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ObjectiveTo estimate incidence and prevalence of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in a university hospital–based health management organization (Hospital Italiano Medical Care Program) in Argentina.MethodsOverall and sex-specific incidence rates (IRs) and prevalence were calculated (age ≥ 50 yrs). Incidence study followed members with continuous affiliation ≥ 1 year from January 2000 to December 2015. Diagnosis as per the 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology (ACR) criteria for PMR or the ACR 1990 criteria for GCA. Prevalence was calculated on January 1, 2015.ResultsThere were 176,558 persons who contributed a total of 1,046,620 person-years (PY). Of these, 825 developed PMR, with an IR (per 100,000 PY) of 78.8 (95% CI 73.4-84.2) overall, 90.1 (95% CI 82.9-97.2) for women, and 58.9 (95% CI 51.1-66.6) for men. Ninety persons developed GCA; the IR was 8.6 (95% CI 6.8-10.4) overall, 11.1 (95% CI 8.5-10.6) for women, and 4.2 (2.2-6.3) for men. There were 205 prevalent PMR cases and 23 prevalent GCA cases identified from a population of 80,335. Prevalence of PMR was 255 per 100,000 (95% CI 220-290) overall, 280 (95% CI 234-325) for women, and 209 (95% CI 150-262) for men; and the prevalence of GCA was 28.6 per 100,000 (95% CI 16.9-40.3) overall, 36.4 (95% CI 20.1-52.8) for women, and 14.2 (95% CI 0.3-28.1) for men.ConclusionThis is the first study of incidence and prevalence of PMR and GCA in Argentina. There were similarities and differences with cohorts from other parts of the world, but population-based epidemiologic studies in Latin America are needed.

Objectives The aims of this study were to compare learned helplessness (LH) and perceived self-efficacy (SE) in patients with fibromyalgia (FM) and rheumatoid arthritis (RA) and to assess their correlation with functional disability, level of perceived pain, and fatigue. Methods This multicenter, cross-sectional study included consecutive patients (aged ≥18 years) with RA, according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria, and FM, according to 2010 American College of Rheumatology criteria. Learned helplessness was measured by the Rheumatology Attitude Index, Spanish version; SE with the Arthritis Self-efficacy Scale, Spanish version; functional capacity with the Health Assessment Questionnaire (HAQ), Argentine version; depression with Center for Epidemiological Studies-Depression Scale 7-item version and perceived pain and fatigue by the visual analog scale. Disease activity was measured by the Clinical Disease Activity Index (CDAI) and disease impact with the Fibromyalgia Impact Questionnaire (FIQ). Results A total of 215 patients, 100 with FM and 115 with RA, were included. Mean age was 59 (SD, 14) years and 58 (SD, 13) years for FM and RA, patients respectively. Whereas LH and depression were significantly higher, SE was significantly lower in FM patients. We found a positive correlation between LH and HAQ, pain, depression, fatigue, FIQ, and CDAI in FM and RA patients. We observed a negative correlation between SE and HAQ, pain, depression, fatigue, FIQ (FM), and CDAI (RA) in both groups. Conclusions Both LH and SE correlate significantly with functional capacity, perceived pain, disease activity, and disease impact in RA and FM patients. Learned helplessness was higher in patients with active disease or high disease impact, as opposed to those in remission or with low disease impact, and the reverse was true for SE. Patients with FM had significantly more LH, pain, fatigue, and depression and less SE compared with those with RA.

Resumen Objetivos Describir los hallazgos ecograficos en pacientes con artritis reumatoide (AR) en remision clinica y evaluar la capacidad de la ecografia con Doppler de poder (DP) para reclasificar la actividad de la enfermedad en este grupo de pacientes. Material y metodos Se incluyeron pacientes consecutivos con diagnostico de AR (criterios ACR/EULAR 2010) en remision clinica por DAS28 ( Resultados Se incluyeron 86 pacientes, de los cuales 23 (26,7%) tuvieron al menos una articulacion con senal DP positiva. Un 13% de los pacientes fueron reclasificados hacia baja actividad de la enfermedad aplicando el ECO-DAS28 cuando se consideraron activas las articulaciones con senal DP grado ≥ 1, el 12% cuando se considero actividad una senal DP ≥ 2 y el 2% de los pacientes cuando se considero la senal DP igual a 3. Ningun paciente se reclasifico a un nivel de moderada o alta actividad. Conclusiones A pesar de encontrar actividad inflamatoria residual por ecografia en aproximadamente un cuarto de los pacientes con AR en remision clinica, solo un bajo porcentaje fue reclasificado a un estado de baja actividad de la enfermedad y ninguno a un nivel de moderada o alta, aplicando los ECO-DAS28 propuestos.

The aim of the present study was to describe the ultrasound (US) findings in patients with rheumatoid arthritis (RA) in clinical remission, and to evaluate the ability of power Doppler (PD) US to reclassify disease activity in these patients.We included consecutive patients with RA according to 2010 American College of Rheumatology/European League Against Rheumatism criteria, who were in clinical remission by the Disease Activity Score (DAS282.6). Twenty joints of both hands were assessed by US. PD signal was evaluated on a semi-quantitative scale from 0 to 3. Three different US-modified DAS28 (US-DAS28) were constructed, replacing the clinical swollen joint count by the PD US joint count using PD score ≥1, ≥2 or ≥3, respectively.Eighty-six patients were included. Twenty-three (26.7%) patients had at least one joint with abnormal US-positive PD signal. Thirteen percent of patients were reclassified to low disease activity by applying the US-DAS28 when joints were considered active with a PD signal ≥1; 12%, when a PD signal ≥2 was considered, and 2% of the patients were reclassified when a PD score of 3 was considered. No patients were reclassified to a level of moderate or high activity applying US-DAS28.Although around a quarter of patients with RA in clinical remission showed PD US features indicating residual activity, only a small percentage were reclassified to a state of low activity and none to a level of moderate or high activity, applying the proposed US-DAS28.

Objective.To estimate incidence and prevalence rates of rheumatoid arthritis (RA) in the city of Buenos Aires (CABA), Argentina, using data from a university hospital–based health management organization.Methods.Global, age-specific, and sex-specific incidence and prevalence rates were calculated for members of the Hospital Italiano Medical Care Program (HIMCP), age ≥ 18 years. Incidence study followed members with continuous affiliation ≥ 1 year from January 2000 to January 2015 until he/she voluntarily left the HIMCP, RA was diagnosed, death, or study finalization. Cases from the Rheumatology Section database, electronic medical records, laboratory database, and pharmacy database were filtered with the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Prevalence was calculated on January 1, 2015, and standardized for CABA. Capture-recapture (C-RC) analysis estimated true population sizes.Results.In the study period, incidence rates (cases per 100,000 person-yrs) were 18.5 (95% CI 16.7–20.4) overall, 25.2 (95% CI 22.4–28.0) for women, and 8.8 (95% CI 6.8–10.8) for men. Prevalence rates (percentage of RA cases in the sample population) were 0.329 (95% CI 0.298–0.359) overall, 0.464 (95% CI 0.417–0.510) for women, and 0.123 (95% CI 0.093–0.152) for men. Standardized CABA prevalence rate was 0.300 (95% CI 0.292–0.307). C-RC adjusted rates were almost the same as unadjusted rates.Conclusion.This study’s incidence and prevalence rates are in the lower range of the rates found around the world. Our female to male prevalence ratio was 4:1. Our peak incidence age was in the sixth and seventh decades for both sexes.

Background It has been shown that there is a window of opportunity for treatment in Rheumatoid Arthritis (RA). Several Argentinean studies showed an average of 8 months to arrive to a rheumatology visit and 12 months to receive DMARDs. There aren9t recent studies. Objectives To establish delay time from onset of rheumatoid arthritis (RA) symptoms to the first rheumatology visit, to diagnosis of the disease and to the beginning of treatment with DMARDs; and to assess impact of such delay on structural damage, in a cohort of RA patients. Methods A retrospective study was performed including all patients with RA (fulfilling ACR/EULAR 2010 criteria) seen at a Prepaid Medical Health Plan between 2002–2015. Diagnosis delay and its impact on functional capacity measured by HAQ-A and structural damage by Sharp van der Hejde score (SvdH) was estimated. Demographic and clinical data, and dates ofdiagnosis, onset of symptoms and HAQ-A were extracted from electronic medical records. Svdh score was performed by an experienced rheumatologist. Results 246 patients (mean age at diagnosis 67.25±14 years, 199 (81%) female) were included. Clinical presentation was poliarticularin 49% of the cases, oligoarticularin 47% and monoarticular in 3%. 79% had high titers of anti-cyclic citrullinated peptide antibodies, 12% low titers, and 9% were negative. Rheumatoid factor was positive in 82.5%. Mean time of follow up was 7 years (SD: 3.8). At the end of the follow-up,median HAQ-A (n=145) was 0.125 (IRQ: 0–0.87). Hands and feet lastxray available were analized in 171 patients. Median Svdh score was 15 (IQR: 6–33). 242 patients (98.4%) received DMARDs as initial treatment: methotrexate monotherapy (76%) was the most frequent one. 41 patients (17%) received biological agents at some point of their disease. Table 1 shows different delay times in accessing rheumatology consultation, diagnosis and beginning of treatment. At the end of follow up, 21 patients (12.28%) had noradiological damage (Svdh score =0). In the ROC curve (AUC 0.57,95% CI: 0.45 - 0.69), 5.6 months of diagnosis delay was the best cut off valueto discriminate the presence of erosions (SvdH erosions score>0), with a sensitivity and specificity of 54.17% and 61.90%, respectively. Delay in diagnosis greater than 12 months (n=70) was associated with significantly radiological damage: Svdh mean 30.91 (IC 95% 21.99–39.79) vs 21.32 (IC 95% 16.93–25.72); p=0.0325. Conclusions In a Prepaid Medical Health Planwith ease of referral, there is still a significant delay in diagnosis and treatment of RA patients.Delay in diagnosis greater than 12 months was associated with more radiological damage. Disclosure of Interest None declared

To evaluate the association between learned helplessness (LH) and self-efficacy (SE) with disease activity, functional capacity, and level of pain in patients with rheumatoid arthritis (RA) and to compare LH and SE between patients in remission and patients with active disease.This multicentre, cross-sectional study included consecutive patients (aged ≥ 18 years) with RA according to 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria. LH was measured by the Rheumatology Attitude Index (RAI), Spanish version; SE with the Arthritis Self-efficacy Scale (ASES), Spanish version; functional capacity with the Health Assessment Questionnaire, Argentinian version (HAQ-A); and perceived pain by the visual analogue scale (VAS). Disease activity was measured by the Clinical Disease Activity Index (CDAI).A total of 115 patients (82% females) with a mean (± sd) age of 58 ± 13 years were included. We found a significantly positive correlation between LH and perceived pain (p 0.001), HAQ-A score (p 0.001), and CDAI (p 0.001) and a significantly negative correlation between SE and perceived pain (p 0.001), HAQ-A score (p 0.001), and CDAI (p 0.001). We found greater levels of SE and lower grades of LH in patients in remission compared to those with active disease (median 76 vs. 58; p 0.001 and 6 vs. 11; p 0.001, respectively).LH and SE correlated significantly with disease activity, functional capacity, and perceived pain. Levels of SE were higher in patients in remission compared to those with active disease as opposed to levels of LH, which were lower in patients in remission compared to those with active disease. These results show that cognitive factors are related to disease activity and their modifications may have importance in the management of RA.