teaching unit. Overall satisfaction on classroom training for residents of Rheumatology is high. There are opportunities for improvement relating to training in certain techniques, monitoring and evaluation of the training period and training in research skills.

Resumen La Comision Nacional de Reumatologia ha elaborado una encuesta sobre la satisfaccion de los residentes respecto a su periodo formativo. Contestaron un 37% de los 176 invitados a participar. Un 71% manifesto que estaba satisfecho o muy satisfecho de la influencia de la actividad asistencial en su formacion. El 38% estaba insatisfecho o muy insatisfecho de la supervision por parte de la plantilla. El 39% estaba insatisfecho o muy insatisfecho del adiestramiento en microscopia de luz polarizada. El 52% contesto que no existian reuniones periodicas estructuradas de monitorizacion de su formacion. El 66% declaro que no habia existido ningun tipo de evaluacion efectiva de su formacion. El 39% se mostro insatisfecho o muy insatisfecho respecto a las facilidades para publicar que le brindo su unidad docente. La satisfaccion global sobre la formacion asistencial de los residentes de reumatologia es elevada. Existen oportunidades de mejora referentes al entrenamiento en determinadas tecnicas, la monitorizacion y evaluacion del periodo formativo y la formacion en habilidades de investigacion.

Antineutrophil cytoplasmic antibodies (ANCA) are autoantibodies, usually IgG, directed against azurophilic granules in neutrophils and lysosomes in monocyte components. ANCA are found in patients with small-vessel vasculitides but their true role in the pathogenic cascade remains unclear and these autoantibodies are not always related to disease activity. Several studies demonstrate the existence of ANCA in other diseases, such as infections or neoplasia, and in up to 2% of healthy individuals. In these situations, ANCA could be considered as an inflammation epiphenomenon. ANCA are usually detected by indirect immunofluorescence (IIF) on smears of ethanol-fixed human neutrophils that define patterns such as peripheral (P-ANCA), cytoplasmic (C-ANCA) or atypical (A-ANCA). The antigen is subsequently identified by means of enzyme-linked immunosorbent assay (ELISA). The sensitivity and specificity of both techniques depend heavily on the extent of the vasculitides, clinical activity when the test is performed, and the methodology used in IFI or ELISA. The utility of ANCA in the classification, diagnosis and monitoring of disease is controversial. ANCA determination is recommended at regular intervals during follow-up because an increase in these autoantibodies detected by IFI and ELISA anticipates disease reactivation in 58% and 75% of patients, respectively.

Hypocalcemia is a common finding in medical practice. The clinical manifestations include a wide spectrum, ranging from an accidental finding to an emergency situation requiring immediate therapeutic measures. Consequently, correct differential diagnosis is essential. In some cases the etiology is obvious, but in a few patients exhaustive investigations may be needed to determinate the origin of the hypocalcemia. The main factors that can influence serum calcium are serum phosphorus concentration, serum parathyroid hormone (PTH) and vitamin D metabolite concentrations. The main causes of adult hypocalcemia, grouped by the physiopathological mechanism, are hypoalbuminemia, loss of calcium from the circulation, and inadequate entry of calcium into the circulation from the intestines or bone.

The National Rheumatology Board is responsible for postgraduate formation in rheumatology. Herein we present the new criteria for accreditation of teaching units. These criterion contemplate four domains, namely: structure, clinical work, teaching and research. Each domain is divided in subdomains and items. Some of them are of an obligatory nature. This document serves as reference for future applications. The document may be reviewed in the future.