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Introduction: Metabolic syndrome is a pathological entity associated with a high risk of cardiovascular disease. Data regarding the frequency of this syndrome, lipid profile, and atherogenic index of plasma in patients with radiographic axial spondyloarthritis are scarce. We aim to determine the prevalence of metabolic syndrome in patients with spondyloarthritis. We also aim to determine discriminative values of atherogenic indexes between patients with and without metabolic syndrome., Methods: We conducted a cross-sectional study including 51 patients meeting the ASAS 2009 criteria for radiographic axial spondyloarthritis. We measured the following parameters: triglyceride (TG), high-density lipoproteins (HDL c ), low-density lipoprotein cholesterol (LDL c ), and total cholesterol (TC). We calculated TC/HDL c , TG/HDL c , LDL c /HDL c ratios, and atherogenic index of plasma (LogTG/HDL c )., Results: Metabolic syndrome was noted in 33% of cases. Patients with active disease had a higher body mass index (26.89±5.88 versus 23.63±4.47kg/m 2 , p=0.03), higher TG (1.41±0.64 versus 0.89±0.5mmol/L, p=0.05) and a lower HDL c level (1±0.28 versus 1.31±0.22mmol/L, p=0.01). However, the LogTG/HDL c and TG/HDL c were higher in patients under TNFα inhibitors. The ability of the TG/HDL c ratio and LogTG/HDL c to distinguish patients with or without metabolic syndrome were good at cut-offs of 1.33 and 0.22, respectively (specificity: 91.2% and sensitivity 70.6% for both ratios)., Conclusion: Our study showed that metabolic syndrome is frequent in patients with axial spondyloarthritis. Atherogenic indexes can be used for predicting metabolic syndrome in these patients., (Copyright © 2022 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA)., Methods: A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients' association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA., Results: Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice., Conclusions: The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice., (Copyright © 2020 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Atlas of Axial Spondyloarthritis in Spain 2017 aims to better understand the reality of the patients suffering from this disease from an integrated approach., Methods: The Atlas 2017 based its results on an extensive cross-sectional patient survey conducted in Spain (2016), validated by a multidisciplinary group of experts on spondyloarthritis., Results: Data from 680 patients with axSpA were obtained, most of them suffered from AS, were HLA-B27 positive, older than 45 years, and live as part of a couple. A large percentage had university studies, were disabled and members of a patient association. Patients reported a diagnostic delay of 8.5 years, high disease activity (BASDAI 5.5±2.2), moderate-important stiffness (61.0%), medium-high functional limitation (74.9%), and psychological distress (GHQ 5.7±4.5). A total of 54.7% reported taking NSAIDs, 28.4% DMARDs, 36.3% biological therapy and 32.2% were not receiving pharmacological treatment., Conclusions: The Atlas survey data reveals still a long diagnostic delay, high disease activity, psychological distress, while an important proportion could be undertreated., (Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objective: Recent data published on biological therapy in axial spondyloarthritis (axSpA) since the last publication of the recommendations of the Spanish Society of Rheumatology (SER) has led to the generation of a review of these recommendations based on the best possible evidence. These recommendations should be a reference for rheumatologists and those involved in the treatment of patients with axSpA., Methods: Recommendations were drawn up following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Centre for Evidence Based Medicine at Oxford. The level of agreement was established through the Delphi technique., Results: In this review, we did an update of the evaluation of disease activity and treatment objectives. We included the new drugs with approved therapeutic indication for axSpA. We reviewed both the predictive factors of the therapeutic response and progression of radiographic damage. Finally, we drafted some recommendations for the treatment of patients refractory to anti-tumor necrosis factor, as well as for the possible optimization of biological therapy. The document also includes a table of recommendations and a treatment algorithm., Conclusions: We present an update of the SER recommendations for the use of biological therapy in patients with axSpA., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objective: To standardize clinical evaluation of patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) using a checklist., Methods: Qualitative study that included: 1) nominal group (18 experts); 2) literature reviews of measures used in the assessment of patients with axial SpA or PsA; and 3) focus groups, one with rheumatologists and another with patients, organized to become familiar with their opinion on medical assistance. Taking this into account, the experts selected the measures to be included in the checklist based on their relevance, feasibility, and the outcome type., Results: The checklist includes measures for the evaluation of personal history, physical examination, activity and function, laboratory tests, imaging studies and treatments. It also defines risk factors of radiographic progression, predictors of the response to biological therapies, and comprises measures of excellence., Conclusions: This checklist for patients with axial SpA and PsA could help standardize daily clinical practice and improve clinical management and patient prognosis., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Background: Axial spondyloarthritis (axSpA) is characterized by new bone formation. The complex systems underlying this process involve Wnt-signaling pathway. It has been observed that serum levels of dickkopf-1 (DKK-1), an important inhibitor of Wnt-signaling, are decreased in patients with axSpA. However, these data are from studies including only patients with long-standing disease. The aim of this study is to investigate if symptom duration influences on serum DKK-1 levels in patients with axSpA., Material and Methods: A cross-sectional study including consecutive patients with axSpA (ASAS criteria) naïve for anti-TNF therapy. Collected data included demographic and disease characteristics, time since first symptom onset, assessment of disease activity and function, and determination of DKK-1 serum levels. Patients were classified as early axSpA (symptom duration ≤5 years) and established axSpA (>5 years). Linear regression models were employed to investigate the variables related to DKK-1 serum levels., Results: In total, 90 patients were included. Sixty-eight patients had early axSpA and 22 had established disease. Serum levels of DKK-1 were significantly higher in patients with early axSpA compared with established axSpA (22.1±12.6 vs 16.4±10.7pM; p=0.04). Among all tested variables, only symptom duration was significantly and inversely correlated with DKK-1 serum levels (beta: -0.041; p=0.01)., Conclusion: Serum DKK-1 levels in axSpA depend on disease duration. As disease duration increases, DKK-1 serum levels decrease. Based on this, an intensive treatment at early stages of the disease could have a better outcome on inhibiting/slowing radiographic progression in patients with axSpA., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Spinal involvement is common both in the spondyloarthritides and in rheumatoid arthritis, in which the cervical segment is selectively affected. Rheumatoid involvement of the cervical spine has characteristic radiologic manifestations, fundamentally different patterns of atlantoaxial instability. Magnetic resonance imaging (MRI) is the technique of choice for evaluating the possible repercussions of atlantoaxial instability on the spinal cord and/or nerve roots in patients with rheumatoid arthritis as well as for evaluating parameters indicative of active inflammation, such as bone edema and synovitis. Axial involvement is characteristic in the spondyloarthritides and has distinctive manifestations on plain-film X-rays, which reflect destructive and reparative phenomena. The use of MRI has changed the conception of spondyloarthritis because it is able to directly detect the inflammatory changes that form part of the disease, making it possible to establish the diagnosis early in the disease process, when plain-film X-ray findings are normal (non-radiographic axial spondyloarthritis), to assess the prognosis of the disease, and to contribute to treatment planning., (Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: The term axial spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases with a common genetic basis that course with axial and peripheral involvement and enthesitis. Recently, the Assessment of SpondyloArthritis international Society (ASAS) established some diagnostic criteria, including for the first time magnetic resonance imaging (MRI) findings. Given the difficulties of obtaining MRI in some environments and the lack of experience with axial spondyloarthritis, a group of radiologists and rheumatologists sought to establish some practical guidelines to ensure the correct use of MRI in this disease., Material and Methods: Using the Delphi method, we used a questionnaire with 49 items stratified into 4 blocks to survey 46 experts in the MRI diagnosis of axial spondyloarthritis., Results: The experts agreed on 82% of the items. The degree of agreement was 100% in the block "Importance of early diagnosis of axial spondyloarthritis", 69% in the block "Optimization of the use of MRI in the diagnosis of axial spondyloarthritis", 93% in the block "Use of MRI in axial spondyloarthritis: Technical aspects", and 57% in the block "Usefulness of MRI in the prognosis, follow-up, and evaluation of the response to treatment in axial spondyloarthritis"., Conclusions: Despite the importance of MRI in the early diagnosis of axial spondyloarthritis, this study shows the need for standardization and points to relative disagreement about how to use MRI in the follow-up of the disease and evaluation of the response to treatment. The results of this study can help improve the use of MRI in axial spondyloarthritis., (Copyright © 2014 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)