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Published by Elsevier Ltd., Background: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. Methods: In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. Findings: 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m3 [95% CI 1·01-1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10-1·30]; p, MAG is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K01 AR070585 and K24 AR074534 [JY]). KDW is supported by the Department of Veterans Affairs and the Rheumatology Research Foundation Scientist Development award. JAS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253, and P30 AR072577), the Rheumatology Research Foundation (K Supplement Award and R Bridge Award), the Brigham Research Institute, and the R. Bruce and Joan M. Mickey Research Scholar Fund. NJP is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32-AR-007258). AD-G is supported by grants from the Centers for Disease Control and Prevention and the Rheumatology Research Foundation. RH was supported by the Justus-Liebig University Giessen Clinician Scientist Program in Biomedical Research to work on this registry. JY is supported by grants from the National Institutes of Health (K24 AR074534 and P30 AR070155).

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has registered more than 234 million confirmed cases and more than 4.7 million deaths throughout the world until October 2, 2021. During the last few months, a significant number of reports of COVID-19 in patients with rheumatic diseases have been published. In this study the objective is to report the clinical characteristics of Chilean patients with rheumatic diseases and COVID-19 reported in the “Global Rheumatology Alliance” (GRA) physician registration platform.MethodsChilean patients with rheumatic diseases and COVID-19 were included in the Covid-19 GRA physician-reported registry.Results54 patients were included. The most common primary rheumatic disease was rheumatoid arthritis (RA) with 28 cases (51.9%). 30 patients (55.6%) used corticosteroids, of which 20 (66.7%) used a dose of 10 mg or less. 33 patients (61.1%) only used conventional DMARDs, 4 (7.4%) only biological, and 6 (11.1%) the combination. A total of 35 patients (64.8%) had to be hospitalized. 2 patients (3.7%) died. 26 patients of the 35 hospitalized (74.2%) required some type of ventilatory support, of which 5 (19.2%) required non-invasive and 8 (30.8%) invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO).DiscussionMost of included Chilean rheumatic patients were hospitalized, with a low mortality rate but with a high percentage of patients requiring at least non-invasive mechanical ventilation.Key Points-The most common primary rheumatic disease was rheumatoid arthritis (RA) followed by lupus (LES)-Most of the included Chilean rheumatic patients were hospitalized, with a high percentage of patients requiring at least non-invasive mechanical ventilation, but with a low mortality rate.-Worsening of arthralgias or activation of the rheumatic disease was not reported.

In psoriatic arthritis and spondyloarthritis, there is still room for new drugs, with different mechanisms of action, that allow better personalization of treatment. The objective of this review is to facilitate the clinician's decision to use tofacitinib, upadacitinib, or guselkumab, new treatment alternatives within the wide variety of drugs currently available

Na artrite psoriática e na espondiloartrite, ainda há espaço para novos fármacos, com diferentes mecanismos de ação, que permitam melhor personalização do tratamento. O objetivo desta revisão é facilitar a decisão do clínico de usar tofacitinibe, upadacitinibe ou guselkumabe, novas alternativas de tratamento dentro da ampla variedade de medicamentos disponíveis atualmente

En artritis psoriásica y espondiloartritis existe aún espacio para nuevos medicamentos, con distintos mecanismos de acción, que permitan personalizar mejor el tratamiento. El objetivo de esta revisión es facilitar al clínico la decisión de utilizar tofacitinib, upadacitinib, o guselkumab, nuevas alternativas de tratamiento dentro de la gran variedad de fármacos disponibles actualmente.

espanolObjetivo Desarrollar un documento de consenso para estandarizar los terminos, abreviaturas y acronimos en espanol empleados en el campo de las espondiloartritis (EspA). Metodos Se creo un grupo de trabajo internacional compuesto por todos los miembros de Assessment of SpondyloArthritis International Society (ASAS) nativos de habla espanola, miembros del comite ejecutivo del Grupo para el estudio de la Espondiloartritis de la Sociedad Espanola de Reumatologia (GRESSER), 2 metodologos, 2 linguistas de la Real Academia Nacional de Medicina de Espana (RANM) y 2 pacientes de la Coordinadora Espanola de Asociaciones de Espondilitis (CEADE). Se realizo una revision de la literatura de los ultimos 15 anos (publicaciones, el CIE y CIF, guias, consensos y recomendaciones) para identificar los terminos, abreviaturas y acronimos discrepantes. Mediante un Delphi de 3 rondas y una reunion presencial, se discutieron, seleccionaron y acordaron los terminos, abreviaturas y acronimos a utilizar. Durante todo este proceso se siguieron las recomendaciones de la RANM basadas en el Diccionario panhispanico de terminos medicos. Resultados Se consensuaron 46 terminos, abreviaturas y acronimos. Se acepto la traduccion al espanol para 6 terminos y 6 abreviaturas empleados para nombrar o clasificar la enfermedad y para 6 terminos y 4 abreviaturas relacionados con las EspA. Se acordo no traducir 15 acronimos por estar ya establecidos, pero al mencionarlos, se recomendo seguir esta estructura: tipo de acronimo en espanol y acronimo y forma extensa en ingles. Con respecto a 7 terminos o abreviaturas asociados a acronimos, se acordo traducir solo la forma extensa y se consensuo una traduccion. Conclusiones Con esta estandarizacion del lenguaje de las EspA se pretende establecer un uso comun de la nomenclatura en espanol para las EspA. Su implementacion sera muy beneficiosa, evitando malentendidos y consumo de recursos. EnglishObjective To develop a consensus to standardize the use of Spanish terms, abbreviations and acronyms in the field of spondyloarthritis (SpA). Methods An international task force comprising all native Spanish-speaking Assessment of SpondyloArthritis International Society (ASAS) members, the executive committee of Grupo para el estudio de la Espondiloartritis de la Sociedad Espanola de Reumatologia (GRESSER), two methodologists, two linguists from the Real Academia Nacional de Medicina de Espana (RANM) and two patients from the Spanish Coordinator of Spondylitis Associations (CEADE) was established. A literature review was performed to identify the conflicting terms/abbreviations/acronyms in SpA. This review examined written sources in Spanish including manuscripts, ICF and ICD, guidelines, recommendations and consensuses. This was followed by a nominal group meeting and a three-round Delphi. The recommendations from the RANM based on the Panhispanic dictionary were followed throughout the process. Results Consensus was reached for 46 terms, abbreviations or acronyms related to the field of SpA. A Spanish translation was accepted for 6 terms and 6 abbreviations to name or classify the disease, and for 6 terms and 4 abbreviations related to SpA. It was agreed not to translate 15 acronyms into Spanish. However, when mentioning them, it was recommended to follow this structure: type of acronym in Spanish and acronym and expanded form in English. With regard to 7 terms or abbreviations attached to acronyms, it was agreed to translate only the expanded form and a translation was also selected for each of them. Conclusions Through this standardization, it is expected to establish a common use of the Spanish nomenclature for SpA. The implementation of this consensus across the community will be of substantial benefit, avoiding misunderstandings and time-consuming processes.

The financial coverage granted by law in Chile for patients with psoriatic arthritis who require biological treatment is of paramount importance and a great advance. However physicians must be knowledgeable about the advantages and limitations of this therapy. The challenge of clinicians is to choose the drug with the greater odds of achieving therapeutic success, with less adverse events and lower costs for our health system. This article aims to help doctors to select the best biological treatment for a specific patient, trying to optimize its effectiveness, minimizing adverse effects, always looking for an efficient use of resources.

Summary Background Patients with primary systemic vasculitis or polymyalgia rheumatica might be at a high risk for poor COVID-19 outcomes due to the treatments used, the potential organ damage cause by primary systemic vasculitis, and the demographic factors associated with these conditions. We therefore aimed to investigate factors associated with COVID-19 outcomes in patients with primary systemic vasculitis or polymyalgia rheumatica. Methods In this retrospective cohort study, adult patients (aged ≥18 years) diagnosed with COVID-19 between March 12, 2020, and April 12, 2021, who had a history of primary systemic vasculitis (antineutrophil cytoplasmic antibody [ANCA]-associated vasculitis, giant cell arteritis, Behcet's syndrome, or other vasculitis) or polymyalgia rheumatica, and were reported to the COVID-19 Global Rheumatology Alliance registry were included. To assess COVID-19 outcomes in patients, we used an ordinal COVID-19 severity scale, defined as: (1) no hospitalisation; (2) hospitalisation without supplemental oxygen; (3) hospitalisation with any supplemental oxygen or ventilation; or (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs), adjusting for age, sex, time period, number of comorbidities, smoking status, obesity, glucocorticoid use, disease activity, region, and medication category. Analyses were also stratified by type of rheumatic disease. Findings Of 1202 eligible patients identified in the registry, 733 (61·0%) were women and 469 (39·0%) were men, and their mean age was 63·8 years (SD 17·1). A total of 374 (31·1%) patients had polymyalgia rheumatica, 353 (29·4%) had ANCA-associated vasculitis, 183 (15·2%) had giant cell arteritis, 112 (9·3%) had Behcet's syndrome, and 180 (15·0%) had other vasculitis. Of 1020 (84·9%) patients with outcome data, 512 (50·2%) were not hospitalised, 114 (11·2%) were hospitalised and did not receive supplemental oxygen, 239 (23·4%) were hospitalised and received ventilation or supplemental oxygen, and 155 (15·2%) died. A higher odds of poor COVID-19 outcomes were observed in patients who were older (per each additional decade of life OR 1·44 [95% CI 1·31–1·57]), were male compared with female (1·38 [1·05–1·80]), had more comorbidities (per each additional comorbidity 1·39 [1·23–1·58]), were taking 10 mg/day or more of prednisolone compared with none (2·14 [1·50–3·04]), or had moderate, or high or severe disease activity compared with those who had disease remission or low disease activity (2·12 [1·49–3·02]). Risk factors varied among different disease subtypes. Interpretation Among patients with primary systemic vasculitis and polymyalgia rheumatica, severe COVID-19 outcomes were associated with variable and largely unmodifiable risk factors, such as age, sex, and number of comorbidities, as well as treatments, including high-dose glucocorticoids. Our results could be used to inform mitigation strategies for patients with these diseases. Funding American College of Rheumatology and the European Alliance of Associations for Rheumatology.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ., Objectives: To determine factors associated with COVID-19-related death in people with rheumatic diseases. Methods: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. Results: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. Conclusion: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

The body composition and fat distribution is different between men and women, with different levels of circulating adipokines. These differences become more evident when suffering from an inflammatory disease, such as spondyloarthritris. In this review, we will explore the influence of obesity, body composition and adipokines on the differences in disease activity, progression and response to treatment, between men and women with spondyloarthritis.Obesity, mainly determined by the body fat content, which is higher in women, is related to worse disease activity scores. Men with higher disease activity lose more muscle mass than women. Leptin, which is usually found at higher levels in overweight women, seems to be associated with greater spinal radiographic progression when it rises during the course of the disease. Being a woman and obesity, mainly because of the body fat content, are related to a worse response to TNF-α blockers.Overlooking biological sex variation in body composition, circulating adipokines and hormonal levels, and the subsequent differences in clinical presentation, may ultimately hamper clinical treatment.

The financial coverage granted by law in Chile for patients with psoriatic arthritis who require biological treatment is of paramount importance and a great advance. However physicians must be knowledgeable about the advantages and limitations of this therapy. The challenge of clinicians is to choose the drug with the greater odds of achieving therapeutic success, with less adverse events and lower costs for our health system. This article aims to help doctors to select the best biological treatment for a specific patient, trying to optimize its effectiveness, minimizing adverse effects, always looking for an efficient use of resources.

Background Axial spondyloarthritis (axSpA) can be associated with significant burden and impaired work activity. In Chile, several barriers impede adequate treatment, such as insufficient access to specialists and biological treatment. Furthermore, there is an important lack of insight into the local situation. This hampers the development of adequate national treatment standards and financial support. Objectives 1. To evaluate the disease burden, quality of life and work participation in Chilean axSpA patients. 2. To assess gender differences in disease burden and 3) compare patients with and without biologics. Methods A cross sectional online survey among Chilean SpA patients, recruiting via the internet website and associated social media of the Chilean SpA Patient Foundation (“Espondilitis Chile”). The survey was written in Spanish and requested information, mostly via multiple choice options, on gender, age, disease characteristics (diagnosis, disease duration, treatment), disease burden (BASDAI and BASFI), quality of life (ASAS Health Index) and work participation (WPAI). Only axSpA patients were included for further analyses. The association between BASDAI, quality of life or work participation (presenteeism, absenteeism) and subgroups (gender, biologics) was assessed through univariable regression and subsequently multivariable regression analyses, correcting for age, disease duration and concomitant treatment (NSAIDs, DMARDs, opiates). Results Between July and October 2018, 625 patients completed the website survey, of whom 472 reported a diagnosis with axSpA (91% radiographic axSpA, 37% male, mean age 42 years, 83% BASDAI≥4, table 1). Twenty percent used a biological and patients with biologics were more likely to have a paid job (p=0.01) and had significantly lower BASDAI, BASFI, ASAS HI and risk of absenteeism. In multivariable analyses, biologics remained significantly associated with a lower BASDAI. Interestingly, biologics were used significantly more often in male patients compared to females (26% versus 16%, p Conclusion The results of the web survey demonstrate a high level of disease burden and work impairment in Chilean axSpA patients. The use of biologics is low, although its use is independently associated with having a lower disease activity. Women used significantly less biologics despite reporting a worse disease state (BASDAI, ASAS HI) and greater work disability, suggesting inequality in access to treatment. Acknowledgement This study was conducted with help of the Chilean spondyloarthritis patient foundation ”Espondilitis Chile”. Disclosure of Interests Sebastian Ibanez Consultant for: Novartis, Paid instructor for: Bristol Myers Squibb, Speakers bureau: Abbvie, Rianne van Bentum: None declared, Omar Valenzuela Consultant for: Novartis, Paid instructor for: Bristol Myers Squibb, Speakers bureau: Abbvie, Irene van der Horst-Bruinsma Grant/research support from: MSD, Pfizer, AbbVie, Consultant for: Abbvie, UCB, MSD, Novartis, Speakers bureau: BMS, AbbVie, Pfizer, MSD

Background:Patients with a diagnosis of Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA) may have predominant axial or peripheral symptoms, and the frequency and distribution of these symptoms may determine the clinical diagnosis by the rheumatologist (“clinical clusters”). Clustering analysis represents an unsupervised exploratory analysis which tries to identify homogeneous groups of cases (“statistical clusters”) without prior information about the membership for any of the cases.Objectives:To identify “statistical clusters” of peripheral involvement according to the specific location of these symptoms in the whole spectrum of SpA and PsA (without prior information about the diagnosis of the patients), and to evaluate whether these “statistical clusters” are in agreement with the “clinical clusters”.Methods:Cross-sectional and multicentre study with 24 participating countries. Consecutive patients considered by their treating rheumatologist as suffering from either PsA, axial SpA (axSpA) or peripheral SpA (pSpA) were enrolled. Four different cluster analyses were conducted: the first one using information about the specific location from all the peripheral musculoskeletal manifestations (i.e., peripheral arthritis, enthesitis and dactylitis), and thereafter a cluster analysis for each peripheral manifestation individually. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.Results:4465 patients were included in the analysis. Two clusters were found with regard to the location of all the peripheral manifestations (Fig. 1). Cluster 1 showed a low prevalence of peripheral manifestations in comparison with cluster 2; however, when peripheral involvement appeared in cluster 1, this was mostly represented by arthritis of hip, knee and ankle, as well as enthesitis of the heel. Patients from cluster 1 showed a higher prevalence of males (63% vs 44%), HLA-B27 positivity (69% vs 38%) and axial involvement (80% vs 52%), as well as more frequent diagnosis of axSpA (66% vs 21%) and more frequently fulfilling the ASAS axSpA criteria (69% vs. 41%). Patients from cluster 2 showed a higher prevalence of psoriasis (63% vs 25%), a more frequent diagnosis of PsA (61% vs 19%), and they fulfilled more frequently the peripheral ASAS (26% vs 11%) and the CASPAR criteria (57% vs 19%).Figure 1.Distribution of the peripheral involvement across clustersThree clusters were found with regard to the location of the peripheral arthritis. Clusters 2 and 3 showed a high prevalence of peripheral joint disease, although this was located more predominantly in the lower limbs in cluster 2, and in the upper limbs in cluster 3. Cluster 1 showed a higher prevalence of males, HLA-B27 positivity, axial involvement, a lower presence of psoriasis, a more frequent diagnosis of axSpA and fulfilling the ASAS axSpA criteria in comparison with clusters 2 and 3, respectively. Clusters 2 and 3 showed a higher prevalence of enthesitis and dactylitis in comparison with cluster 1, a more frequent diagnosis of PsA and fulfillment of the CASPAR criteria.Information about the location of enthesitis exhibited three groups: cluster 1 showed a very low prevalence of enthesitis, while cluster 2 and 3 showed a high prevalence of enthesitis, with a predominant involvement of axial enthesis in cluster 2 and peripheral enthesitis in cluster 3.Finally, the analysis of dactylitis also exhibited three clusters that showed a very low prevalence of dactylitis, predominantly toes and predominantly fingers involvement, respectively.Conclusion:These results suggest the presence of heterogeneous patterns of peripheral involvement in SpA and PsA patients without clearly defined groups, confirming the clear overlap of these peripheral manifestations across the different underlying diagnoses.Acknowledgements:This study was conducted under the umbrella of ASAS with unrestricted grant of Abbvie, Pfizer, Lilly, Novartis, UCB, Janssen and Merck.Disclosure of Interests:None declared

ResidenteMedicinaInterna,� FacultaddeMedicinaClinica� Alemana-Universidaddel� Desarrollo. 4 Gastroenterologapediatrica,� PontificiaUniversidadCatolica� deChile. a EstudianteOdontologia,� FacultaddeMedicinaClinica� Alemana-Universidaddel� Desarrollo. b DocenteOdontologia,�Facultad� deMedicinaClinicaAlemana- UniversidaddelDesarrollo.

Background:Antiphospholipid syndrome (APS) is characterized by thrombosis and obstetric morbidity in the context of positive antiphospholipid antibody markers. More than a quarter of hypertensive APS patients (26%) have renal artery stenosis (RAS) (1). Treatment includes anticoagulation, blood pressure control and management of cardiovascular risks. In some cases, the severity of the renal vascular lesion requires surgical interventionObjectives:To evaluate long term outcomes in APS patients with RAS.Methods:Retrospective database study. All records of APS patients with RAS were analyzed and demographic variables, comorbidities, treatment received, renal outcome and mortality were recorded.Uni- and multivariate analyses were performed by logistic regression with death and chronic kidney disease (CKD) as dependent variables. In the multivariate analysis, the covariates considered were age at diagnosis of stenosis, diabetes, smoking, dyslipidemia, unilateral or bilateral stenosis, stenosis greater than 50%, surgery and the use of immunosuppressants, anticoagulation and statins.Research and development office has approved this study.Results:33 RAS patients were analyzed. Diagnosis of RAS was made by MRI renal angiography and in some cases by CT angiogram and intra-arterial digital subtraction angiography. Patient characteristics are detailed in Table 1. The median duration of follow-up was 152 months (IQR 65).Table 1.Patient Characteristics.N° Patients33Age median48 (IQR 16)Smokers%18.1(6)Comorbidities %Diabetes mellitus type 2 6 (2) Hypertension 100(33)High LDL 36.3(12)Primary APS %39.4 (13)Secondary APS %60.6 (20)Unilateral RAS%75.8 (25)Bilateral RAS%24.2 (8)Degree of stenosis< 30% 15.1 (5)30-50% 30.3 (10)50-80% 33.3 (11)>80% 21.2 (7)Treatment%Medical treatment 75.7 (25)Surgical treatment 30.3 (10)Renal biopsy was performed in 3 patients: crescentic glomerulonephritis was found in 2 patients and one had a thrombotic microangiopathy.Treatment: 25 patients (75.7%) were anticoagulated with vitamin K antagonists, 19 (57.6%) received immunosuppressive therapies, 18 (54.5%) were on statins. Ten patients (30.3%) were managed surgically with balloon angioplasty. Restenosis occurred in 4/10 patients (40%) and percutaneous renal artery stenting was performed successfully in all four. Ten patients died (30.3%). Renal outcomes are shown in Table 2.Table 2.Outcome in APS with RAS PatientsN %Died 10 30.3Transplanted 1 3Renal Dysfunction 17 51.5CKD Stage III 10 30.3CKD Stage IV 4 12.1CKD Stage V 3 9In the univariate analysis, surgery was significantly associated with a lower probability of reaching CKD (p=0.042; OR 0.2; 95% CI 0.03-0.94). In the multivariate analysis, the tendency to benefit from surgery was maintained but the statistical significance was lost, probably due to the low number of patients.In the subgroup analysis, the tendency to benefit from surgery was maintained in patients with or without anticoagulation, immunosuppressants, statins, with primary or secondary APS, with uni- or bilateral stenosis, with or without dyslipidemia, but this benefit was lost in smokers independent of the grade of stenosis.Conclusion:RAS is a treatable cause of hypertension and a poor prognostic marker in APS patients.In this study, APS patients with RAS who underwent intervention with angioplasty or stenting had a trend to a lower probability of developing CKD in contrast to studies in atherosclerotic RAS. The beneficial effect of surgery was lost in smoking patients. In this relatively young population mortality was high.References:[1]Sangle SR, D’Cruz DP, Abbs IC, Khamashta MA, Hughes GR. Renal artery stenosis in hypertensive patients with antiphospholipid (Hughes) syndrome: outcome following anticoagulation. Rheumatology (Oxford) (2005) 44:372–7.Disclosure of Interests:María José Villar: None declared, Shirish Sangle: None declared, Sebastian Ibáñez Consultant of: Novartis, Paid instructor for: Bristol Myers, Speakers bureau: Abbvie, David d’cruz Grant/research support from: GlaxoSmithKline

Background In the last three decades, major advances in the spondyloarthritis (SpA) field have been achieved leading to new terminology. Whilst this terminology is well established in English, there is concern about the disparity of translated words and acronyms in Spanish, which is used by more than 437 million people in 21 countries. Objectives To develop a consensus to standardise the use of the Spanish terms, abbreviations and acronyms employed in the field of SpA. Methods An international task force was created comprising of all ASAS Spanish-speaking native members representing 5 countries, the executive committee members of GRESSER, two methodologists, two linguists from Real Academia Nacional de la Medicina Espanola (RANM) and two patients from CEADE. First, a literature review spanning the last 15 years was performed to identify the conflicting terms/abbreviations/acronyms. This review examined available written sources in Spanish including manuscripts, ICF and ICD, guidelines, recommendations and consensus. A three-round Delphi method including a face-to-face meeting, then followed. The recommendations from the RANM based on the Panhispanic dictionary in medical terms were consistently followed throughout the process. Results Consensus was reached for 44 terms, abbreviations or acronyms related to the field of SpA. A Spanish translation was accepted for 6 terms and 6 abbreviations to name the disease or its subgroups (SpA, axSpA, nr-axSpA, pSpA, AS, r-SpA, PsA) and for 6 terms and 4 abbreviations related with the disease (enthesitis, sacroiliitis, IBP, MRI-SIJ, BME, mNY). Additionally, it was agreed not to translate into Spanish 15 acronyms because they are very well established (ASDAS, BASDAI, BASFI, BASMI, mSASSS, RASS, BASRI, BAS-G, ASQoL, PsAQoL, MASES, MASEI, PASI, PARS, ASAS). However, when mentioning these acronyms, it is recommended that the following structure is used: type of variable in Spanish and acronym and expanded form in English. With regards to the terms or abbreviations attached to 7 acronyms (ASDAS-CI, ASDAS-MI, ASAS-HI, ASASpr, ASAS 5/6, ASAS20, ASAS40 improvement criteria), it was agreed to translate only the expanded form and a translation was also selected for all of them. Conclusions A consensus in Spanish nomenclature for SpA has been developed by ASAS group. The implementation of this consensus across the Spanish-speaking community will be of substantial benefit, avoiding misunderstandings and time-consuming processes. Acknowledgements GRESSER(E. Galindez, J. Gotor, M. Moreno, J. Quiros, A. Urruticoechea), CEADE(P. Plazuelo, M. Garrido), RANM(C. Gonzalez, C. Remacha) Disclosure of Interest None declared

Objective To develop a consensus to standardise the use of Spanish terms, abbreviations and acronyms in the field of spondyloarthritis (SpA). Methods An international task force comprising all native Spanish-speaking Assessment of SpondyloArthritis International Society (ASAS) members, the executive committee of Grupo para el estudio de la Espondiloartritis de la Sociedad Espanola de Reumatologia (GRESSER), two methodologists, two linguists from the Real Academia Nacional de Medicina de Espana (RANM) and two patients from the Spanish Coordinator of Spondylitis Associations (CEADE) was established. A literature review was performed to identify the conflicting terms/abbreviations/acronyms in SpA. This review examined written sources in Spanish including manuscripts, ICF and ICD, guidelines, recommendations and consensuses. This was followed by a nominal group meeting and a three-round Delphi. The recommendations from the RANM based on the Panhispanic dictionary were followed throughout the process. Results Consensus was reached for 46 terms, abbreviations or acronyms related to the field of SpA. A Spanish translation was accepted for 6 terms and 6 abbreviations to name or classify the disease, and for 6 terms and 4 abbreviations related to SpA. It was agreed not to translate 15 acronyms into Spanish. However, when mentioning them, it was recommended to follow this structure: type of acronym in Spanish and acronym and expanded form in English. With regard to 7 terms or abbreviations attached to acronyms, it was agreed to translate only the expanded form and a translation was also selected for each of them. Conclusions Through this standardisation, it is expected to establish a common use of the Spanish nomenclature for SpA. The implementation of this consensus across the community will be of substantial benefit, avoiding misunderstandings and time-consuming processes.

For years the mainstay of antiphospholipid syndrome treatment has been anticoagulation and antiplatelet therapy, but the autoimmune nature of the disease, and complications of these therapies, created the need to develop new therapeutic strategies. New therapeutic alternatives inhibit at different levels, the cascade of events leading to the pro-thrombotic state characteristic of the antiphospholipid syndrome. We conducted a literature review of these new treatments, focusing on the pathophysiological bases that support them and their possible clinical applications.

Periodontitis may have a triggering and aggravating role of various medical conditions, including rheumatoid arthritis.To evaluate the periodontal status in Chilean patients with rheumatoid arthritis (RA), treated in a public hospital.A trained professional conducted a periodontal examination in 40 patients with RA aged 23 to 73 years (85% women). When present, the severity of periodontitis and its relationship with gender, smoking, age, corticosteroids dose and AR activity were assessed. AR activity was evaluated using the Disease Activity Score Calculator for Rheumatoid Arthritis (DAS 28).Thirty five of the 40 patients had periodontitis and in 13, it was severe. Men, smokers, and older patients had more severe stages. Patients using higher doses of corticosteroids had lower severity of periodontitis. No relationship between the severity of periodontitis and AR activity was found.Periodontitis is common and severe in patients with RA, and is influenced by gender, age, smoking and corticosteroid dose.

We report a 37 years old diabetic male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2600 cells/mm3. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis.

We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm³. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis.

For years the mainstay of antiphospholipid syndrome treatment has been anticoagulation and antiplatelet therapy, but the autoimmune nature of the disease, and complications of these therapies, created the need to develop new therapeutic strategies. New therapeutic alternatives inhibit at different levels, the cascade of events leading to the pro-thrombotic state characteristic of the antiphospholipid syndrome. We conducted a literature review of these new treatments, focusing on the pathophysiological bases that support them and their possible clinical applications.

Listeria monocytogenes, rare pathogen in the general population, causes serious infections in patients at the extreme ages of life, pregnant woman, and those with immunosuppression. The clinical manifestations are essential to suspect the disease in patients at risk, allowing an early prescription of antimicrobial therapy, before the results of the cultures are available. Clinical course and prognosis depends on how early treatment is started and, in pregnant women, the gestational age. In Clínica Alemana, at Santiago, we detected a 15 fold rate rise of neonatal listeriosis between year 2007 and 2008. Ten cases were diagnosed between January and July 2008 and the seven cases occurring in pregnant women are reported here. All these patients were in their first pregnancy, which could be associated with similar lifestyle and food habits. Considering this new epidemiological scenario, it is important to educate the population, and to conduct an epidemiological study in order to determine the national situation of Listeria monocytogenes infection.