Carlos Lozada

Objective: Psoriatic arthritis (PsA) is chronic disease that compromises multiple domains and might be associated with progressive joint damage, increased mortality, functional limitation, and considerably impaired quality of life. Our objective was to generate evidence-based recommendations on the management of PsA in Pan American League of Associations for Rheumatology (PANLAR) countries.Methods: We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to adapt the 2019 recommendations of the European Alliance of Associations for Rheumatology. A working group consisting of rheumatologists from various countries in Latin America identified relevant topics for the treatment of PsA in the region. The methodology team updated the evidence and synthesized the information used to generate the final recommendations. These were then discussed and defined by a panel of 31 rheumatologists from 15 countries.Results: Theses guidelines report 15 recommendations addressing therapeutic targets, use of antiinflammatory agents and corticosteroids, treatment with disease-modifying antirheumatic drugs (conventional synthetic, biologic, and targeted synthetic), therapeutic failure, optimization of biologic therapy, nonpharmacological interventions, assessment tools, and follow-up of patients with PsA.Conclusion: Here we present a set of recommendations to guide decision making in the treatment of PsA in Latin America, based on the best evidence available, considering resources, medical expertise, and the patient's values and preferences. The successful implementation of these recommendations should be based on clinical practice conditions, healthcare settings in each country, and a tailored evaluation of patients.

Background: Clinical experience has shown that a single measure is not sufficient to assess disease activity in rheumatoid arthritis (RA). Various clinimetric tools are necessary to address the many clinical situations that can arise. Methods: In order to develop a comprehensive measurement tool, the Pan American League of Associations for Rheumatology searched for the most frequent measures of disease activity applied in RA by means of a semi-systematic review of the available literature. Results: We found that the most frequently reported measures of disease activity were the 28-joint Disease Activity Score, C-reactive protein, and the erythrocyte sedimentation rate, followed by patient-reported measures of pain and stiffness and many other composite indices and patient-reported outcome measures. The most frequent physician-reported sign of disease was the swollen joint count, and the most frequently self-reported feature was the increase in disease activity or flares. Conclusion: In this article, we present a new clinimetric tool developed based on expert consensus and on data retrieved from our search. Disease activity can be better assessed by combining various data sources, such as clinical, laboratory, and self-reported outcomes. These variables were included in our novel clinimetric tool. Key Points• The goal of treatment of RA is to achieve the best possible control of inflammation, or even remission; therefore, disease management should include systematic and regular evaluation of inflammation and health status.• Clinimetric tools evaluate a series of variables (e.g., symptoms, functional capacity, disease severity, quality of life, disease progression) and can reveal substantial prognostic and therapeutic differences between patients.• Our clinimetric tool, which is based on a combination of data (e.g., clinical variables, laboratory results, PROMs), can play a relevant role in patient assessment and care.

Axial spondyloarthritis (axSpA) comprises a spectrum of chronic inflammatory manifestations affecting the axial skeleton and represents a challenge for diagnosis and treatment. Our objective was to generate a set of evidence-based recommendations for the management of axSpA for physicians, health professionals, rheumatologists and policy decision makers in Pan American League of Associations for Rheumatology (PANLAR) countries. Grading of Recommendations, Assessment, Development and Evaluation-ADOLOPMENT methodology was used to adapt existing recommendations after performing an independent systematic search and synthesis of the literature to update the evidence. A working group consisting of rheumatologists, epidemiologists and patient representatives from countries within the Americas prioritized 13 topics relevant to the context of these countries for the management of axSpA. This Evidence-Based Guideline article reports 13 recommendations addressing therapeutic targets, the use of NSAIDs and glucocorticoids, treatment with DMARDs (including conventional synthetic, biologic and targeted synthetic DMARDs), therapeutic failure, optimization of the use of biologic DMARDs, the use of drugs for extra-musculoskeletal manifestations of axSpA, non-pharmacological interventions and the follow-up of patients with axSpA.

Background Ultrasound (US) is an important tool to support the clinician in the diagnosis and treatment monitoring of rheumatoid arthritis (RA). The EULAR recommended it for the follow up of RA patients. In spite of the evidence supporting the value of US, the real impact in treatment decisions is not clearly defined. Objectives To investigate the impact of US findings in the treatment decisions of rheumatologists in patients with RA in a real-life setting. Additionally, to verify the US findings that play a role in change of treatment, types of changes and their distribution. Methods RA patients were included. As a first step, the rheumatologist performed a clinical examination (including DAS28) and recorded the treatment approach suggested according his clinical evaluation (i.e. starting, changing or stopping pharmacological medication as well as local injection). In the same day, after the clinical assessment, the patients were sent for an US examination using the 7-joint score, which was performed by an independent rheumatologist sonographer who reported the US findings to the same rheumatologist that previously evaluated clinically the patient. This last decided, according to the US findings to maintain or change the previous suggested therapy. Additionally, the clinical rheumatologist reported the reasons which induced to change or not the treatment after the US examination Results A total of 128 RA patients were included [female 117 (91.4%), male 11 (8.59%)], with mean ± SD disease duration of 9.88±8.22 years. Ninety-four patients (73.4%) had active disease according the DAS 28, whereas 34 (26.5%) were considered in remission. US findings influenced a change in the treatment in 56 cases (43.7%) (47 with clinical active disease and 9 in remission). Among the main reasons that induced a change in the treatment based on the US examinations were: grade of synovitis (25%), higher number of synovitis than clinical examination (16.6%) and presence of power Doppler (PD) (16.7%). The most frequent treatment changes were increasing dose or start a new combination of DMARDs [39 patients (69.5%)]. The multiple logistic regression analysis showed that synovitis of 2nd metacarpophalangeal joint (MCPj) was the US finding with more influence in the decision to change treatment (p=0.016). With respect to distribution, 122 patients (95.3%) had al least one joint with US synovitis and 76 patients (59.3%) had at least one joint with PD. The wrist, 2nd MCPj and 2nd metatarsophalangeal joint (MTPj) were the most affected in terms of synovitis whereas the 5th MTPj showed more erosions (37.7%) and the extensor fingers tendons showed more tenosynovitis (23.02%). Conclusions US demonstrated to play an important role in the treatment decision of RA patients. The impact was more frequent in patients with active disease but also affected the decision in patients considered in clinical remission. Disclosure of Interest None declared

Glucosamine is now widely used in the hope that it will relieve symptoms of osteoarthritis and stop its progression, yet studies have so far failed to prove convincingly that it works, how it might work, or whether it is safe to take long-term. This is an overview of the evidence to date for currently available glucosamine preparations, as well as for glucosamine used in combination with another popular nutraceutical, chondroitin sulfate.