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Las miopatías inflamatorias corresponden a un grupo heterogéneo de enfermedades adquiridas que comprometen el sistema muscular. Tienen en común la presencia de debilidad como síntoma predominante asociado a inflamación muscular. La polimiositis (PM) es una entidad subaguda que afecta principalmente adultos y compromete estructuras musculares proximales. En este artículo se presenta el caso de un paciente de 19 años de edad con diagnóstico confirmado de PM por clínica (compromiso muscular proximal, disfagia), por los resultados de las pruebas bioquímicas (elevación sérica de la creatina kinasa o CK), por estudio de la ultraestructura por microscopia óptica de alta resolución y por los resultados de la resonancia magnética nuclear (RMN) de músculo, quien fue refractario al manejo inicial con corticoesteroides, azatioprina y ciclofosfamida. Con la administración de inmunoglobulina por vía intravenosa se observa una respuesta clínica favorable con aumento progresivo de la fuerza muscular. A pesar de que los esteroides constituyen el tratamiento de elección, en los casos refractarios se usan los agentes inmunosupresores, y la recomendación para su utilización depende de la experiencia médica o conocimiento empírico y de los resultados de los estudios de análisis de seguridad y eficacia. La inmunoglobulina por vía IV es ampliamente usada en el tratamiento de varias enfermedades autoinmunes y su eficacia radica en el efecto inmunomodulador. Sin embargo, es necesario realizar estudios clínicos controlados adicionales, que evalúen su eficacia y seguridad en pacientes con PM.

Among rheumatic diseases and specifically spondyloarthropathies (SpA), the study of biomarkers, defined as molecules that reflect either biologic or specific pathological process, is an important and necessary area in basic and clinical research, being a consequence or the response of an intervention. Other markers provide information about the pathogenesis of this disease. Recently, HLA-B27 has been used as diagnostic criteria to detect SpA. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) are clinical scores used to assess disease activity. A new activity index, Ankylosing Spondylitis Disease Activity Score (ASDAS) considers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as biomarkers. This review describes the state of the art of research on SpA biomarkers. There are promising new candidates as biomarkers such as metallopro-teinase 3, Type II collagen neoepitopes (C2C and C1-2C), C-propeptide of Type II collagen (CPII), aggrecan 846 epitope, macrophage colony stimulating factor, serum amyloid A protein and interleukin-6, among others.

OBJECTIVES This study aimed to identify potential blood-derived biomarkers distinguishing patients with ankylosing spondylitis from those with mechanical low back pain. METHODS Serum and synovial fluid samples from our cohorts were assayed by using enzyme-linked immunosorbent assay for the following inflammatory biomarkers: interleukin (IL)-1α, IL-6, IL-8, IL-17, IL-23, monocyte chemotactic protein (MCP)-1, macrophage inflammatory proteins (MIP)-1α, MIP-1β, tumor necrosis factor-α (TNF-α), interferon-α (IFN-α), IFN-β, metalloproteinase (MMP-3), and bone morphogenetic protein 7 (BMP-7). RESULTS After screening, a panel of serum and synovial fluid samples with a series of potential biomarkers, cytokines including IL-6, IL-8, MMP-3, and MCP-1 were selected for additional testing because they exhibited higher concentrations than paired serum samples in the synovial fluid. Sera obtained from 50 patients with ankylosing spondylitis and 27 patients with mechanical low back pain were measured for these biomarkers. CONCLUSIONS The MCP-1 serum was identified as a biomarker candidate, distinguishing ankylosing spondylitis from mechanical low back pain with a sensitivity of 96% and a specificity of 83.3%.

Behçet disease is a systemic disease with diverse clinical symptoms which vary according to the organs and systems involved. Typically, patients have oral and genital ulcers and episodic ocular involvement with periods of clinical improvement. We report an 18-year-old mole presenting with chest pain and hemoptysis and a history of ulcers in the oral cavity and scrotum. A chest CAT scan showed a mass located adjacent to the heart that a pulmonary arteriography defined as a left pulmonary artery aneurism. The patient was operated, excising left inferior pulmonary lobe. Due to skin and ocular involvement, the patient complied with criteria for Behçet disease. Immunosuppressive treatment with prednisone and azathioprine was started and the patient was discharged from the hospital.

Resumen La osteoporosis es una enfermedad silenciosa hasta que se presenta su principal complicacion: las fracturas; con un importante costo economico y social para el paciente y el sistema de salud, constituyendose en un verdadero problema de salud publica. Las mujeres en la etapa postmenopausica tienen un mayor riesgo de osteoporosis y por ende de fractura. Actualmente disponemos de un variado grupo de medicamentos que, a traves de diferentes mecanismos de accion, mejoran la densidad mineral osea y disminuyen el riesgo de fractura. En el presente articulo se presenta al lector informacion relevante de cada uno de los medicamentos empleados en el tratamiento de esta entidad desde el punto de vista farmacologico y de efectividad clinica. Palabras clave: osteoporosis, fractura, menopausia, densidad mineral osea. Summary Osteoporosis is a silent illness until fractures appears, with a very high economic and social cost for the patient and the health system, representing a true problem of public health. Postmenopausal women have a higher risk of osteoporosis and fracture. Actually are available different drugs that through a varied mechanism of action, increase bone mineral density and reduce fracture risk. In this article we present relevant information about the pharmacology and clinical effectiveness of each one of drugs used in the treatment of osteoporosis.

6 páginas La enfermedad de Behçet (EB), descrita por primera vez en 1937 por el dermatólogo turco Hulusi Behçet, es una enfermedad crónica sistémica compleja de causa desconocida, caracterizada por la aparición recurrente de úlceras orales y genitales, uveítis a repetición y compromiso variado de distintos órganos o sistemas (piel, mucosas, articular, neurológico, renal, pulmonar, vascular e intestinal)1. Esta patología es usualmente vista en los países que se extienden del Mediterráneo hasta el lejano oriente, en lo que corresponde a la ancestralmente conocida ruta de la seda2. Su etiopatogenia es desconocida, aunque el concepto más aceptado actualmente como desencadenante de la enfermedad propone que ciertos antígenos de agentes infecciosos (posiblemente por mimetismo molecular), pueden desencadenar una respuesta autoinmune en pacientes genéticamente susceptibles3. El presente caso es de particular relevancia, no sólo por reunir las principales características clínicas de esta entidad, sino también por la presencia de una complicación vascular a nivel pulmonar, que puso en riesgo la vida del paciente al momento de la presentación inicial del cuadro clínico. Behçet disease is a systemic disease with diverse clinical symptoms which vary according to the organs and systems involved. Typically, patients have oral and genital ulcers and episodic ocular involvement with periods of clinical improvement. We report an 18-year-old mole presenting with chest pain and hemoptysis and a history of ulcers in the oral cavity and scrotum. A chest CAT scan showed a mass located adjacent to the heart that a pulmonary arteriography defined as a left pulmonary artery aneurism. The patient was operated, excising left inferior pulmonary lobe. Due to skin and ocular involvement, the patient complied with criteria for Behçet disease. Immunosuppressive treatment with prednisone and azathioprine was started and the patient was discharged from the hospital.

Describimos el caso de una paciente femenina de 49 años con esclerosis sistémica difusa con compromiso cutáneo y pulmonar severo, rápidamente progresivo, sin respuesta al manejo inmunosupresor convencional; quien fue sometida a transplante de células madres hematopoyéticas (TCMH) con mejoría sostenida del compromiso cutáneo y pulmonar a los 6 meses post-TCMH. The following case presents a 49 year-old patient with diffuse SSc and poor evolution given by rapidly progressive of severe skin and lung involvement, who had undergone autologous stem cell transplantation in December 2008. Sustained improvement of skin thickening and of major organ involvement was achieved at six months.

8 páginas Although most ankylosing spondylitis patients show an apparent clinical response to infliximab therapy, there is considerable individual variation. Because current clinical assessment relies heavily on subjective patient self-evaluation, biomarkers of high sensitivity and specificity are much needed. Here, we assessed potential biomarkers in 47 ankylosing spondylitis patients who received three standard pulses of infliximab. Before each infusion and at week 10, the following were measured: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet count, serum levels of metalloproteinase-3 (MMP-3), and 22 different cytokines. We discovered that, 2 weeks after the first infusion, the combination of ESR, CRP, and platelet count distinguished responders from non-responders with 81.3% sensitivity and 72.7% specificity. The distinguishing power was much less when each acute phase reactant was used alone. Among the 22 cytokines, serum IL-1alpha was able to distinguish responders from non-responders at week 6, with sensitivity of 84.9% and specificity of 53.8%. Serum IL-1alpha was probably generated from the joint compartments, as synovial fluid levels were much higher than corresponding serum levels. Although infliximab infusions led to rapid and significant suppression of serum MMP-3 levels, serum MMP-3 levels did not distinguish responders from non-responders. Besides identifying potential biomarkers, our results also demonstrate the usefulness of using sensitivity and specificity to assess usefulness of potential biomarkers.

Anticyclic citrullinated peptide (anti-CCP) antibodies are highly specific for the diagnosis of rheumatoid arthritis (RA). The clinical distinction between RA and psoriatic arthritis (PsA) is often difficult to establish; therefore, the presence of rheumatoid factor (RF) and anti-CCP antibodies could be useful. Seven percent to 40% of patients with longstanding psoriasis will develop PsA at some point. Therefore, it is important to study the positivity of these antibodies in these two interrelated populations.The aim of this study was to determine the seropositivity of anti-CCP antibodies in patients with psoriasis and PsA and to compare it with that seen in patients with other inflammatory, noninflammatory (osteoarthritis) arthritides and healthy controls.Serum anti-CCP antibodies were measured in 106 patients with cutaneous psoriasis, 72 patients with PsA, 41 healthy controls (HC), 41 patients with undifferentiated or early inflammatory arthritis (UA), and 41 patients with RA and 41 with osteoarthritis using a commercial second-generation enzyme-linked immunosorbent assay. We considered a positive result to be20 UI/mL, as recommended by the manufacturer.Of 106 patients with PsA, 55 were women and 51 men. The mean age was 42.87 +/- 17.71 years and the mean disease duration was 5.3 +/- 2.10 years. Anti-CCP antibodies were not present in patients with psoriasis without arthritis. In contrast, 7 of 72 (9.72%) patients with PsA were positive for anti-CCP antibodies with a median titer of 7.16 units. Only one patient with PsA was positive for RF. Most of these patients were female with polyarticular joint involvement. Distal interphalangeal involvement was present in 4 and 2 had dactylitis. We found clear differences when we compared patients with PsA with patients with psoriasis (P = 0.001). Of the 43 patients with UA studies, 4 initially exhibited a low titer positive anti-CCP antibody, and at follow up, another patient developed anti-CCP antibodies and later developed RA. None of the patients with UA developed PsA at 5-year follow up. Thirty-two of the 41 patients had a positive anti-CCP antibody and the mean +/- standard deviation of the anti-CCP units was 80.61 +/- 55.5.2. Six of the 41 (14.6%) patients with osteoarthritis studied had positive anti-CCP with a mean titer of 7.388. None of the healthy controls exhibited positively for anti-CCP antibodies.Anti-CCP antibodies may be found in patients with PsA and not in our patients with only cutaneous psoriasis. These antibodies may also be found in some patients with osteoarthritis and rarely in patients with UA; such patients will be of interest to follow prospectively.

To evaluate the role of tumor necrosis factor-alpha (TNF-alpha) gene as susceptibility marker for spondyloarthritis (SpA), two polymorphisms (-238 and -308 positions) were analyzed in 229 patients with SpA (113 with ankylosing spondylitis [AS], 92 with undifferentiated SpA [U-SpA], 24 with reactive arthritis), and 169 ethnically matched healthy control subjects. The HLA-B alleles were detected by PCR-SSP technique and the TNF-alpha polymorphism by PCR-RFLP. In comparison with healthy control subjects, the frequencies of TNF-238 in SpA were similar. In contrast, the analysis of -308 polymorphism showed increased frequencies of the T2(A) allele in the whole SpA group (p0.05, pC = NS, OR = 1.83) as well as the T2(A) allele (pC0.05, OR = 2.4) and T1T2(AG) genotype (p0.05, pC = NS, OR = 2.25) in U-SpA patients. Comparison of B27-negative patients and healthy control subjects yielded similar results. There was no significant correlation between TNF genotypes and clinical data. The present study demonstrates that TNF-alpha -308 polymorphism appears to be associated with the genetic susceptibility U-SpA. The association seems independent of the susceptibility conferred by the HLA-B27 in this group of patients.

To evaluate the role of LMP (low molecular weight protein) genes as susceptibility markers for spondyloarthritis (SpA), LMP gene polymorphisms were analyzed in 223 Mexican patients with SpA (81 undifferentiated SpA [U-SpA], 117 with ankylosing spondylitis [AS], 25 with reactive arthritis) and in 139 ethnically matched healthy individuals. LMP genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism. The LMP2 and LMP7 allele frequencies were similar in patients and healthy controls. Genotype analysis revealed an increased frequency of LMP2 R/R genotype in the whole group of SpA (pC = 0.003, OR = 2.06, 95%CI = 1.3-3.25) and in the clinical subgroups of AS (pC = 0.039, OR = 1.88, 95%CI = 1.1-3.22) and U-SpA (pC = 0.003, OR = 2.56, 95%CI = 1.37-4.8) compared with healthy controls. Analysis in the LMP7 did not reveal significant differences in patients and healthy controls. The HLA-B27-negative AS subgroup also showed an increased frequency of LMP2 R/R genotype (pC = 0.027, OR = 4.81, 95%CI = 1.21-22.13). The LMP2-R/R AS patients were younger than LMP2-H/R and H/H patients at onset of the disease (16.0 +/- 6.8 years for R/R, 22.0 +/- 11.2 years for H/R and 28.6 +/- 10.9 years for H/H) (p0.05). The data suggest that, besides HLA-B27, LMP2 genotypes are also involved in the genetic susceptibility to develop AS in Mexicans. Furthermore, the age at onset of this disease might also be influenced by genotypes of this gene.

To evaluate the efficacy and safety of etoricoxib and indomethacin in the treatment of patients with acute gout.A randomized, double-blind, active-comparator study was conducted at 42 sites. A total of 189 men and women (or =18 years of age) who were experiencing an acute attack (or =48 hours) of clinically diagnosed gout were treated for 8 days with etoricoxib, 120 mg/day (n = 103), or indomethacin, 50 mg 3 times a day (n = 86). The primary efficacy end point was the patient's assessment of pain in the study joint (0-4-point Likert scale) over days 2-5. Safety was assessed by adverse experiences (AEs) occurring during the trial.Etoricoxib demonstrated clinical efficacy comparable to that of indomethacin in terms of the patient's assessment of pain in the study joint. The difference in the mean change from baseline over days 2-5 was -0.08 (95% confidence interval -0.29, 0.13) (P = 0.46), which fell within the prespecified comparability bounds of -0.5 to 0.5. Secondary end points over the 8-day study, including the onset of efficacy, reduction in signs of inflammation, and patient's and investigator's global assessments of response to therapy, confirmed the comparable efficacy of the two treatments. The etoricoxib-treated patients had a numerically lower incidence of AEs (43.7%) than did the indomethacin-treated patients (57.0%) and a significantly lower incidence of drug-related AEs (16.5% versus 37.2%; P0.05).Etoricoxib at a dosage of 120 mg once daily was confirmed to be an effective treatment for acute gout. Etoricoxib was comparable in efficacy to indomethacin at a dosage of 50 mg 3 times daily, and it was generally safe and well tolerated.

To determine the agreement of scores on the original visual analog scale (VAS) or Likert scale of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Dougados Functional Index (DFI) with scores on a numerical rating scale (NRS). To assess the reproducibility and responsiveness of the instruments with the original scale and NRS.Five hundred thirty-six patients with ankylosing spondylitis from the Netherlands, Mexico, and Switzerland completed a questionnaire in which all questions from the BASDAI, BASFI, and DFI were presented twice in random order with an 11-point NRS and either a 10-cm VAS (BASDAI and BASFI) or a 5-point Likert scale (DFI). Agreement of scores using Bland-Altman plots and intraclass correlation coefficients (ICCs), reproducibility using ICCs, and responsiveness were assessed.Large variability between the scores on the original scales and the NRS was found in individual questions of all 3 questionnaires, although total scores showed ICCs of at least 0.88. Reproducibility of all answer modalities showed low ICCs in individual questions, but moderate to good ICCs in total scores (Dutch group 0.62-0.89; Mexican group 0.53-0.72). Moderate to large effects (0.48-1.04) were found in responsiveness scores in the 3 questionnaires. No major differences in reproducibility and responsiveness between the answer modalities were found.Although large variability between the scores on the original answer scales and the NRS was observed, the BASDAI, BASFI, and DFI can be administered with an NRS, which does not show important differences compared with the original scales.

Objective: To develop and test an index to evaluate the radiographic changes that occur in the tarsus and adjacent areas of the foot in patients with spondyloarthropathies (SpA). Methods: The spondyloarthropathy tarsal radiographic index (SpA-TRI) was developed in three consecutive steps: (a) detection of descriptors after reviewing 70 radiographic files; (b) descriptor gradation and subsequent modifications performed by a consensus committee, and (c) interobserver variability assessed by three blinded and independent observers on 272 radiographs: anteroposterior 118, lateral 90, oblique 64 from 121 patients with SpA, and intraobserver variability on 75 radiographs from 25 patients with SpA. Statistical analysis included percentage of agreement and κ test. SpA-TRI score ranges from 0 to 4 (0=normal; 1=osteopenia or suspicious findings; 2=definite joint space narrowing, bony erosion(s), periosteal whiskering, or enthesophyte(s) in the plantar fascia or Achilleal tendon attachments; 3=para-articular enthesophyte(s); 4=bony ankylosis (joint space fusion or complete bridging)). Results: Complete agreement for every evaluation was >40%, and discordance >1 grade was

There are no formal statistics about the incidence, prevalence or demographics of patients with spondyloarthropathies (SpAs) in colombia. However, information from a few studies provides a preliminary snapshot of SpAs in the country. In this article, the authors review what has been published; document what their group is doing and outline what they still need to do in the future. The analysis suggests that although information on SpA in Colombia is limited, it is known that the diagnostic entities of SpA are different than those reported at other latitudes. Thus, it is important to improve and expand the current database of SpA, particularly undifferentiated SpA, not only in Colombia but in all of Latin America.

Background RAPID-3 is a patient-driven tool to measure disease activity in rheumatoid arthritis (RA) without the need of laboratory test or the inclusion of a provider joint count and can be self reported by the patient.DAS-28 is a composite tool that needs patient, provider a laboratory information to measure disease activity Objectives To Asses the correlation of RAPID-3 and DAS-28 in a cohort of colombian patients with RA Methods 119 consecutive patients with early and established RA were evaluated at the Hospital Militar Central rheumatology service in Bogota-Colombia between August and December 2013. A complete medical history was obtained, including complete demographic information, comorbilities, concomitant medications and family history and laboratory tests. All patients completed a self reported RAPID-3 and were evaluated for a 28 swollen and painful joint count to obtain the DAS-28-ESR. Spearman correlations were computed for components of DAS28-ESR and RAPID3. Results 15,2 years). Mean scores were HAQ=0,6 (0,7), DAS28=3.8 (1.4) and RAPID3=12,3 (7.4). RAPID3 was strongly correlated with DAS28 (Spearman r:0.763, p Conclusions RAPID-3 had a good correlation with DAS-28. Furthermore it9s a self reported test and does not require an acute-phase reactant which makes it more atractive in a country with limited resources. References Anderson J, Caplan L, Yazdany J, Robbins ML, Neogi T, et al. (2012) Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res 64: 640–7 Pincus T, Swearingen CJ, Bergman M, Yazici Y. RAPID3 (routine assessment of patient index data 3), a rheumatoid arthritis index without formal joint counts for routine care: proposed severity categories compared to disease activity score and clinical disease activity index categories. Journal of Rheumatology. 2008;35(11):2136–2147 Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5733

Background Biological therapy have revolutionized the treatment of some autoimmune diseases, such as rheumatoid arthritis (RA), and spondyloarthropathies (SpA). Patients receiving biologics have a increased risk of opportunistic infections, particularly of reactivating latent tuberculosis (LTB). Objectives To describe the presence of LTB and viral hepatitis in a cohort of patients (pts) with biologic therapy. Methods Cross-sectional study. 157 patients of a rheumatology center treated with biological therapy were evaluated. Medical records were reviewed. Variables: sex, mean age, diagnosis, current biological therapy, PPD (>10mm), hepatitis B virus surface antigen reactivity, hepatitis C virus antibody reactivity, chest x-ray, biological therapy since 2001, antinuclear antibodies (ANAS), and associated autoimmunity. Descriptive analysis was done for qualitative and categorical variables (percentages and averages) using STATA11. Results In 23 patients (14.7%) was documented LTB. 12 pts (52.2%) are women and 11 pts (47.8%) are male. Mean age: 50,6 y/o. 13 pts (56.5%) have diagnosis of SpA, 9 patients (39,1%) RA, and 1 patient (4.37%) psoriatic arthritis (PsA). 9 pts (39,1%) receive Adalimumab, 7 pts (30,43%) Infliximab, 3 pts (13%) Etanercept, 3 pts (13%) Rituximab, and 1 pt (4,4%) Tocilizumab. Since year 2001, 16 patients (69,6%) have received just one biologic as treatment, 4 pts (17.4%) 3 biologics, 2 pts (8,7%) 2 biologics, and 1 pts (4,3%) 6 biologics. Infliximab is the biologic more prescribed (12 pts, 52,2%) as first choice since 2001. Adalimumab (57,1%) is the one most formulated in the group that have received more tan one biologic. All patients chest X-ray were reported as normal . 14 pts (60.87%) have positive ANAS. Associated autoimmunity: 3 pts (13.4%) uveitis, and 2 pts (8.70%) Sjogren syndrome (SS). Pneumology prescribed all patients Isoniazid for minimun 9 months. The biologic was started o continued after three months on Isoniazid. In 5 patients (3.18%) was documented seropositivity for Hepatitis B (HBV). 3 pts (60%)) are men and 2 pts (40%) are women. Mean age: 56.1 y/o. 4 pts (80%) have diagnosis of RA, and 1 pt (20%) have diagnosis of SpA. 2 pts receive adalimumab (40%), 2 pts Etanercept (40%), and 1 pt Abatacept (20%). Since year 2001, 1 pt (20%) have received 2 biologics, and 1 pt (20%) 4 biologics. Infliximab (40%) and Adalimumab (40%) are the biologic more prescribed. 2 pts (40%) have positive ANAS. Associated autoimmunity: 1 pt (20%) inflammatory bowel disease, and 1 pt (20%) SS. In a 58 y/o female patient with diagnosis of SpA, in treatment with Adalimumab was found seropositivity for Hepatitis C. Associated autoimmunity: Uveitis. All patients were evaluated by gastroenterology. None of these biologic was discontinued. Conclusions LBT prevalence in this cohort is higher that reported in other cohorts 1. Adalimumab is the biologic more used in patients with LBT. Normal chest x-ray does not exclude LTB. HBV prevalence is similar to previous data reported. 1 The surveillance of LBT and viral hepatitis must be mandatory in patients receiving biological therapy. References Nacci F, Matucci-Cerinic M. Tuberculosis and other infections in the anti-tumour necrosis factor-alpha (anti-TNF-α) era. Best Pract Res Clin Rheumatol. 2011 Jun;25(3):375-88. Disclosure of Interest None Declared

Background It has been suggested that rheumatic diseases may have additional underlying factors in common with chronic periodontitis. Spondyloarthritis (SpA) is associated with other inflammatory diseases such as psoriasis and uveitis; however, it is unclear whether these patients have a higher risk of inflammatory periodontal disease (PD). It is increasingly being realized that the systemic effects from PD makes substantial contributions to distal inflammatory processes. Few studies have addressed the possible link between ankylosing spondylitis (AS) and PD, and there is scarce data on whether SpA is associated with PD especially in our population. Objectives To investigate the association between clinical indices of PD and disease activity characteristics in SpA patients receiving treatment. Methods From a rheumatology outpatient clinic 30 SpA patients according to The European Spondylarthropathy Study Group (ESSG) classification criteria were enrolled over a seven month period. Patients with previous periodontal treatment, receiving TNF blockers, recent use of antibiotics, infections, edentulous, with malignancies or orthodontic treatment were excluded. Demographic, epidemiologic and disease specific variables were collected. Periodontal examination was performed by 2 experienced and calibrated periodontists, assessing bleeding on probing, plaque index, mean and extension of clinical attachment loss, mean pocket depth, inflammation and number of teeth. The extension of periodontitis was evaluated by pocket depth and clinical attachment and the severity of periodontitis was evaluated by clinical attachment loss. The association between clinical index of periodontitis and disease activity measures were was analyzed using chi square test. Results Thirty patients were included in the study with mean age of 41.4 ± 10.7 years evolution time disease of 11.1± 8.0 years, mean BASDAI of 5.9±1.9 and mean BASFI of 5.0± 2.0 The diagnosis of AS was establish in 26,7% (n=8), undifferentiated uSpA 63.3% (n=19) and reactive arthritis (ReA) 10% (n=3). HLA-B27 was present in 23.3% of the patients. The mean number of teeth was 26.6 IC 95% (25.5 - 27.7). Twenty three percent of the patients had sites with attachment loss ≥ 2mm, 50% had low plaque index, 43% lower levels of inflammation and 16.7% bleeding on probing. The percentage of sites with mean pocket depth was 2.36 and any patient had extension of periodontal inflammation. There was an association between the severity of periodontal involvement in patients with more than 5 years of evolution of the disease (p= 0.021), these patients had BASFI and BASDAI scores > 4.0, CRP Conclusions These preliminary results shows that treated SpA patients with moderate grade of clinical activity present acceptable periodontal status, however, the time evolution of the SpA is a risk factor for the severity of the periodontal condition. This is the first study including different subtypes of SpA spectrum and not only AS. References Keller J. Arthritis and Rheum 2013;65:167-173 Pischon N. Ann Rheum Dis 2010;69:34-38 Disclosure of Interest None Declared

Background ASAS classification criteria have been developed and validated to make an early classification of patients presenting with symptoms of spondyloarthritis (SpA), and to better distinguish between patients with predominantly axial SpA (axSpA) and predominantly peripheral SpA (pSpA). Objectives To investigate the performance of the criteria sets for SpA in a clinical cohort, according to the different available criteria sets (ASAS, ESSG, and Amor) and to assess how the ASAS classification criteria perform in daily clinical practice. Methods The cohort was established before the development of the ASAS SpA classification criteria, implying that there could not be selection towards the application of these criteria Patients with a clinical diagnosis of SpA attending a specialized rheumatology outpatient clinic were retrospectively classified. The group of patients who met all three criteria sets was compared to the group of patients who met neither. Results In total, 83.3% of the patients in the cohort (n=581) could be classified as SpA according to the ASAS criteria, 74.1% according to ESSG criteria and 53.1% according to Amor criteria (figure 1). Thirty four percent of patients had predominantly peripheral SpA. A high level of overlap between criteria sets was found and 46.8% (n= 272) of the patients fulfilled all three criteria sets. Those fulfilling the three criteria sets were older (p=0.047), had more SpA features (p= Image/graph Conclusions ASAS criteria are more sensitive classifying patients as having SpA and perform better than the ESSG or Amor criteria with the rheumatologists’ diagnosis as external standard. ASAS criteria perform well in clinical practice allowing physicians to make an early classification. References Rudwaleit M, Ann Rheum Dis 2009;68:777-83 Rudwaleit M, Ann Rheum Dis 2011;70:25-31 Disclosure of Interest None Declared

Background The MRI of SI joints, included in the ASAS criteria, is being increasingly used to detect early sacroiliitis and as a tool to measure response to treatment in clinical studies. However, evaluation of the MRI of SI joints has been considered difficult to a non-experienced observer, in which case, Sacroiliitis could be mis diagnosed or delay diagnosis and cost increase. Objectives To evaluate the concordance rate of detecting abnormalities of sacroiliac joints on MRI, between a musculoskeletal expert observer and conventional radiologist, in a group of patients with SpA Methods 66 patients with diagnosis of SpA according to the ESSG (European Study Group spondyloarthritis), who were attended to a SpA clinic from January to November of 2012 and their MRI films of SI joints and its originals reports by conventional radiologist were selected. Those images were read independently in a second time by a musculoskeletal expert observer. The agreement between two readers was analyzed through the kappa statistic. Results The agreement between the two readers (musculoskeletal expert radiologist and conventional radiologist) was poor (K 0.37), on the normal case (K 0.39), and on chronic findings (K0.31), while there was moderate agreement on the presence of acute changes (K 0.45). The agreement between a rheumatologist expert in SpA and a musculoskeletal expert radiologist observer also was analyzed, the agreement was acceptable to be useful in ascertaining acute inflammatory and chronic structural changes due to sacroiliitis (sacroilitis by X-ray K 0,5; acute changes K 0,52, chronic changes K 0,61). Conclusions Sacroiliitis can be difficult to detect in early stages of SpA. The agreement for changes due to sacroiliitis by MRI between expert and non- expert radiologist in this study was poor, while between two experts readers (Radiologist and Rheumatologist) was better. Although MRI is highly sensitive in detecting early changes according to other studies, these findings may be no detected by non-expert observers, that’s why training of rheumatologists and radiologists in the evaluation of sacroiliac joints on MRI is necessary, to optimize the accuracy of the diagnostic test, avoid mis diagnostic and cost increase. Disclosure of Interest None Declared

Background The anti-chromatin antibody is frequently is elevated in patients with active SLE and its titer correlates with activity. Objectives The objective of this study is to determine the diagnostic value of anti-chromatin antibodies in the assessment of clinically active SLE. Methods A cross-sectional study with 74 patients (110 samples) diagnosed with SLE. Disease activity was evaluated by Safety of Estrogens in SLE National Assessment— SLE Activity Index (SELENA-SLEDAI) and the British Isles Lupus Activity Group 2004 (BILAG 2004) index. Serological titers of anti-dsDNA high avidity, anti-chromatin and anti-C1q antibodies were measured by enzyme-linked immunosorbent assay (ELISA) using commercially available kits INOVA Diagnostics, Inc. Complement levels by nephelometric test Values in this study were expressed as mean ± standard deviation (SD). The chi-squared test was used for the categorical variables as needed. The Wilcoxon Rank-Sum Testwas used for comparison of SLEDAI score indices. Correlation among the levels of complements, anti-dsDNA, anti-chromatin, anti-C1q antibodies and disease activity scores was made by the nonparametric Spearman’s rank correlation test (correlation coefficient ρ [rho]). Values of p Results The mean SLEDAI score was 3,36 ± 3,19 (0-14). 49,9% (n=54) of patients had a SLEDAI score of ≥ 4. Activity by BILAG A/B: Renal 9% (n=10), mucocutaneous 8,18 (n=9), musculoskeletal 6,5% (n=7), neuropsychiatric 1,8% (n=2), hematological 1,8% (n=2), cardiorespiratory and constitucional 0,9% (n=1). 60% of patients had activity by SLEDAI or BILAG. Biomarkers: Anti-chromatin antibodies 64,08 ± 74,3 (1-251), anti-dsDNA 54,99 ± 77,63 (12-543), anti-C1q antibodies 14,66 ± 23,09 (2-153), C3 97,81± 30,5 (26-152) and C4 16,53 ± 8,99 (2-42). The prevalence of positive anti-chromatin, anti-dsDNA and anti-C1q antibodies in the recruited patients was 51%, 45%, and 16% respectively. Anti-chromatin antibodies and anti dsDNA antibodies were found to be positive in 70% and 72% active-SLE patients by SLEDAI ≥ 4 (p The Wilcoxon Rank-Sum Testshowed an excellent correlation between anti-chromatin antibodies and SLEDAI score ≥ 4 (p Conclusions Anti-chromatincould precede the development of lupus flares and thus has a value in predicting lupus flares and preempting treatment. References Translational Research 2012;159:326–342. Arthritis Research & Therapy 2009, 11:R154. Ann Rheum Dis 2007;66:693–696. Disclosure of Interest None Declared

Background The illness perception is a cognitive representation that directly influences the patient’s emotional response to their disease and its behavior to cope with this. Illness perception focuses on cognitive perceptions (identity, consequences of the disease, duration of this, personal control, and treatment effectiveness) and emotional (conscience about illness, emotions generated and understanding of this). Objectives Determine the illness perception in patients with SLE according to their sociodemographic characteristics, disease activity and quality of life Methods A cross-sectional study with 72 patients diagnosed with SLE from two Colombian hospitals was performed. Socioeconomic/demographic data, clinical features and disease duration were recorded. Disease activity was measured by the SLE Disease Activity Index (SELENA-SLEDAI); quality of life by the Medical Outcomes Survey Short Form 36 (SF-36). The revised Illness Perception Questionnaire (IPQ-R) was used for the estimation of the illness perception. Statistical analysis: Correlations between the variables, we calculated by Pearson rank correlation test Results Mean age 30,3 ± 11.8 (12-65) 84.7% women, median 6 years disease duration (2-13), 77.7% living in a couple; 51% havecollege/university education. Most of patients are unemployed (68%). The mean scores of SF-36 physical component summary was 40.6 ± 10.7 (13-57) and Mental Component Summary 46.5 ± 11.1 (23.6-65). Mean disease activity by SLEDAI was 2,8 ± 3,1 (0-12); being inactive (SLEDAI ≤2) 61% of patients. Patients living in a couple attribute more somatic symptoms as caused by SLE (r 0,21 p=0,07), think the disease is chronic and will last forever (r 0,20 p=0,05) and have more symptoms of anxiety and depression because of the SLE (r 0,24 p=0,03). At higher educational level they are less confident that the treatment will control the disease (r -0,30 p=0,01) and don’t understand their illness (r-0,35 p=0,002). Unemployed people have more symptoms of anxiety and depression because of the SLE (r-0,22 p=0,05) and believe that the disease has negative consequences on their lives (r -0,28 p=0,01). With more number of flares, patients attribute more somatic symptoms as caused by SLE (r 0,40 p

Background Undifferentiated spondyloarthritis are part of the spondylitis group and share clinical features with other subtypes. In our environment has been reported that these undifferentiated forms of the disease are the most frequent group, contrary to what happens in the Caucasian population possibly by environmental influences, genetic and ethnic differences Objectives To describe demographic, clinical findings and laboratory in a group of Colombian patients with undifferentiated spondyloarthritis Methods We selected 162 patients with undifferentiated spondyloarthritis that did not meet criteria for other spondyloarthritis according to ESSG, who attended the Rheumatology clinic of the Central Military Hospital, Bogota 2001-2011. The clinical, demographic characteristics and HLA typing were collected as recommended by ASAS. 121 patients underwent HLA typing (PCR-SSP). The data analysis was performed from a statistical package SPSS Results We identified 162 patients, 102 (63%) were male, 60 (37%) women. The average age was 35±11.4 years, age at onset 29±9.3 and the evolution time of the disease was 6.1±7.7 years.The patients had a history of enthesopathy 117 (72%), arthritis 102 (63%), inflammatory back pain 82 (51%), buttock pain 56 (34,5%), dactylitis 21 (13%), infection 13 (8%), family history 13 (8%) and uveitis 10 (6,1%). The pattern of initial presentation was back pain 66 (41%), arthritis 40 (25%), several symptoms 38 (23,4%), enthesopathy 13 (8%), buttock pain 4 (2,4%) and uveitis 1 (0,6%). The clinical findings at the time of diagnosis: Enthesopathy 105 (65%), sacroilitis 66 (41%), arthritis 30 (19%) and dactylitis 6 (4%). The ASAS criteria: Peripheral 105 (65%) and Axial 57 (35%). Of the 121 patients with HLA typing, 31 (25,6%) were B27, 24 (19,8%) B15 and 66 (54,5%) other alleles B. Other data: Schober: 4.2±1.2, BASFI: 5.3±2.2, BASDAI: 5.9±2.1, ESR: 16.6±13.9, CRP: 0.7±2.2 Conclusions The group of undifferentiated spondyloarthritis patients analyzed, are characterized by the presence of several signs and symptoms within which the most frequent were enthesitis, peripheral arthritis and back pain, similar to what it is described in other series. Most of this group of patients met ASAS peripherals criteria. The HLA-B27 was found with low frequency being most prevalent other B alleles contrary to what has been described in Caucasians, which may influence the development of the disease. The above leads to a further long-term follow up and determine in this group: how many patients get recovered, which of these patients evolve into an ankylosing spondylitis and what are other factors influencing this evolution in our population References Zeidler H, Mau W, Khan MA. Undifferentiated spondyloartrhopathies. Rheum Dis Clin North Am 1992;18:187-202 Valle-Onate R, Candia L, Romero-Sanchez C, Iglesias-Gamarra A, Caballero-Uribe C, Santos-Moreno P, Reyes E, Londono J. Epidemiology of Spondyloarthritis in Colombia. Am J Med Sci 2011;341(4):293–294 Disclosure of Interest None Declared

Background Colombia is considered an intermediate tuberculosis (TB)-burden country, so initial and annual tuberculin skin test (TST) control is mandatory for all Rheumatoid Arthritis (RA) patients on biologic therapy, especially those on anti-TNF therapy. Objectives The aim of this study was to determine the prevalence of TST positivity in a cohort or RA patients from a Colombian rheumatology center, and its relationship with disease activity, biologic and non biologic therapy. Methods A descriptive, cross sectional study was performed. Records of patients from a rheumatology center were revised. All RA patients on biological therapy where included, data about TST results (performed by mantoux method), previous active or latent TB treatment, DAS28, present and past biologic therapy as well as present non biologic therapy for RA and comorbidities where included. Percentages and averages where performed. Chi square test for categorical variables and wilcoxon test for numerical and categorical associations were performed on STATA 4 software. Results 107 established-RA patients where included, 79 women (73.83%) and 28 men (26.17%), with an average age of 57.2 years old (36-82 SD 11.25). Average disease duration 4.4 years (0,3-14,1 SD 3.39). Average DAS28 2.8 (1,1-6,3 SD 1.09). Most patients where on anti TNF therapy, 38 (35.5%) on adalimumab, 20 (18.6%) on etanercept, 9 (8.4%) on infliximab and 3 (2.8%) on certolizumab; followed by 20 patients on rituximab (18.6%), 9 on tocilizumab (8.4%) and 8 on abatacept (7.4%). 18 patients had positive TST (16.8%). From the positive TST patients, 88.8% (16) received treatment for latent tuberculosis, and one for active tuberculosis. In the group of positive TST, 9 (50%) patients where on anti TNF therapy (6 on adalimumab, 2 on etanercept and 1 on infliximab), and 9 with other therapies (6 on rituximab, 2 on tocilizumab and 1 on abatacept), from these non anti TNF patients, 5 (55%) used anti TNF therapy in the past. In regard of non biologic DMARDs, from the patients with positive TST, 12 (66.6%) used methotrexate and 6 (33.3%) used prednisolone, while in the group of negative TST, 45 (50.56%) used methotrexate and 27(30.33%) prednisolone. Bivariate analysis showed no correlation between TST positivity and any biological treatment, prednisolone or methotrexate use, disease duration or comorbidities. Conclusions 16.8% patients had positive TST in this cohort of Colombian RA patients, similar as found in other Latin American studies ([1][1]). Most TST positive patients where on anti TNF therapy or had a history of use of this therapy with no statistical significance. There was no correlation between the use of MTX or PDN and an anergic TST, as found in other RA studies ([2][2]). There’s a need for the use of other latent-TB screening tests in our country ([3][3]). Further studies are needed to evaluate the impact of biologic therapy in the incidence of latent TB on RA in Colombia and Latin America. 1. Tamborenea MN. Rheumatol Int. 2010. 2. Belard E. Inflamm Bowel Dis. 2011. 3. Chang B. Clin Rheumatol. 2011 References Disclosure of Interest None Declared [1]: #p-7 [2]: #p-8 [3]: #p-9

La miositis por cuerpos de inclusión (MCI) es una patología poco común que se presenta en individuos mayores de 50 años y con mayor frecuencia en hombres; sin embargo, los síntomas pueden empezar 20 años antes de su diagnóstico. Hasta un 30% de los casos de miopatías inflamatorias pueden ser de MCI y su prevalencia varía en los diferentes países y grupos étnicos. Clínicamente se manifiesta como debilidad lentamente progresiva proximal y distal. En este artículo se presenta un caso de una paciente de 78 años con antecedentes previos de diabetes mellitus tipo 2, hipertensión arterial, e hipotiroidismo, con cuadro de 18 meses de evolución consistente en debilidad de miembros inferiores, incapacidad para subir y bajar escaleras, limitación en la marcha, acompañado de disestesias. Se realizó la medición de la creatin quinasa (CK) y su valor inicial fue 7820, la electromiografía y neuroconducciones mostraron polineuropatia axonal motora en las cuatro extremidades y miopatía inflamatoria. Se trató con glucorticoides a dosis de 1 mg/kg y después de seis meses de tratamiento no se observó mejoría. Se decide tomar biopsia muscular que mostró miopatía por cuerpos de inclusión, lo que explicó la falla terapéutica inicial. Este caso es interesante desde el punto de vista clínico, ya que no es frecuente la elevación de la CK en los niveles que presentó la paciente y por las múltiples comorbilidades asociadas.