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espanolEn el ano 2015 la Sociedad Espanola de Reumatologia (SER) publico su posicionamiento sobre farmacos biosimilares. En esta actualizacion, la SER, sigue manifestando su compromiso inequivoco con la sostenibilidad del sistema sanitario de nuestro pais y se alinea con las medidas que, sin reducir la calidad asistencial, esten encaminadas a asegurar su sostenibilidad. Desde la publicacion del anterior posicionamiento la Comision Europea ha autorizado la comercializacion de nuevos farmacos biosimilares, lo que abre una excelente oportunidad de avanzar en la eficiencia de la atencion sanitaria. En este nuevo escenario de incremento de la oferta terapeutica de biologicos, la SER considera imprescindible preservar la libertad de prescripcion de los medicos que realizan la indicacion de farmacos basandose exclusivamente en las caracteristicas y circunstancias individuales de cada paciente, sin olvidar los aspectos economicos que se derivan de dicha actuacion. EnglishIn 2015 the Spanish Society of Rheumatology (Sociedad Espanola de Reumatologia [SER]) published its position paper on biosimilar drugs. In this update, the SER, continues to manifest its unequivocal commitment to the sustainability of the health system of our country and is aligned with the measures that, without reducing quality of care, are aimed at ensuring its continuity. Since the publication of the previous position paper, the European Commission has authorized new biosimilar drugs, which provides an excellent opportunity to advance the efficiency of health care. In this new scenario of increased therapeutic offer of biologics, the SER considers it crucial to preserve the freedom of prescription of physicians who prescribe drugs based exclusively on the characteristics and individual circumstances of each patient, without forgetting the economic aspects there of.

In 2015 the Spanish Society of Rheumatology (Sociedad Espanola de Reumatologia [SER]) published its position paper on biosimilar drugs. In this update, the SER, continues to manifest its unequivocal commitment to the sustainability of the health system of our country and is aligned with the measures that, without reducing quality of care, are aimed at ensuring its continuity. Since the publication of the previous position paper, the European Commission has authorized new biosimilar drugs, which provides an excellent opportunity to advance the efficiency of health care. In this new scenario of increased therapeutic offer of biologics, the SER considers it crucial to preserve the freedom of prescription of physicians who prescribe drugs based exclusively on the characteristics and individual circumstances of each patient, without forgetting the economic aspects there of.

espanolObjetivos Analizar las caracteristicas clinicas y de metabolismo oseo de una serie de pacientes con fracturas vertebrales tras la suspension de denosumab (DMab). Metodos Estudio observacional retrospectivo de 10 pacientes con fracturas vertebrales tras suspender DMab atendidas en el Servicio de Reumatologia de un hospital espanol de tercer nivel entre 2015 y 2018. Resultados Se registraron un total de 49 fracturas espontaneas tras una media de 6 dosis de DMab y transcurridos 10,9 meses desde la suspension del farmaco. El 90% habia recibido tratamiento previo, 7 de 10 bisfosfonatos orales. Tras la suspension, CTX y P1NP estaban elevados y la media de T-score en cuello femoral y columna lumbar fue menor que previo a DMab. Las vertebras mas afectadas fueron L3, L5, D6, D7, D9 y D11. Conclusion La descripcion de nuevos casos de fracturas vertebrales multiples en los meses posteriores a la suspension de DMab subraya la preocupacion emergente en la comunidad cientifica siendo preciso apoyar en evidencias solidas las nuevas recomendaciones sobre su manejo. EnglishObjectives Analyse clinical and bone metabolism features in a case series of patients with multiple vertebral fractures after discontinuation of denosumab (DMab). Methods An observational descriptive study analysing data from ten patients with multiple vertebral fractures after DMab discontinuation that were admitted to our rheumatology department between 2015 and 2018. Results There were a total of 49 spontaneous fractures after an average of 6 DMab doses and 10.9 months from discontinuation. Ninety percent had already received treatment other than DMab 7 of 10 oral bisphosphonates. After discontinuation, CTX and P1NP remained elevated and mean T-score for femoral neck and lumbar spine was lower than before treatment. The most affected vertebrae were L3, L5, D6, D7, D9 and D11. Conclusion This report of ten new cases suffering multiple vertebral fractures early after discontinuation of DMab highlights the emerging concern on the subject in the scientific community and the need to clarify its pathogenic mechanism, and to support by solid evidence the new recommendations on its management.

Resumen Objetivo Generar recomendaciones sobre el bloqueo de la interleucina 6 (IL-6) en pacientes con artritis reumatoide (AR), basadas en la mejor evidencia y experiencia. Metodos Se selecciono a 10 expertos reumatologos en el manejo de los inhibidores de la IL-6. Los 2 coordinadores generaron 23 preguntas sobre el bloqueo de la IL-6 en la AR (perfiles de indicacion, eficacia, seguridad, etc.) para ser contestadas mediante una revision sistematica de la literatura. Con base en las preguntas se definieron los criterios de inclusion y exclusion, y las estrategias de busqueda (para interrogar Medline, Embase y la Cochrane Library). Dos revisores seleccionaron los articulos resultantes de la busqueda. Se generaron tablas de evidencia. Paralelamente, se evaluaron abstracts de congresos de EULAR y ACR. Con toda esta evidencia los coordinadores propusieron 8 recomendaciones preliminares que se evaluaron, discutieron y votaron en una reunion de grupo nominal con el resto de los expertos. Para cada recomendacion se establecio el nivel de evidencia y grado de recomendacion, y el grado de acuerdo mediante un Delphi. Se definio acuerdo si al menos el 80% de los participantes contestaban si a la recomendacion (si o no). Resultados Las 8 recomendaciones preliminares se aceptaron tras el Delphi. Abarcan aspectos como su uso en monoterapia, en combinacion, en pacientes refractarios o intolerantes, la evaluacion de su respuesta, la optimizacion o la gestion del riesgo. Conclusiones Este documento pretende resolver algunos interrogantes clinicos habituales y facilitar la toma de decisiones con el bloqueo de la IL-6 en el manejo de la AR.

Introduction During the last years, regulatory agencies raised some relevant concerns with regard to the possibility of administrating biological therapy (BT) to non-SpA patients. Especially, the possibility of treating women with fibromyalgia as non-radiographic axSpA (nr-axSpA) was mentioned. Objectives To evaluate if the gender distribution and clinical pattern of patients with axSpA initiating biological therapy (BT) was modified in clinical practice after its approval for non radiographic-axSpA (nr-axSpA). Methods Baseline dataset from a prospective ongoing cohort including all patients with axSpA treated with BT at the Rheumatology Department of University Hospital La Paz, Madrid, Spain, was analysed. Patient's characteristics and disease activity parameters were collected. Based on the approval indication date of BT for nr-axSpA, patients were classified in two periods according to the starting date for the first BT: period 1 (before 2013) and period 2 (during or after 2013). Gender distribution and disease’ characteristics were compared between both groups using Chi-square and Student-t tests. Results In total, 385 patients initiated BT: 266 (69%) in period 1 and 119 (31%) in period 2. No significant differences between both periods were observed regarding gender distribution (38% and 39% of women; p = 0.8). Out of those patients with nr-axSpA initiating BT in period 2, the majority (60%) were men. Women starting BT in period 2 had significantly higher systemic inflammation and mobility restriction compared with women in period 1 [median (interquartile range) CRP 10.2 mg/l (3.0–24.9) vs 3.2 mg/l (2.0–9.4); p = 0.02 and BASMI 2.7 (1.8–3.5) vs. 2.0 (1.2–2.6); p = 0.01, respectively]. In addition, they also presented significantly higher disease activity [BASDAI 6.5 (5.4–8.0) vs. 5.8 (4.6–6.8); p = 0.02; ASDAS, mean (SD) 3.6 ± 3.4 vs. 3.2 ± 1.0; p = 0.02, respectively] and more functional limitation [BASFI 5.7 (3.8–6.7) vs. 4.3 (2.0–6.1); p = 0.01, respectively] than men treated in period 2. Conclusions In our clinical practice, the frequency of women who started BT did not increase since their approval for nr-axSpA. Women treated with BT after 2012 had more objective disease activity parameters than before their approval for nr-axSpA treatment.

Background Hypophosphatasia (HPP) is a rare and underdiagnosed condition characterized by deficient bone and teeth mineralization. The aim of this study was first, to evaluate the diagnostic utility of employing alkaline phosphatase (ALP) threshold levels to identify adults with variants in ALPL among individuals with persistently low ALP levels and second, to determine the value of also including its substrates (serum pyridoxal-5′-phosphate—PLP—and urinary phosphoetanolamine-PEA) for this purpose in order to create a biochemical algorithm that could facilitate the diagnostic work-up of HPP. Results The study population comprised 77 subjects with persistent hypophosphatasaemia. They were divided into two groups according to the presence (+GT) or absence (−GT) of pathogenic ALPL variants: 40 +GT and 37 −GT. Diagnostic utility measures were calculated for different ALP thresholds and Receiver Operating Characteristic (ROC) curves were employed to determine PLP and PEA optimal cut-off levels to predict the presence of variants. The optimal threshold for ALP was 25 IU/L; for PLP, 180 nmol/L and for PEA, 30 µmol/g creatinine. Biochemical predictive models were assessed using binary logistic regression analysis and bootstrapping machine learning technique and results were then validated. For ALP Conclusions In this study, we propose a biochemical predictive model based on the threshold levels of the main biochemical markers of HPP (ALP 180 nmol/L) that when combined, seem to be very useful to identify individuals with ALPL variants.

Resumen La enfermedad gonococica diseminada es una manifestacion infrecuente de la afectacion por Neisseria gonorrhoeae, que presenta una clinica variada y no bien definida, siendo la afectacion articular un hallazgo caracteristico. Presentamos el caso de una mujer de 64 anos con enfermedad gonococica diseminada de inicio agudo, que comenzo con deterioro generalizado y oligoartritis. Se realizo artrocentesis de carpo, obteniendose un liquido sinovial de aspecto purulento, cuyo estudio microbiologico identifico Neisseira gonorrhoeae. En el estudio se objetivo un complemento hemolitico total (CH50) de cero, no detectandose la fraccion C2 del complemento. Son muy pocos los casos descritos en la literatura de enfermedad gonococica diseminada asociada a deficit de C2. Presentamos un nuevo caso y revisamos los previamente publicados.

Methotrexate (MTX) is a remarkable drug with a key role in the management of rheumatoid arthritis (RA) at every stage of its evolution. Its attributes include good overall efficacy for signs and symptoms, inhibition of structural damage and preservation of function with acceptable and manageable safety, a large dose-titratable range, options for either an oral or parenteral route of administration, and currently unrivalled cost-effectiveness. It has a place as a monotherapy and also as an anchor drug that can be safely used in combination with other conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or used concomitantly with biological DMARDs or targeted synthetic DMARDs. MTX is not without potential issues regarding toxicity, notably hepatotoxicity and bone marrow toxicity, as well as tolerability problems for some, but not all, patients. But many of these issues can be mitigated or managed. In the face of a welcome expansion in available targeted therapies for the treatment of RA, MTX looks set to remain at the foundation of pharmacotherapy for the majority of people living with RA and other inflammatory rheumatic diseases. In this article, we provide an evidence-based discussion as to how to achieve the best outcomes with this versatile drug in the context of a treat-to-target strategy for the management of RA.

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR's., Our study was supported by grants RD16/0012/0011 and PI14/00442 from the Ministerio de Economia y Competitividad (Instituto de Salud Carlos III; Spain) and cofunded by the Fondo Europeo de Desarrollo Regional (FEDER). Data from ACT-RAY clinical trial were kindly provided by Hoffmann-La Roche Ltd. No financial support was received from Hoffmann-La Roche Ltd Data from EMECAR and PROAR cohorts were provided by the Spanish Society of Rheumatology. No financial support was received from the Spanish Society of Rheumatology. None of these institutions played any role in the analysis or interpretation of data, nor were they involved in the writing of the manuscript. Roche and Sociedad Espanola de Reumatologia were involved in the collection of data from ACT-RAY, and EMECAR and PROAR, respectively. However, these funders had no role in study design, analysis, decision to publish, or preparation of the manuscript.

Background Gout is the most common inflammatory articular disease in adults concerning a 1%–2% of the general population, and even a 4%–5% in older than 70 years. Recently, it has been reported an increase of the prevalence of gout, especially in developed countries. Objectives The principal purpose of our study is to describe the clinical and epidemiological characteristics of hospitalised patients with diagnosis of gout in Spain including mortality, comorbidities and healthcare costs in the last decade Methods Retrospective observational study based on data from the Database of Hospital from the Spanish National Health Service. The study was conducted in patients over eighteen years old with any gout diagnosis as principal or other diagnosis, who were admitted in the hospital between the years 2005–2015. The clinical characteristics analysed were sex, age, costs and length of hospital stay. Comorbidities as diabetes, congestive heart failure, acute myocardial infarction and cerebrovascular disease were identified with International Classification of Diseases, ninth revision, common modification (ICD-9-CM). Results The study cohort included 192.037 patients with gout, 82.6% of those were males. There was a progressive increase in the number of hospitalised patients with gout from 12 851 patients in 2005 to 23 318 in 2015; this was associated with an increase in mortality, reaching its highest value in 2015 with a 4.9% of gout hospitalised patients. The average age at dead in 2015 was 79.2 years and 85.16 years in male and female respectively, an age slightly lower than in the general population. The average cost in these hospitalised patients was 4931 €, reaching a peak of 5384 € in the last year. The hospital stay reached its lowest numbers in 2015 with an average of 8.9 days per patient. These comorbidities had statistical association with an added mortality risk in cerebrovascular disease (odds ratio [OR] 1.57, 95% confidence interval [CI]1.46–1.49), liver disease (OR 2.61 95% CI 2.34–2.9), kidney disease (OR 1.34 95% CI 1.28–1.41), dementia (OR 2.13 95% CI 1.88–2.42). On the contrary, in type 2 diabetes (OR 0.92 95% CI 0.87–0.96), we found a statistically significant lower mortality risk. Furthermore, it was found a statistically reduced mortality risk in females (OR 0.85 95% CI 0.8–0.9) Conclusions In Spain we have a progressive increase in the hospital admissions for gout, higher mortality rates and higher healthcare costs. This shows the need for changes in prevention and management of gout disease. Disclosure of Interest None declared

Background Gout is the most common inflammatory articular disease in adults concerning a 1%–2% of the general population, and even a 4%–5% in older than 70 years. Recently, it has been reported an increase of the prevalence of gout, especially in developed countries. Objectives The main objective of this study is to describe the clinical and epidemiological characteristics of gout hospitalised patients in Spain (as the main reason of admission) and the economic outcomes of its management by the main care departments in charge when this disease is the principal diagnosis. Methods The main objective of this study is to describe the clinical and epidemiological characteristics of gout hospitalised patients in Spain (as the main reason of admission) and the economic outcomes of its management by the main care departments in charge when this disease is the principal diagnosis. Results From the whole 192.037 patients we have with gout diagnosis we performed a sub-analysis of 10.512 patients with gout as the main cause of hospitalisation, from witch the 85.9% are males. The admission number for this cause has remained constant or with a slight increase, with an average of 956 patients per year (equivalent to a 5.5% of gout total admissions). The average male age was 64.02 years (standard deviation (SD) 14.43) and 73.9 years (SD 13.69) for women (p Regarding the average of hospital stay of these patients, it was 6.71±6.8 days with an average cost of 3471±2678 €. Three medical specialities (Internal Medicine with 3852 hospital admissions (36.6%), Rheumatology with 2600 (24.7%) and Traumatology with 2033 (19.3%)), attended to an 80.6% of the total gout patients as main diagnosis for admission. It was noticed that the hospital stay was lower in the Traumatology Department with an average of 4.85±6.78 days compared with the Rheumatology and Internal Medicine departments, which had an average of 6.52±5.65 days and 7.76±6.83 days respectively. However, it was found the lowest cost in the Rheumatology Department, with an average of 2892 €. Conclusions Only 24.7% of hospitalised patients with gout as main diagnosis are attended by Rheumatology Departments. However, Rheumatology was the most efficient clinical department in the care of this pathology. This conclusion should be considered in order to improve the management of gout in the health system Disclosure of Interest None declared

Background Despite the fact that genetic and serological risk factors have been studied in rheumatoid arthritis (RA), the symptoms phase of preclinical RA is poorly characterised. Taking into account the importance of early diagnosis and effective treatment for the prevention of structural damage and long-term disability in RA, it is important to find clinical or image variables that identify patients with clinically suspected arthralgias at risk of developing a chronic arthritis (CSA). Objectives To identify baseline clinical, immunological and ultrasound variables in patients with arthralgias clinically suspected of progression to chronic arthritis. Methods Longitudinal prospective study of patients with CSA and follow-up from November 2015 in pre-arthritis clinics. Patients were assessed at baseline and every 6 months until 2 years, with clinical, laboratory and ultrasound data using standardised protocols. The criteria for eligible patients for inclusion in the study were:≤12 months of symptoms onset, inflammatory arthralgias (predominance in nights or mornings, improvement during the day or with movement, and morning stiffness of ≥30 min), and the involvement of small joints of hands or feet. Patients with clinical synovitis at baseline visit, patients with fibromyalgia or osteoarthritis were excluded. Results Twenty-six patients were recruited in 26 months of the study (1 male, 25 female), with an average baseline age of 44.7±12.6 years, an average delay time of symptoms to first visit of 8.7±3.3 months, a mean follow-up time of 7.7±8.1 months an average body mass index (BMI) of 27.7±7.2. Five patients had familial background of autoimmune diseases in first degree relatives (RA, psoriasis, inflammatory bowel disease), 6 (23.1%) were seropositive (RF and/or ACPA), 7 (26.9%) had increased baseline acute-phase reactants (PAR), and 11 (47.8%) were smokers or former smokers. Most of the patients reported a progression of the arthralgias (55%) and a subjective joint swelling at some point (70%). Of 24 patients, 8 (33.3%) developed clinical arthritis (7 RA, 1 undifferentiated arthritis), with a longer follow-up (15.7±7.4 vs. 7.5±7.2 months, p=0.016), greater baseline HAQ (11.8±8.3 vs. 3.9±4.8, p=0.033) and higher percentage of moderate inflammatory activity in the baseline ultrasound (83.3% vs. 8.3%, p=0.004), compared to patients that didn’t develop arthritis. There was a trend towards a higher seropositivity, (37.7% vs. 18.8%), a higher patient global disease assessment (45±29 vs. 30±27 on a 100 mm scale), higher patient pain scores (using a visual analogue pain 100 mm scale) (58±41 vs. 34±23) among patients who eventually developed arthritis, although not statistically significant. No differences were found with PAR, BMI, age, smoking habit or painful joint count at baseline visit. Conclusions In our pre-arthritis clinics of patients with clinically suspicious arthralgias, 33% progressed to arthritis, underlying the importance of these clinics. Functional disability and ultrasound at baseline visit are especially useful in predicting future progression to arthritis. It is necessary to recruit more patients in order to obtain more robust conclusions. Disclosure of Interest None declared

OBJECTIVE: To draft recommendations on interleukin 6 (IL-6) blockade in rheumatoid arthritis (RA), based on best evidence and experience.; METHODS: A group of 10 experts on IL-6 blockade in RA was selected. The 2 coordinators formulated 23 questions about IL-6 blockade (indications, efficacy, safety, etc.). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (Medline, EMBASE and the Cochrane Library were searched). Two different reviewers selected the articles. Evidence tables were created. At the same time, European League Against Rheumatism and American College of Rheumatology abstracts were evaluated. Based on this evidence, the coordinators proposed preliminary recommendations that the experts discussed and voted on in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Centre for Evidence Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no).; RESULTS: The 8 preliminary recommendations were accepted after the Delphi process. They covered aspects such as the use of these therapies in monotherapy, in combination, in patients with refractory disease or intolerant patients, response evaluation, optimization and risk management.; CONCLUSIONS: The manuscript aims to solve frequently asked questions and aid in decision making strategies when treating RA patients with IL-6 blockade. Copyright © 2018 Elsevier Espana, S.L.U. and Sociedad Espanola de Reumatologia y Colegio Mexicano de Reumatologia. All rights reserved.

Background The use of biological therapy (BT) in rheumatoid arthritis (RA) has supposes a very important change in the disease9s treatment and prognosis. Drugs like Anti-TNFα have proven unquestionable effectiveness. However, the lack or loss of such effectiveness over time raises the dilemma of what factors may influence it. There are studies that suggest the influence of BMI on the efficacy of these drugs and therefore on the control of the disease. Objectives To determine the influence of BMI on disease activity and response to treatment with infliximab (ifx) in patients with RA. Methods A retrospective observational study of a population of 76 patients with RA who received infliximab treatment, in a standard guideline of 3 mg/kg, in our service between 2000 and 2016 inclusive. The BMI was classified for some sub-studies in four categories: low ( 1.2, or>0.6 and DAS28 Results Characteristics of the 76 patients included in the study when initiating IFX therapy were: 66 (86.8%) were women, median (range) age 54 (21–83) years, 77,% RF+, 81% ACPA+, disease duration 10,8 (1,0–39,0) years, 59% with concomitant methotrexate and 55% with other DMARDs. Median (range) BMI was 25,5 (16,7–40,2) kg/m 2 . According to BMI, patients with underweight, normal, overweight and obesity were 0 (0,0%), 41 (53,9%), 22 (28,9%) and 13 (17,2%), respectively. The association between BMI and disease activity (median DAS28 (p25-p75)) is shown in Table 1: The association between BMI and treatment response (median deltaDAS28 (p25-p75) and EULAR response (%)) is shown in Table 2: In the longitudinal analysis, a trending but not statistically significant relationship between adjusted BMI and DAS28 was observed at six month and at one year of treatment onset: β: 0,051; 95% CI (-0,06 to 0,109) and β: 0,037; 95% CI (-0,022 to 0,097) Conclusions BMI seems to influence, in a non significantly manner, in disease activity and in treatment response in RA treated with infliximab. Obesity BMI values are associated with increased activity and a lower response to this treatment than lower BMI values. Disclosure of Interest None declared

Disseminated gonococcal infection is a rare presentation of the sexually transmitted pathogen, Neisseria gonorrhoeae. Here, we report the case of a 64-year-old woman with disseminated gonococcal infection, which started with symptoms of oligoarthritis and malaise. Neisseria gonorrhoeae was identified in the carpal synovial fluid. The follow-up study revealed an absence of total hemolytic complement and complement C2 was not detected. Being relatively common, C2 deficiency has been associated with disseminated gonococcal infection in a few cases. We present a new case and discuss those previously published.

The present invention relates to the use of allelic variants of human TLR10, including the allelic variant of human TLR10, I473T, as biomarkers for predicting gravity or prognosis in inflammatory diseases, including rheumatoid arthritis, and/or for predicting the response to a treatment using anti-inflammatory agents such as anti-TNFα agents. RESUMEN: La presente invención se refiere al uso de variantes alélicas de TLR10 humano, incluyendo a la variante alélica de TLR10 humano I473T: como biomarcador para predecir la gravedad o el pronóstico en enfermedades inflamatorias, incluyendo la artritis reumatoide y/o para predecir la respuesta a un tratamiento con agentes antiinflamatorios, tales como agentes anti-TNFα. Solicitud Internacional: PCT/ES2017/000089 (07.07.2017) Nº Pub. Solicitud Internacional: WO2018/020060A1 (01.02.2018)

Resumen Describimos un caso de artritis septica de rodilla por Corynebacterium striatum, bacilo Gram positivo colonizador habitual de la flora de la piel y mucosas, que rara vez ha sido implicado en artritis septicas de articulaciones nativas. Se trata de un varon de 84 anos diagnosticado de artritis septica de rodilla izquierda por Corynebacterium striatum que evoluciona de forma torpida con antibioterapia convencional, por lo que se solicita tratamiento compasivo con dalbavancina, con excelente respuesta clinica. Este caso resalta el potencial papel patogeno que las especies del genero Corynebacterium pueden tener en artritis septicas de articulaciones nativas y subraya la importancia de su deteccion precoz y tratamiento dirigido para obtener resultados clinicos satisfactorios.

We describe a case of septic arthritis in a native knee due to Corynebacterium striatum, gram-positive bacilli that are usually commensal organisms of skin and mucosal membranes, but are seldom implicated in native septic arthritis. An 84-year-old man with Corynebacterium striatum septic arthritis of his native left knee and no response to conventional antibiotic therapy. Thus, the patient was allowed to take dalbavancin for compassionate use, with an excellent clinical outcome. This case emphasizes de role of Corynebacterium striatum in native joint infections and highlights the importance of early detection and appropriate treatment in improving the clinical outcome.

Objective To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Methods Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. Results The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if =2, low disease activity if >2 and =5), moderate if >5 and

La presente invención se refiere al uso de variantes alélicas de TLR10 humano, incluyendo a la variante alélica de TLR10 humano I473T, como biomarcador para predecir la gravedad o el pronóstico en enfermedades inflamatorias, incluyendo la artritis reumatoide y/o para predecir la respuesta a un tratamiento con agentes antiinflamatorios, tales como agentes anti-TNF [al]. Solicitud: 201600636 (26.07.2016) Nº Pub. de Solicitud: ES2656587A1 (27.02.2018) Nº de Patente: ES2656587B1(11.12.2018)