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Objectives The aim of this study was to evaluate the performance of a comprehensive diagnosis program called "Reuma-check" for the diagnosis of axial spondyloarthritis (SpA) in patients with low back pain (LBP). Methods This is a cross-sectional study. Patients with LBP aged 18 years or older were preselected, and those with at least 1 SpA feature completed the circuit. They were referred after 2 strategies: education for orthopedists and a campaign on social networks. All patients underwent a clinical evaluation, laboratory testing, and imaging (including human leukocyte antigen B27 evaluation and magnetic resonance imaging). The diagnosis of axial SpA was established by an expert rheumatologist opinion. Time from onset of symptoms to "Reuma-check," time from patient referral to admission of the checkup, and time from "Reuma-check" to diagnosis were evaluated. Results A total of 175 of 246 patients were included, most of them came from the social media campaign (55%). Seventy-five (43%) of 175 patients were diagnosed as axial SpA. The median time from referral (or self-referral) to access to the program was 1.3 months. The median time from symptoms onset to access to the program was 31.7 months, and the median time from the performance of "Reuma-check" to final diagnosis was 2 weeks. Features associated with a diagnosis of axial SpA were as follows: inflammatory LBP (odds ratio [OR], 6.64; 95% confidence interval [CI], 1.6-28), clinical enthesopathy (OR, 4.56; 95% CI, 1.1-18.4), positive human leukocyte antigen B27 (OR, 23.02; 95% CI, 3.5-58), and positive magnetic resonance imaging (OR, 14.34; 95% CI, 3.5-58). Conclusions "Reuma-check" allowed a high frequency of axial SpA diagnosis and improved access to rapid diagnosis, shortening the time from referral to diagnosis with a shorter acquisition time for the ancillary studies. Patients with a final diagnosis of axial SpA presented distinctive features.

To evaluate the performance of the European League Against Rheumatism (EULAR) definition of arthralgias suspicious for progression to RA in patients with hand arthralgias and to estimate the added value of both auto-antibodies and ultrasound (US) with power Doppler (PD).Consecutive patients admitted for hand arthralgias to "Reuma-check" ® program were included. This program includes the following at baseline: clinical assessment, laboratory tests, US with PD of both hands, and radiography of both hands and feet. All patients were followed-up after baseline evaluation by their treating rheumatologists, and a definitive diagnosis of RA (ACR/EULAR 2010 criteria) was established or not.A total of 465 consecutive patients were included. During follow-up, 44 (9.4%) were diagnosed with RA. Mean of baseline EULAR features describing arthralgia suspicious for progression to RA was 4.1 in patients with final diagnosis of RA vs 2.3 in non-RA patients (p 0.0001). The AUC for the EULAR defined features describing arthralgia suspicious for progression to RA for the final diagnosis of RA was 0.7827, while adding US with PD, rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibodies (ACPA) data, the AUC was 0.9172 (p 0.0001). In the multivariate regression logistic analysis, baseline features associated with a final diagnosis of RA were difficulty with making a fist, RF, ACPA, and US with PD.EULAR definition of arthralgia suspicious for progression to RA had an acceptable performance to predict the future development of RA and improves adding information of both RF, ACPA and US with PD data.Key Points• Clinically suspect arthralgia may trigger rheumatologists to monitor patients closely for an early diagnosis.• EULAR definition of arthralgia suspicious for progression to RA predicts future development of arthritis.• Auto-antibodies and ultrasound improve EULAR definition of arthralgia suspicious for progression to RA.

BACKGROUND The prevalence of human leukocyte antigen B27 (HLA-B27) is variable around the world. Our objectives were to estimate the frequency of HLA-B27 in an Argentinian cohort of axial spondyloarthritis (axSpA), to evaluate the differences between HLA-B27-positive and HLA-B27-negative patients, and to analyze its performance as a diagnostic biomarker. METHODS Observational study including patients older than 18 years, with axSpA diagnosis assessed in a fast track program (Reuma-Check SpA). All patients underwent the following: blood tests, HLA-B27, sacroiliac images, and enthesitis ultrasound. Sociodemographic data and SpA symptoms were also collected. The clinical assessor was blinded to complementary studies. For the sensitivity and specificity analysis, patients with chronic low back pain without axSpA who performed the same circuit in the same period were used as control, paired 1:1 (sex and age). RESULTS One hundred fifty patients were included, 75 axSpA and 75 controls. The frequency of HLA-B27 was 43% (95% confidence interval [CI], 30-53). The differences between HLA-B27-positive and HLA-B27-negative patients were observed in age of low back pain onset (36 vs 46 years), BASFI (Bath Ankylosing Spondylitis Functional Index) (4 vs 5), and extra-articular SpA features such as uveitis and inflammatory bowel disease (29% vs 50%). When this frequency was compared (low back pain control group), the difference was 43% versus 9% (odds ratio, 7.7; 95% CI, 2.8-24), and HLA-B27 had a sensitivity of 43%, specificity of 91%, positive predictive value of 85%, negative predictive value of 58%, and likelihood ratio of 4.9 (95% CI, 3-8). CONCLUSIONS The frequency of HLA-B27 in axSpA was 43%; positive patients had an earlier age of onset (36), a higher BASFI, and more SpA features. For the diagnosis of SpA, HLA-B27 had a good specificity but low sensitivity.

Introducción: Los datos reportados sobre el compromiso axial de la Artritis psoriásica (APs) son variables (25 al 70%), esta frecuencia esta vinculada a las diferentes formas de definirla. Objetivos: Estimar la prevalencia de compromiso axial en un grupo de pacientes diagnosticados de APs en el circuito Reuma-Check, realizar una caracterización clínica, laboratorio e imágenes y analizar las diferencias entre los pacientes que la presentan. Métodos: Pacientes que fueron admitidos al programa Reuma-Check con síntomas músculo esqueléticos: artralgias/artritis, dactilitis o entesitis asociado a psoriasis o antecedentes familiares. Una vez diagnosticados se interrogaba sobre la presencia de síntomas axiales: lumbalgia de más de 3 meses asociado al menos a uno de los siguientes: BASDAI >4, maniobras sacroiliacas y características inflamatorias. Se realizaba un segundo Reuma-Check para el estudio completo del compromiso axial (imágenes, HLA B27, BASFI). Resultados: De 139 pacientes 73 (52%) fueron finalmente diagnosticados de APs, 33% presentaban compromiso axial clínico. Se observo (con respecto a los que no tenían compromiso axial) mayor presencia de manifestaciones no musculo esqueléticas como uveítis e enfermedad inflamatoria intestinal, 42 vs 12 % (p: 0,004), mayor numero de entesitis 0,5 vs 0 (p: 0,04), y un compromiso funcional (HAQ) mayor, 0,8 vs 0,5 (p: 0002). En el análisis multivariado la presencia de manifestaciones no músculo esqueléticas y MASES se asociaron en forma independiente con el compromiso axial. Conclusión: La prevalencia de síntomas axiales fue de 33%, las características fueron inflamatorias y con actividad por BASDAI. Los pacientes con síntomas axial presentaban características de APS más severas.

Background:Golimumab is a human monoclonal antibody directed against TNFα in its soluble and transmembrane forms. It can be used subcutaneously or intravenously and has shown efficacy for use in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS).Objectives:The aim of this study was to evaluate the efficacy, safety, and cumulative survival of golimumab in patients with RA, PsA and AS from different rheumatology centers in Argentina.Methods:We performed a longitudinal study of consecutive adults with RA (ACR/EULAR 2010 criteria), PsA (CASPAR criteria) and AS (ASAS 2009 criteria), who have started treatment with subcutaneous or intravenous golimumab according to medical indication in each center. Data was obtained by review of medical records. Sociodemographic and clinical data, musculoskeletal manifestations, comorbidities, previous treatments were recorded. In reference to golimumab treatment, start date, route of administration and concomitant treatments were identified. Disease activity was assessed using DAS28 for RA patients, DAPSA and MDA for PsA and BASDAI for AS. The presence of adverse events (AE) was recorded. If golimumab was stopped, date and cause was documented. Patients were followed up until golimumab discontinuation, loss of follow-up, or study completion (November 30, 2020). Statistical analysis: Chi2 test or Fischer exact test and T test or Mann Whitney and ANOVA or Kruskal Wallis, as appropriate. The incidence of EA was assessed in events every 100 patient/year. Kaplan-Meier curves and log Rank analysis. Cox proportional regression.Results:One hundred eighty two patients were included, 116 with a diagnosis of RA, 30 with PsA and 36 with AS. Most of them (70.9%) were female with a median (m) age of 55 years (IQR 43.8-64) and m disease duration of 7 years (IQR 4-12.7) at treatment initiation. Al least one prior biological DMARD or a small molecule was received by 63 patients (34.6%). The most frequent indication cause was conventional DMARD failure. In 94.8% of the patients Golimumab was administered subcutaneously, and in 80.8% in association with conventional DMARDs, the most frequently used was methotrexate. Total follow-up was 318.1 patients/year.Golimumab treatment showed clinical improvement in all three groups of patients. In RA patients DAS28 significantly decreased during the first 12 months of follow-up, m 5.9 (IQR 4.9-6.6) at baseline, 3.8 (IQR 2.6-4.6) at 6 months and 2.8 (IQR 2.1-3.6) at 12 months, p The incidence of adverse events was 6.6 per 100 patients/year, being infections the most frequents ones. During follow-up, 50 patients (27.5%) discontinued golimumab, the most frequent cause was treatment failure (68%), followed by lack of health insurance (16%) and adverse events (10%). Golimumab persistence was 79% and 57.6% at 12 and 24 months, respectively. Treatment survival was 50.2 months (95% CI 44.4-55.9). Patients who had received prior treatment with biological DMARDs or small molecules showed lower survival (Figure 1). In the multivariate analysis, adjusting for age, sex and disease duration, those patients showed twice the risk of suspending treatment (HR 2.01, 95% CI 1.1-3.7).Figure 1.Golimumab survival according to prior b-DMARD o small molecule treatment.Conclusion:Golimumab treatment in real life patients in Argentina has shown good efficacy and safety. Drug survival was over 4 years and almost 80% were still using golimumab after one year. Prior treatment with other b-DMARDs o small molecules was associated with lower treatment survival.Disclosure of Interests:Carolina Ayelen Isnardi Speakers bureau: Bristol Myers Squibb, Janssen, Grant/research support from: Pfizer, Emma Estela Civit De Garignani Speakers bureau: Abbvie, Novartis, Agustín García Ciccarelli Speakers bureau: Janssen, Novartis, Consultant of: Novartis, Grant/research support from: Janssen, Novartis, Jimena Sanchez Alcover: None declared, Rodrigo Garcia Salinas Speakers bureau: Abbvie, AMGEN, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen Cilag, Montpellier-UCB, Novartis, Roche – Genentech, Sanofi, Merck Serono., Sebastian Magri Speakers bureau: Abbvie, AMGEN, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen Cilag, Montpellier-UCB, Novartis, Roche – Genentech, Sanofi, Merck Serono., Eduardo Albiero Consultant of: Janssen, Carla Gobbi Speakers bureau: Pfizer, Consultant of: Pfizer, Janssen, Edson Velozo Speakers bureau: Janssen, Novartis, Pfizer, Consultant of: Abbvie, Janssen, Novartis, Grant/research support from: Janssen, Novartis, Pfizer, Enrique Soriano Speakers bureau: AbbVie, Novartis, Bristol MS, Novartis, Eli Lilly, Genzyme, Pfizer, Amgen, and Roche, Consultant of: Novartis, AbbVie, Pfizer, Eli Lilly, Sanofi, Sandoz, Amgen., Grant/research support from: Roche, Novartis, AbbVie, Glaxo Smith Kline, BMS, Martín Brom: None declared, Johana Zacariaz Grant/research support from: Bristol Myers Squibb, Ingrid Strusberg Speakers bureau: Gema Biotech SAU, BMS, Abbvie, Consultant of: Gema Biotech SAU, Abbvie, Janssen, Grant/research support from: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Marcos BARAVALLE Speakers bureau: Montepellier, Consultant of: Abbvie, Janssen, Grant/research support from: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Sol Castaños Speakers bureau: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Liliana Morales Speakers bureau: Lilly, Consultant of: Janssen, Grant/research support from: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Sergio Paira: None declared, Romina Calvo: None declared, Alberto Ortiz: None declared, Rodolfo Perez Alamino Speakers bureau: Pfizer, Abbvie, Amgen, Bristol-Myers-Squibb, Lilly, Janssen, Novartis, Hernan Maldonado Ficco Speakers bureau: Pfizer, Abbvie, Jansen, Novartis, Bago, Bristol, Eli Lilly., Consultant of: Pfizer, Abbvie, Novartis, Jansen, Bago, Eli Lilly., Gustavo Citera Speakers bureau: Abbvie, BMS, Lilly, Jansen, Gema, Pfizer, Roche, Grant/research support from: Pfizer

Background The purpose of the T2T approach in RA is to achieve remission or LDA according to results from objective activity measurements. This strategy has proven clinical benefits, however objective adherence T2T measurement tools are lacked in daily practice. Objectives To evaluate the setting, usage of a T2T adherence measure: T2T70 and T2T100, and its association with sustained low disease activity (LDAS) as a measure of outcome. Methods Prospective study, consecutive patients with RA diagnosis (ACR/EULAR 2010) and follow-up between 1 and 24 months were included. Data from electronic medical record (EHR) were collected. Demographic variables, characteristics of the disease and treatment were recorded. The following T2T characteristics were defined and collected from each patient: number of visits, visits where treatment was adjusted, CDAI measurements, use of ultrasound to measure disease activity and achievement of LDA. Sustained LDA (LDAS) was defined when the patient had 2 or more records of that consecutive state of activity. Measures of adherence to T2T were defined as follows: T2T-70, when therapeutic decisions were accompanied by the measurement of activity by 70% and the interval between visits did not exceed 6 months; And T2T-100, when 100% of the decisions were accompanied with the activity measurement and the interval between each visit did not exceed 6 months. Statistical analysis: a descriptive analysis of the variables was performed and Chi2 test (categorical) and Student or MannWhitney test (continuous) were applied. For multivariate logistic regression analysis we considered as dependent variable LDAs. Results 96 patients were included, with a mean follow-up of 15 months (DS 7.8), equivalent to 120.6 patients/year. Eighty percent of the patients were women, mean age 53.7 years (SD 13), disease duration 36 months (RIC, 12–52), 64% had early diagnosis, 85% and 75% positive For FR and ACPA, respectively. According to T2T characteristics, 526 visits were recorded, 270 were treatment adjustment and 208 (78%) of them were performed according to the CDAI value. The frequency of LDAS was 20% (IC95: 12–30). The frequency of T2T-70 compliance was 62.5% (IC95: 52–72) and T2T-100 was 42% (IC95: 32–52). Compliance with T2T-70 and T2T-100 presented a statistically significant association to the achievement of LDAS in the uni and multivariate analysis (p: 0.000). Compliance with T2T-70 and T2T-100 was associated with a shorter time course of disease; And T2T-70 also showed association with early diagnosis. Conclusions T2T-70 and T2T-100 adherence were 62% and 42%, respectively, patients who met these criteria reached more LDAS. The early diagnosis and shorter time to disease evolution at baseline were variables that were variables that were associated with more compliance of these tools. Acknowledgements Dra Josefina Marcos. Disclosure of Interest None declared

Introduction/objectives: The combination of biologic agents and synthetic disease modifying anti-rheumatic drugs has proven to be effective for the treatment of patients with active Rheumatoid Arthritis; notwithstanding monotherapy was only exceptionally considered. However, with the advent of biologic agents with other modes of action and evidence contributed by tocilizumab studies, this option begun to be considered. The aim of this study was to evaluate the prevalence of monotherapy with biologic agents in patients with RA and factors associated with the use of this type of treatment, in the context of everyday practice. Method: An observational, analytical, cross-sectional study was carried out, including patients over 18 years old who were diagnosed with RA, according to ACR/EULAR 2010 classification criteria, and who were treated with biologics. Demographic, clinical and treatment variables were evaluated. Results: From a total 450 patients with RA, 171 treated with biologic agents were evaluated. 31.6% received biologic monotherapy, most frequently due to MTX adverse effects. The most commonly used anti-Tumor Necrosis Factor as monotherapy was adalimumab. Monotherapy with biologic agents was seen to be associated with the use of drugs with other mechanisms than TNF blockers, most frequently tocilizumab. Bivariate and multivariate analyses have shown that monotherapy is an independent factor for no NSAID use. Corticosteroid use was lower in patients receiving monotherapy, although it did not reach statistical significance. Conclusion: The biologic monotherapy frequency was 31.6%. The associated factors were use modes of action other than anti-TNF and a decreased use of NSAIDs.

Resumen El hallazgo de anticuerpos especificos y datos histopatologicos son indispensables para llegar al diagnostico de sindrome de Sjogren (SS). La biopsia de glandulas salivales menores (BGSM), si bien es un procedimiento sencillo, debe ser realizada en una institucion a fin de evitar complicaciones. Objetivo Estimar la frecuencia de complicaciones mediatas e inmediatas y el redito de la tecnica. Materiales y metodos Se incluyeron los pacientes derivados al Hospital Rivadavia para realizacion de biopsia, entre octubre del 2007 y mayo del 2010. Los pacientes fueron citados a la semana y al mes del procedimiento para control de la lesion. Resultados Frecuencia de complicaciones inmediatas (n = 186): 15 pacientes: 8,1%, IC del 95%, 4,7-13,2 (sangrado 7,5%, lipotimia 3,2%, hematomas 2,7%; no hubo accidentes). Complicaciones mediatas (n = 164): 16 pacientes: 9,75%, IC del 95%, 5,9-15,6 (dolor 7,32%, signos inflamatorios 3,66%, trastornos de sensibilidad 3,05%, granuloma 1,22%). No hubo casos de infecciones, ni dehiscencia del punto de sutura. Redito microscopico: total 154 biopsias: se obtuvo tejido glandular en el 90,9%, IC del 95%, 85-95 (tipica, sialoadenitis, infiltrado grado III y IV). Conclusiones La BGSM presenta una baja frecuencia de complicaciones mediatas e inmediatas y un alto redito en el estudio anatomo-patologico.

Findings of specific antibodies and histopathology data are essential for the diagnosis of Sjogren syndrome (SS). Although the minor salivary gland biopsy (MSGB) is technically simple, it needs to be performed in a medical institution to avoid complications. Objective To determine the frequency of complications and the usefulness of this technique. Materials and methods Patients who underwent a minor salivary gland biopsy for a possible diagnosis of SS at Rivadavia Hospital between October 2007 and May 2010 where included. The patients were seen a week and a month after the procedure for follow-up. Results Frequency of acute complications (n=186): 15 patients; 8.1%, 95% CI: 4.7–13.2 (Bleeding 7.5%, syncope 3.2%, hematoma 2.7%. No accidents occurred). Medium term complications (n=164): 16 patients: 9.75%, 95% CI: 5.9–15.6 (pain 7.32%, inflammation 3.66%, sensitivity disorders 3.05%, granuloma 1.22%). No infections or suture dehiscence occurred. Microscopic results: 154 biopsy reports were received: glandular 90.9%, 95% CI: 85–95 (typical, sialadenitis, grade III and IV infiltration). Conclusions MSGB has very low frequency of medium term and acute complications and it has high usefulness.