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Carolina Ochôa Matos,1,2 Filipe Cunha-Santos,3,* Augusto Silva,1,2,* Miguel Alpalhão,4,5 Paulo Filipe,4,5 João Eurico Fonseca,1,2 Carlos Miranda Rosa,1 Joana Antunes,4,5 Elsa Vieira-Sousa1,2 1Rheumatology Department, Unidade Local de Saúde de Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal; 2Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal; 3Rheumatology Department, Unidade Local de Saúde da Guarda - Hospital Sousa Martins, Guarda, Portugal; 4Dermatology Department, Unidade Local de Saúde de Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal; 5Dermatology University Clinic, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal*These authors contributed equally to this workCorrespondence: Carolina Ochôa Matos, Hospital de Santa Maria, Rheumatology Department, Avenida Professor Egas Moniz, Lisboa, 1649-035, Portugal, Tel +351 217805139, Fax +351217805610, Email carolinaochoamatos@gmail.comPurpose: Psoriatic arthritis (PsA) and psoriasis (Pso) are highly heterogeneous inflammatory diseases. Multidisciplinary approaches are associated with improved results in both musculoskeletal (MSK) and skin manifestations. We describe the experience and main diagnostic and therapeutic outcomes of one of the largest and longest-running Rheumatology/Dermatology multidisciplinary PsA Clinic.Methods: Single center, cross-sectional study of all patients observed at the PsA Clinic of Hospital de Santa Maria, Portugal, between November 2010 and February 2021. The total number of visits/ patients, demographics, referral indications, and definite skin and MSK diagnosis were registered. In patients with PsA confirmed diagnosis, PsA and Pso characteristics, previous treatments and their modifications were captured using Reuma.pt.Results: Eight hundred and two visits were performed, corresponding to 505 patients, 51.3% female, with a mean age of 51.0 ± 13.8 years. The main indication for referral was diagnosis uncertainty (56.4%), and a definitive PsA diagnosis was established in 28.9% of these cases. For patients in whom PsA was not identified, the main alternative diagnoses were osteoarthritis [peripheral (n = 70) or axial (n = 29)], fibromyalgia (n = 22), axial spondylarthritis without Pso (n = 21), tendinitis/enthesitis (n = 20), and carpal tunnel syndrome (n = 19). The main alternative dermatological diagnoses were seborrheic dermatitis (n = 15), nail dystrophy not due to Pso (n = 15), onychomycosis (n = 14) and eczema (n = 9). In patients with confirmed PsA (n = 308), 54.5% had already been treated with disease-modifying antirheumatic drugs (DMARD), and 15.9% had received at least one biologic DMARD. Treatment was modified in 78.9% of PsA patients, 58.0% due to uncontrolled skin activity, 34.5% MSK activity, and 7.7% both. Most of the treatment changes occurred due to lack of efficacy (56.4%).Conclusion: This study shows the impact, through diagnostic precision (by increasing the number of psoriatic and non-psoriatic definite diagnoses), and treatment modifications, for skin and MSK manifestations, from over 10 years of the implementation of a multidisciplinary PsA Clinic.Keywords: psoriatic arthritis, psoriasis, multidisciplinary clinic, rheumatology, dermatology

Ana Teresa Melo,1,2,* Eduardo Dourado,1,2,* Raquel Campanilho-Marques,1,2,* Matilde Bandeira,1,2 Sofia C Barreira,1,2 José Costa,3 Rita Pimenta,4 Sofia Antunes-Duarte,4 Inês Cordeiro,1,2 João E Fonseca1,2 1Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; 2Rheumatology Investigation Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; 3Physical Medicine and Rehabilitation Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; 4Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal*These authors contributed equally to this workCorrespondence: Ana Teresa Melo, Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, EPE, R. Prof. Egas Moniz, Lisboa, 1700, Portugal, Tel +351 217805139, Email anateresamelo@campus.ul.ptBackground: Idiopathic inflammatory myopathies (IIM) are a rare heterogeneous group of diseases characterised by chronic skeletal muscle inflammation, but other organs are also frequently involved. IMM represent a diagnostic challenge and a multidisciplinary approach is important to ensure successful diagnosis and adequate follow-up of these patients.Objective: To describe the general functioning of our multidisciplinary myositis clinic, highlighting the benefits of multidisciplinary team management in patients with confirmed or suspected IIM and to characterise our clinical experience.Methods: Description of the organization of a dedicated multidisciplinary myositis outpatient clinic, supported by IMM specific electronic assessment tools and protocols based on our Portuguese Register - Reuma.pt. In addition, an overview of our activity between 2017 and 2022 is provided.Results: An IIM multidisciplinary care clinic, based on a close collaboration between Rheumatologists, Dermatologists and Physiatrist is detailed in this paper. One hundred and eighty-five patients were assessed in our myositis clinic; 138 (75%) of those were female, with a median age of 58 [45– 70] years. At the last appointment, 130 patients had a confirmed IIM diagnosis, and the mean disease duration was 4 [2– 6] years. The most frequent diagnosis was dermatomyositis (n = 34, 26.2%), followed by antisynthetase syndrome (n = 27, 20.8%) and clinically amyopathic/paucimyopathic dermatomyositis (n = 18, 13.8%). Twenty-four patients (18.5%) were on monotherapy and 94 (72.3%) were on combination therapy.Conclusion: A multidisciplinary approach is important to ensure the correct diagnosis and follow-up of these patients. A myositis clinic, with a standardised practice at a tertiary hospital level, contributes to a standardization of care and opens research opportunities.Keywords: inflammatory myopathies, rheumatology, dermatology, rehabilitation medicine, multidisciplinary clinic

Carolina Zinterl,1– 3 Patrícia Costa-Reis,1,4,5 Isabel Castro Esteves,5 José Gonçalo Marques,5 Ana Berta Sousa,5,6 João Eurico Fonseca,2,3 Filipa Oliveira Ramos1– 3 1Pediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; 2Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; 3Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; 4Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; 5Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; 6Department of Basic Immunology, Faculty of Medicine, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, PortugalCorrespondence: Carolina Zinterl, Serviço de Reumatologia, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, EPE, R. Prof. Egas Moniz, Lisboa, 1700, Portugal, Tel +351 217805139, Email carolina.zinterl@chln.min-saude.ptBackground: Systemic autoinflammatory diseases (SAID) are characterized by inappropriate activation of the innate immune system and include not only monogenic periodic fever syndromes but also multifactorial conditions. As SAID are rare and represent a diagnostic challenge, a multidisciplinary approach is important to ensure successful diagnosis and adequate follow-up of these patients.Objective: To describe the organization of our multidisciplinary SAID clinic and to characterize our clinical experience, highlighting the benefits of multidisciplinary team management.Methods: Our SAID clinic takes place monthly and is managed by pediatric rheumatologists closely collaborating with pediatricians specialized in infectious diseases and immunodeficiencies and one medical geneticist. Patients’ data are systematically incorporated in the Rheumatic Diseases Portuguese Register (Reuma.pt). Biological samples are stored in a biobank. We describe our clinical experience based on SAID patients registered into Reuma.pt/SAID between July 2011 and June 2020.Results: We have registered 176 patients, with a median age of disease onset of 3.1 ± 4.4 years and median age at disease diagnosis of 4.7 ± 4.0 years. Most patients were diagnosed with periodic fever, aphthous stomatitis, pharyngitis, adenitis syndrome (PFAPA) (n=133), 20 with undefined SAID (uSAID) and 13 with monogenic SAID, including familial Mediterranean fever (FMF) (n=5), tumor necrosis factor receptor-associated periodic syndrome (TRAPS) (n=1), cryopyrin-associated periodic disease (CAPS) (n=1), and hyperimmunoglobulin D syndrome/mevalonate kinase deficiency (HIDS/MKD) (n=2). A genetic test was performed in 31 patients (18%), and in 26% of these a mutation responsible for the phenotype was found. Thirty-four patients (19%) achieved remission.Conclusion: FMF was the most common monogenic SAID and the percentage of patients with an identified causal mutation was low. A structured electronic clinical record coupled with a biobank and a multidisciplinary approach are crucial to ensure successful diagnosis and adequate follow-up of these patients.Keywords: pediatrics, rheumatology, systemic autoinflammatory syndromes

Inês Leal,1,2 Vasco C Romão,3,4 Sofia Mano,1,2 Nikita Khmelinskii,3,4 Raquel Campanilho-Marques,3,4 Cristina Ponte,3,4 Carla Macieira,3 Filipa Oliveira-Ramos,3,4 Elsa Vieira-Sousa,3,4 Carlos Miranda Rosa,3 Walter Rodrigues,1,2 Luís Abegão Pinto,1,2 Carlos Marques-Neves,1,2 João Eurico Fonseca3,4 1Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; 2Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; 3Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal; 4Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, PortugalCorrespondence: Inês LealHospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte Fax +351 21 780 5653Email ines.leal@chln.min-saude.ptAbstract: Non-infectious uveitis (NIU) is a group of sight-threatening diseases that generates significant burden for the healthcare systems due to its adverse outcomes, irreversible structural complications in the eye with loss of visual function, limited clinical expertise and low-grade evidence for best practice. The usefulness of multidisciplinary care, specifically close collaboration between Rheumatologists and Ophthalmologists in NIU, has been emphasized in the literature. In this paper, the assessment tools and protocols used in our clinic are depicted and an overview of our activity with a brief description of the patients included in our registry, between 2018 and 2020 is provided. The cohort of 290 patients assessed in our NIU clinic, their demographics, sources of referral, details about immunosuppression treatment, and internal and external collaborations is described. This experience-based manuscript aims to describe the general functioning of our multidisciplinary NIU clinic, highlighting the benefits and drawbacks of multidisciplinary team management in patients with NIU, ultimately initiating a dialogue on what an NIU clinic should be and providing information for newly NIU clinics start-up. In conclusion, establishing a standardized and multidisciplinary clinic in NIU allows to systematically observe and follow-up this infrequent disease at a tertiary hospital level, thus improving quality of care delivery and research avenues.Keywords: uveitis, ophthalmology, rheumatology