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Resumen Antecedentes y objetivos La artritis psoriasica se acompana de una serie de comorbilidades cardiovasculares y metabolicas. La obesidad transcribe un estado de inflamacion sistemica de bajo grado. Ademas, es un predictor negativo de la respuesta al tratamiento. Nuestro objetivo es evaluar si existen interacciones entre el estado metabolico, los parametros inflamatorios y la actividad de la enfermedad. Tambien queremos comprobar si las enfermedades metabolicas o cardiovasculares tienen alguna asociacion con la reduccion de la carga inflamatoria mediante el tratamiento de la enfermedad. Material y metodo Hemos realizado un estudio descriptivo transversal de 160 pacientes con artritis psoriasica. Se recogieron variables sociodemograficas, clinicas y analiticas. Tambien se registro la presencia de dactilitis y entesitis, el HAQ, DAPSA y si se cumplen o no los criterios MDA. La prueba de chi-cuadrado y la H de Kruskall Wallis se utilizaron para realizar comparaciones, considerando p Resultados El IMC y el perimetro abdominal se correlacionan con la PCR y la VSG (significacion Discusion y conclusiones El tratamiento anti-TNFα podria reducir el riesgo cardiovascular en pacientes con artritis psoriasica. Puede haber niveles mas altos de PCR y VSG en personas obesas sin que esto implique necesariamente una mayor actividad de la enfermedad.

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.

To describe practice patterns, long-term outcome, and related factors, in relation to biological therapies tapering in rheumatoid arthritis (RA) patients in a well-controlled real-world setting.An observational longitudinal retrospective 10-year study was conducted in all RA patients receiving biological agents in an RA clinic from May 2003 to October 2013. Biological treatment of patients with sustained DAS283.2 or SDAI11 was tapered (dose down-titrated or interval widen) or discontinued as per practice protocol. Primary outcome of tapering was relapse, defined as an increase in DAS28≥1.2. Descriptive, survival analysis, and logistic regression analysis with first relapse as dependent variable were carried out.Of 193 RA patients on biological treatment (mean age 54±14 years, 81% women), tapering was applied in 106 (55%) and discontinuation in 34 (17.6%). During follow-up 38 patients relapsed (62%). Rate of relapse was 10% at 6 months, 19% at 12 months, 33.2% at 2 years and 50% after 5 years. Mean time in dose reduction was 4.5 years [95% confidence interval (95% CI): 3.7-5.3]. Six patients (15.7%) did not respond after reinstatement of full dose of biologic. In the multivariate analysis, pain [OR=1.26 (95% CI: 1.11-1.43); P.001] and erythrocyte sedimentation rate (ESR) [OR=1.01 (95% CI: 1.00-1.03); P=.011] at baseline were associated with relapse after tapering.Tapering may be considered a long-term option in RA patients on biologics and low disease activity, especially if low ESR and pain scores are present at baseline; treatment reinstatement could be considered a safe option in case of relapse.

Immunosuppressive and immunomodulatory treatments are critical for the management of inflammatory and autoimmune conditions such as psoriasis or psoriatic arthritis. Similar to those illnesses, the lung injury and acute respiratory distress shown in coronavirus disease 2019 (COVID‐19) patients are the result of a disruption in the balance of pro‐ and anti‐inflammatory cytokines. This hyperinflammatory response to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), associated with the severity of the coronavirus disease, is called the cytokine storm. There is a growing concern regarding how patients on immunosuppressant biologic therapies might be at higher risk of being infected and whether they need to discontinue their treatment preemptively. Clinical data on COVID‐19‐infected patients with psoriasis or psoriatic arthritis are still scarce. Here, we presented seven cases of these type of patients. The patient infected with COVID‐19 on apremilast and the one on apremilast with infected spouse showed the best safety profile and mildest symptoms. One of the secukinumab patients also presented a relatively good outcome. Infliximab patients and the one with serious comorbidities showed the worst outcome. Even though more clinical data are yet needed to draw strong conclusions, apremilast could be a safer alternative for dermatology and rheumatology patients in case of clinically important active infection.

Psoriatic arthritis is accompained by several cardiometabolic comorbidities. Obesity causes a low-grade systemic inflammation and is a negative predictor of treatment response. We wanted to evaluate if there are interactions between metabolic status, inflammatory parameters and disease activity; and whether metabolic or cardiovascular diseases have any association with the reduction of the inflammatory burden by treating the psoriatic arthritis.We have carried out a cross-sectional descriptive study of 160 patients with psoriatic arthritis. Sociodemographic, clinical and analytical variables were collected, as well as the presence of dactylitis and enthesitis; and HAQ, DAPSA and Minimal Disease Activity criteria. Chi-square test and the H of Kruskall Wallis were used to carry out comparisons, considering P.05 as statistically significant. To establish correlations, Pearson correlation coefficient was used.BMI and waist circumference correlate with CRP and ESR (significance:.05) although the correlation strenght is low (Pearson.4), but there is no such relationship with DAPSA or meeting MDA criteria. Using biologic therapies is associated with a lower prevalence of cardiovascular events (P = 0.047; OR: 0.12, 95% CI: 0.01-0.9) and enthesitis (P = .008; OR: 0.3, CI 95%: 0.16-0.56); and normal levels of CRP (P = .029; OR: 0.25, 95% CI: 0.07-0.87) and ESR (P = 0.024; OR: 0.36, 95% CI: 0.16-0.82) when comparing to conventional therapies.Anti-TNFα treatment could reduce cardiovascular risk in patients with psoriatic arthritis. There may be higher levels of CRP and ESR in obese individuals without this necessarily implying higher disease activity.

Background Patients with psoriasis arthritis (PsA) have heterogeneous clinical presentations, with diverse articular and dermatological features and varied disease courses and outcomes, so the assessment of disease activity implies important difficulties. Although the goal of treatment of PsA is to achieve remission, there is no a universally accepted definition. Objectives The purpose of this study was to assess agreement by experts on recommended disease activity assessment in PsA patients and to develop a consensus definition of clinical remission. Methods A modified Delphi approach was used as a consensus method. A scientific committee of experts provided 86 statements that were submitted in 2 rounds to a panel of 130 Spanish experts in PsA (in September and October 2018, respectively), addressing issues regarding the current assessment of remission, variables that should be included in the minimal assessment of PsA patients and the definition of remission, and the use of disease activity scores. Results The expert panel reached agreement for 53 proposed statements (61.6%). There was consensus that the definition of remission in PsA should include: the absence of signs and symptoms, physical well-being, the absence of impact of the disease, the absence of inflammation and progression in imaging tests (radiography and magnetic resonance) and the absence of inflammation measured by biomarkers (ESR, CRP). It is recommended to use some index designed specifically for the assessment of disease activity and the variables that should include the minimal assessment of PsA patients are: painful/swollen joints, enthesitis, dactylitis, axial involvement, skin and nail involvement, physical function, quality of life, structural damage assessed by imaging techniques, CRP, both patient and physician global assessment, both patient and physician skin assessment and extra-articular manifestations. The use of a treat-to-target (T2T) strategy should be considered in PsA patients, especially in those with a high risk of progression of structural damage. Although the ideal therapeutic goal is remission, there is consensus that low disease activity (LDA) is an acceptable goal. The most recommended tool to assess the disease activity in the clinic is DAPSA, with cut-off values of ≤ 4 for remission and > 4 to 14 for LDA. In patients who have reached the minimum activity of the disease, there was agreement in which the most suitable index was the MDA (Minimal Disease activity), with cut-off values of 5 to 7. ASDAS (or alternatively BASDAI) may be used in cases with axial involvement. There was also consensus to include the Psoriatic arthritis Impact of Disease questionnaire (PsAID) for the assessment of patients’ quality of life in follow-up consultations. The proposed definition of clinical remission in PsA is the absence of disease activity assessed using DAPSA or MDA (and/or aSDAS in patients with axial involvement), and the absence of later radiological progression. Conclusion On the basis of the available evidence and expert consensus, recommendations have been made for disease activity assessment in PsA and a proposal for definition of clinical remission was made that may be useful in the management of PsA patients Disclosure of interests None declared

Background: Patients with psoriatic arthritis (PsA) experience significant disability and reduced quality of life, resulting from the emotional distress and functional impairment associated with psoriatic skin lesions, as well as joint disease. Patient reported outcomes are important to evaluate healthcare interventions and to reflect the impact of PsA on patients’ lives. Objectives: The aims of the present study were to describe disease characteristics of PsA patients with an acceptable symptoms state (PsAID score Methods: Post-hoc analysis of data from a cross-sectional observational, multicenter study, aimed at evaluating the prevalence of MDA in a Spanish population with PsA, to describe their characteristics and to evaluate the association between MDA and the impact of the disease as assessed by the PsAID questionnaire. The original study included 227 adult patients of both genders diagnosed with PsA according to CASPAR criteria with at least one year of disease evolution and on treatment with biological and/or conventional synthetic disease modifying anti-rheumatic drugs (cDMARD). The PsAID questionnaire reflects the effect of PsA from the patient’s perspective. It is composed of 12 physical and psychological domains. PsAID score Results: 122 patients with a PsAID score A moderate relationship between HAQ Conclusion: There are discrepancies between the treatment goals (MDA) and the impact of disease as assessed by PsAID. Clinical characteristics such as DIP involvement, inflammatory load (PCR) and genetic factors (familial history) seem to be associated with a lower probability of being in an acceptable symptoms state in PsA patients. Disclosure of interests: Ruben Queiro Silva: None declared, Juan D. Canete: None declared, Susana Gomez Employee of: I am a current employee of Pfizer., ana Cabez Employee of: Pfizer

Background: Psoriatic arthritis (PsA) patients usually have a high prevalence of cardiovascular risk factors (CVRF) and cardiovascular events, which makes the routine estimation of cardiovascular risk (CVR) highly advisable. Currently, this risk is estimated through classic risk scores (SCORE, Framinghan), however, the values of these scores may underestimate the real CVR of these patients. On the other hand, in clinical decision making and when evaluating the therapeutic response, it is advisable the use of some composite activity index. The heterogeneity of PsA makes it difficult to estimate the real activity and the remission state, so it is important to assess which of these composite index is more suitable for these purposes in clinical practice. Objectives: We aimed to analyze whether carotid ultrasound is a useful tool for estimating CVR in patients with PsA, and if it is capable of correcting the estimated risk using classical tables. We also analyzed the usefulness of the MDA criteria and the DAPSA categories for clinical decision making in real practice. Methods: A cross-sectional study was conducted with 136 consecutive patients with PsA (CASPAR criteria). Sociodemographic and anthropometric data, CVRF, disease activity according to DAPSA categories, HAQ, MDA, and CVR measured by SCORE chart, was collected. An IMT> 800 μm and/or the presence of carotid plaque (Mannheim consensus), defined a high CVR by ultrasound. We analyzed the concordance (kappa) between the MDA response and the low activity and remission categories according to the DAPSA. Clinical variables of PsA associated with a high CVR were evaluated by multivariateanalyses. Results: Intima-media thickness values correlated well with CVR categories according to SCORE (p In the multivariate analysis, some characteristics of the disease were independently associated with a high CVR. This reveals that patients with enthesitis and/or structural damage are those who tend to have a high CVR. When comparing DAPSA and MDA criteria, we found a moderate correlation between the MDA response and the DAPSA low activity (κ = 0.52, p Conclusion: A high percentage of patients with low-moderate risk according to the SCORE risk chart are reclassified as patients with high CVR after the ultrasound examination. The high CVR in our population is related not only to classical CVRF, but also to the inflammatory load (enthesitis) and structural damage (erosions) of PsA. DAPSA is an appropriate instrument for clinical decision making in routine practice because it correlates reasonably well with stringent therapeutic goals such as MDA. Disclosure of interests: None declared

Background: Ustekinumab (UST) is a drug with proven efficacy in two randomized clinical trials in psoriatic arthritis -PsA- (PSUMMIT I and II). The data from these trials suggest that the 90 mg dose may be better than the 45 mg dose. Studies real world evidence (RWE) show that UST is effective and safe, nevertheless most of the evidence is base on the 45mg dose.1 Objectives: Our objective has been to check the effectiveness and safety of UST 90 mg in patients with PsA in RWE conditions. Methods: An observational study in RWE conditions was driven. We included 58 patients (37 women, 21 men, age 55 ± 8.7 years) with PsA from a single university hospital. All patients met CASPAR criteria. The observation period was from July 2017 to the present. All patients received the 90 mg dose from the beginning. The average BMI was 29.9 ± 4.41. 50% of patients were obese. To measure the disease activity, the DAPSA index was used. A descriptive statistic was performed and the McNemar test was used to analyse the mean change of the DAPSA (final-basal). A bivariate analysis was performed to identify associated factors with a DAPSA remission/low activity. Results: The duration of psoriasis was 14.8 ± 12.8 years, and 6.3 ± 6.5 years for the arthritis. 34.5% were oligoarticular forms, 13.8% polyarticular forms, and the remaining 51.7% were mixed forms. The distal interphalangeal joints synovitis was present in 38% of the patients and dactylitis in 24%. 17 patients were naive to biologic drugs (29.3%), UST was second line in 25.9%, third in 32.8%, fourth in 10.3% and fifth in 1.7% of patients. Half of the patients were treated with MTX. In the baseline situation, 9.4% had low activity, 75% had moderate activity, and 15.6% had high activity by DAPSA index. At the end of the analysis, 12.5% were in remission, 59.4% in low activity, and 28.1% in moderate activity, according to the DAPSA index. There were no patients in high activity. That is, 72% were in DAPSA remission/low activity. The average reduction of DAPSA was 9.53 ± 5.52 (McNemar’s p Conclusion: In this RWE series, UST 90 mg was effective and safe in 75% of our patients probability of achieving a remission/low activity state by DAPSA. References [1] Ustekinumab in psoriatic arthritis: need for studies from real-world evidence. Queiro R, Coto-Segura P. Expert Opin Biol ther. 2018 Sep;18(9):931-935. Disclosure of interests: None declared

Background: In the last years multiple genetic variants have been associated with autoimmune disease (AD) risk. However, much less is known on the association with important environmental factors like diet. Objectives: The objective of the present study is to characterize the dietary patterns of six prevalent ADs, including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE). Methods: A cross-sectional cohort of 11,621 individuals from Spain encompassing 1,949 RA, 2,186 psoriasis (PS), 1,437 PsA, 699 SLE, 1,415 ulcerative colitis (UC), 1,952 Crohn’s disease (CD) and 1,983 healthy controls, was recruited by the IMID-Consortium. The weekly consumption frequency of main food categories was recorded, together with drinking habits and smoking status. Multivariate linear models were used to test for association while adjusting for confounders. Results: Patients with AD targeting the digestive system showed the largest differences in comparison to controls. In the rheumatic ADs several food categories were also found to be consumed differently compared to controls. SLE had a high consumption of sweets and pastries, and RA ate more fruit and bread/wholegrain foods and less meat and cold cuts compared to controls. In PsA the dietary pattern differences with controls where milder, and non-overlapping with psoriasis. Disease activity was significantly associated with specific food categories in CD, UC and PS, mildly in RA and SLE, and PsA showed no association. High smoking cessation rates were observed in UC, CD and SLE, but not in Ps, RA and PsA. Tea/coffee and alcohol consumption was low in all ADs compared to controls. Conclusion: Our results show previously unreported associations with dietary habits in rheumatic ADs. Disclosure of Interests: Antonio Julia: None declared, Sergio Hilario Martinez: None declared, Jesus Tornero: None declared, Juan D. Canete: None declared, Antonio Fernandez-Nebro: None declared, Francisco Blanco: None declared, Jesus Rodriguez: None declared, Francisco J Lopez-Longo: None declared, Benjamin Fernandez-Gutierrez: None declared, Jordi Gratacos: None declared, Jose Javier Perez Venegas: None declared, Carolina Perez: None declared, Ruben Queiro Silva: None declared, Alejandro Olive: None declared, Mercedes Alperi-Lopez: None declared, Carlos A. Montilla-Morales: None declared, Jose Luis Andreu: None declared, Juan Carlos Torre-Alonso: None declared, M Angeles Aguirre-Zamorano: None declared, Hector Corominas: None declared, Paloma Vela Casasempere: None declared, Victor Martinez Taboada : None declared, Sara Manrique Arija Speakers bureau: ABBvie, MSD, Janssen, Lillly, Roche, Pfyzer, Novartis., Joan Miquel Nolla: None declared, Isidoro Gonzalez-Alvaro: None declared, Santiago Munoz-Fernandez: None declared, Jose Luis Marenco Speakers bureau: abbie, pfizer, novartis, janmsen, Carlos M. Gonzalez: None declared, Antonio Zea: None declared, Maria Lopez Lasanta: None declared, Daniel Roig: None declared, Jose M Pego-Reigosa: None declared, Mireia Lopez Corbeto: None declared, Pedro Zarco-Montejo: None declared, Mercedes Freire Gonzalez: None declared, Alba Erra: None declared, Elvira Diez Alvarez: None declared, Santos Castaneda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, Esther Rodriguez Almaraz: None declared, Alicia Garcia: None declared, Patricia Carreira: None declared, GEORGINA SALVADOR ALARCON: None declared, Cesar Diaz Torne Consultant for: Grunenthal, Speakers bureau: Grunenthal, Ricardo Blanco: None declared, Alfredo Willisch Dominguez: None declared, Jose Antonio Mosquera Martinez: None declared, Simon Sanchez Fernandez: None declared, Julio Ramirez: None declared, Sara Marsal: None declared

Resumen Objetivo Disenar una estrategia de deteccion y derivacion precoz de pacientes con posible espondiloartritis mediante el desarrollo de recomendaciones consensuadas dirigidas a los medicos de Atencion Primaria (AP). Metodos Se utilizo una metodologia modificada de RAND/UCLA y revision sistematica de la literatura. Se selecciono un grupo de discusion formado por reumatologos y medicos de AP. Se estudio el mapa del proceso y se propusieron recomendaciones y algoritmos que fueron sometidos a 2 rondas Delphi para evaluar el grado de aceptacion y preferencia de criterios en un grupo amplio de reumatologos y medicos de AP. Del analisis de la segunda ronda Delphi se extrajeron las recomendaciones finales. Resultados Se presentan recomendaciones, junto con su grado medio de acuerdo, para la derivacion rapida de pacientes con sospecha de espondiloartritis. En concreto, se recomienda investigar el dolor lumbar cronico en menores de 45 anos en 4 fases: 1) clinica: preguntas clave; 2) clinica: preguntas extra; 3) exploracion fisica, y 4) pruebas complementarias. Se debe derivar a Reumatologia si existen: 1) dolor lumbar inflamatorio; 2) signos indicativos de espondiloartritis, o 3) HLA B27 positivo, elevacion de proteina C reactiva o signos radiologicos de sacroilitis. Se incluyen recomendaciones sobre el proceso de derivacion y otras adicionales. Conclusiones El grado de acuerdo con estas sencillas recomendaciones es amplio. Es necesario disenar estrategias de formacion y sensibilizacion desde los servicios de Reumatologia para mantener una optima colaboracion de AP en la identificacion de los casos y facilitar que los servicios de Reumatologia esten preparados para asumir las derivaciones.

Supported by a grant from the Spanish Instituto de Salud Carlos III-Fondo Europeo de Desarrollo Regional (FEDER). (grant PI 13/00680- StatePlan I+D+I 2013-2016

Resumen Objetivo Establecer las caracteristicas diferenciales segun el sexo y el tiempo de evolucion de la enfermedad en aquellos pacientes diagnosticados de espondilitis anquilosante (EA) asistidos en consultas de reumatologia de toda Espana, incluidos en el Registro Espanol de Espondiloartritis (REGISPONSER), asi como la repercusion diagnostica y terapeutica que ello conlleva. Pacientes y metodos Estudio transversal y observacional de 1.514 pacientes con EA seleccionados de entre 2.367 con espondiloartritis incluidos en REGISPONSER. En cada paciente se evaluaron y registraron de modo exhaustivo los datos demograficos, epidemiologicos, sociosanitarios, clinicos, analiticos, radiologicos y terapeuticos previstos en el protocolo de REGISPONSER que componen el Conjunto Minimo Basico que identifica la enfermedad. La funcion fisica se evaluo mediante «Bath Ankylosing Spondylitis Functional Index». La actividad clinica mediante velocidad de sedimentacion globular, proteina C reactiva y «Bath Ankylosing Spondylitis Disease Activity Index» (BASDAI). A cada paciente se le realizaron radiografias anteroposterior de pelvis, anteroposterior y lateral de columna lumbar y lateral de columna cervical, y se puntuaron segun el indice «Bath Ankylosing Spondylitis Radiographic Index Spine» (BASRI-Spine), que mide el dano estructural. Resultados De los 1.514 pacientes seleccionados, 1.131 (74.7%) eran hombres. Encontramos que existen diferencias significativas en la edad tanto al inicio de los sintomas como en el dia de la inclusion entre ambos grupos, siendo menor en los hombres. Tambien obtuvimos diferencias en el tiempo de evolucion de la enfermedad, que fue menor en el grupo de las mujeres. En cuanto a la existencia de antecedentes de EA entre los familiares de primer grado, las formas familiares fueron mas frecuentes entre las mujeres, tambien resulto superior en estas la puntuacion media del BASDAI, con independencia del tiempo de evolucion. Por el contrario, la mejoria del dolor con la toma de antiinflamatorios no esteroideos fue mayor en el caso de los hombres, asi como la severidad radiologica, ambas de forma significativa. Conclusiones Entre los pacientes con EA espanoles existen algunas diferencias en las manifestaciones clinicas y cuando se controlo segun el tiempo de evolucion, tambien encontramos diferencias radiologicas segun el sexo; los hombres muestran mas dano estructural, mientras que las mujeres presentan mayor actividad. Estos datos sugieren que el fenotipo de EA difiere entre generos, lo que puede influir en el manejo diagnostico y posterior eleccion terapeutica.

Objetivo Dada la gran cantidad de informacion actual sobre el uso de terapias biologicas (TB) en la artritis psoriasica (APs), y la variabilidad de la misma en cuanto a su calidad, desde la Sociedad Espanola de Reumatologia (SER) se ha impulsado la generacion de recomendaciones basadas en la mejor evidencia posible. Estas deben de servir de referencia para reumatologos e implicados en el tratamiento de APs que vayan a utilizar o consideren la utilizacion de TB. Metodos Las recomendaciones se emitieron siguiendo la metodologia de grupos nominales y basadas en revisiones sistematicas. El nivel de evidencia y el grado de recomendacion se clasificaron segun el modelo del Center for Evidence Based Medicine de Oxford y el grado de acuerdo se extrajo por tecnica Delphi. Resultados Se realizan recomendaciones sobre el uso de las TB disponibles en la actualidad en nuestro pais para el tratamiento de la APs. Estas recomendaciones incluyen la evaluacion de la enfermedad, objetivos del tratamiento, esquema terapeutico y cambios en el mismo. Conclusiones Se presentan las actualizaciones a las recomendaciones SER para el uso de TB en pacientes con APs

Objective Due to the amount and quality variability regarding the use of biologic therapy (BT) in psoriatic arthritis (PsA) patients, the Spanish Society of Rheumatology (SER) has promoted the generation of recommendations based on the best evidence available. These recommendations should serve as reference to rheumatologists and those involved in the treatment of patients with PsA, who are using, or about to use BT. Methods Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and degree of recommendation was classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Results We have produced recommendations for the use of TB currently available for PsA in our country. These recommendations include disease assessment, treatment objectives, therapeutic scheme and switching. Conclusions We present an update on the SER recommendations for the use of BT in patients with PsA.

Resumen Bajo el termino de espondiloartropatia, designamos un grupo de diversas entidades reumatologicas inflamatorias cronicas, caracterizadas por la afectacion de las articulaciones sacroiliacas y de la columna vertebral, oligoartritis asimetrica de predominio en extremidades inferiores, entesitis, negatividad del factor reumatoide, y asociacion con el antigeno HLA-B27, entre otras manifestaciones. Bajo este epigrafe incluimos patologias como la espondilitis anquilosante, la artritis psoriasica, las artritis reactivas, las artritis asociadas a enfermedad inflamatoria intestinal, y las espondiloartropatias indiferenciadas. Definimos comorbilidad como la presencia simultanea de 2 o mas enfermedades en una misma persona. Como tal, el estudio de las comorbilidades asociadas a las enfermedades de base inmunoinflamatoria ha crecido en interes en los ultimos anos, sobre todo por la morbimortalidad asociada que ello conlleva en esta poblacion de pacientes. A pesar de que el uso de las nuevas terapias biologicas ha supuesto un mejor control de los pacientes con espondiloartropatias, aun existen una serie de patologias asociadas o comorbilidades que pueden ensombrecer el pronostico de dichos pacientes. Realizaremos una breve descripcion de las comorbilidades relacionadas con las espondiloartropatias, siendo quiza la mas descrita en la literatura cientifica la patologia cardiovascular, sin restar importancia a otras patologias como la osteoporosis y el sindrome metabolico, entre otras.

Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects mainly young men. This disease can affect axial and peripheral joints as well as specific organs, thus impairing quality of life in these patients. There are three types of treatment interventions in these patients: medical treatment, surgical treatment and physical-rehabilitation therapy. Physical-rehabilitation therapy includes distinct modalities such as hydrotherapy, electrothermotherapy, massage, rest, ergotherapy and physical therapy (PT). Among these options, PT is the most important in the treatment of AS. The main objective of PT is to preserve the normal range of movement in affected joints, depending on the stage of the disease. In this setting, many exercises for peripheral and axial joints can be performed, through rehabilitation, breathing exercises and mildly aerobic sports. Although comparison of the results of different PT interventions is difficult, a review of the literature on this subject reveals that spa-exercise therapy is better than supervised group PT, and that the latter is better than individualized PT in the home. Several extrinsic factors influence the results of the above-mentioned interventions. A clear finding is that benefits are obtained if exercise is consistently performed.

Objective To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. Methods We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. Results We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years could be performed in four phases (1) clinical: key questions, (2) clinical: extra questions, (3) physical examination, and (4) additional tests. Conclusions The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments.

To describe the differential characteristics by gender and time since disease onset in patients diagnosed with ankylosing spondylitis (AS) attending the Spanish rheumatology clinics, including those on the "Spanish Registry of spondyloarthritis" (REGISPONSER), as well as the diagnostic and therapeutic implications that this entails.This is a transversal and observational study of 1514 patients with AS selected from 2367 spondyloarthritis cases included in REGISPONSER. For each patient, the demographics, epidemiology, geriatric, clinical, laboratory, radiological, and therapeutic aspects were were evaluated and comprehensively recorded under the aegis of REGISPONSER, constituting the Minimum Basic identifying data for the disease. Physical function was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Clinical activity was evaluated using erythrocyte sedimentation rate, C reactive protein and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Each patient underwent pelvic anteroposterior, anteroposterior and lateral lumbar spine as well as lateral cervical spine x rays; they were scored according to the Bath Ankylosing Spondylitis Spine Radiographic Index, which measures structural damage.Of the 1514 patients screened, 1131 (74.7%) were men. We found significant differences in age at onset of symptoms as well as in the day of inclusion, between the two groups, being lower in men. We also obtained differences in the duration of the disease, which was lower in women. As for the existence of a history of AS among first-degree relatives, family forms were more common among women. The mean BASDAI score was also higher in women, regardless of time since onset of disease. In contrast, the improvement of pain with the use of NSAID's and radiological severity were higher in men, both reaching statistical significance.Among the Spanish AS patients, there are some differences in the clinical manifestations, even when the time since onset of disease was controlled; we also found radiological differences by gender; men showing more structural damage, while women were more active. These data suggest that the phenotype of AS differs between genders. This can influence the subsequent diagnostic approach and therapeutic decisions.