BACKGROUND:Interstitial lung disease (ILD) is the most common pulmonary affection of rheumatoid arthritis (RA). Patients with a severe RA-ILD extent i.e. >20% according to chest Computed Tomography (CT) semiquantitative (SQCT) scores, have poor prognosis. Quantitative CT (QCT) assessment with operator independent methods based on free software represents a reliable solution already tested in other ILD related to rheumatic diseases. OBJECTIVES:The main objective of this monocentric study is to verify if in RA-ILD there is a correlation between QCT and SQCT performed by experienced radiologists. Secondary aims are: (a) to explore if there is a difference of QTC indexes (QCTi) in RA-ILD patients with severe vs mild ILD extent; (b) to evaluate the discriminative ability of QCT in identifying severe RA-ILD patients. MATERIALS AND METHODS:The chest CTs of consecutive RA-ILD underwent to a SQCT assessment by two experienced chest radiologists. All CTs were also blindly post-processed by a rheumatologist in order to obtain the QCTi. QCTi correlations, distribution and discriminative ability were, respectively, verified using Spearman rank test, Mann-Whitney test and ROC curves. RESULTS:The majority of QCTi showed a moderate degree (0.40<r<0.59) with SQCT assessment (p-value<0.01). Patients with severe and mild ILD had dissimilar QCTi values (p=0.001). Almost all of QCTi had a good discriminative ability (AUC from 0.73 to 0.81, p-value=0.0001). CONCLUSIONS:These preliminary findings suggest that RA-ILD extent is related to QCTi. Moreover, QCTi can discriminate very well patients with a severe ILD. So, QCTi may become simple tools quickly estimate RA-ILD prognosis.

BACKGROUND:Despite widespread use of ultrasound in rheumatology, interpretation of findings is predicated on the assumption that healthy individuals show no gradable differences in all joints and across all age ranges. To define the age-related ultrasound thresholds in small joints, this study sought to systematically grade three ultrasound abnormalities (ie, synovial hypertrophy, Doppler signal, and synovial effusion) in the metacarpophalangeal, proximal interphalangeal, wrist, and metatarsophalangeal joints of healthy individuals aged 18-80 years. METHODS:This multicentre, cross-sectional, observational study recruited healthy individuals from 20 centres across 13 countries in Europe, South America, Asia, and the Middle East. Participants included individuals aged 18-80 years from a range of backgrounds, including university and hospital research staff, health-service workers, students, and volunteers from local advertising or national cohorts. Main exclusion criteria were individuals with previous or current inflammatory joint disease, clinical joint inflammation, recent history of joint trauma, hand osteoarthritis, joint pain, and use of corticosteroids or non-steroidal anti-inflammatory drugs. Participants were classified into three age groups (18-39, 40-59, and 60-80 years) representing young, middle, and older age groups. Clinical and ultrasound assessment of bilateral metacarpophalangeal 1-5, proximal interphalangeal 1-5, wrist, and metatarsophalangeal 1-5 joints were conducted according to European Alliance of Associations for Rheumatology guidelines and severity of ultrasound joint abnormalities was graded using the European Alliance of Associations for Rheumatology-Outcome Measure for Rheumatology synovitis score. The age-related threshold for each joint type was identified using the cumulative 95% prevalence rule. People with lived experience of inflammatory arthritis were involved in the study design and interpretation of results. FINDINGS:Participants were recruited from Feb 7, 2017, to July 30, 2019. 802 participants were included in the final analysis. 351 (44%) of 802 participants were aged 18-39 years, 302 (38%) were aged 40-59 years, and 149 (19%) were aged 60-80 years. 578 (72%) of 802 participants were female, 224 (28%) were male, 644 (81%) of 799 were White, and the median age was 42 years (IQR 30-56). Of 28 735 joints scanned, 3728 (13%) had at least one ultrasound finding higher than grade 0. The highest proportion of ultrasound findings higher than grade 0 was in metatarsophalangeal 1 (45%), followed by metatarsophalangeal 2 (39%). Doppler signal activity in the metacarpophalangeal, proximal interphalangeal, wrist, and metatarsophalangeal joints and synovial hypertrophy in proximal interphalangeal 2-5, metacarpophalangeal 5, and metatarsophalangeal 5 was minimal in all age ranges. Synovial effusion findings differed by joint type predominantly, but not by age. INTERPRETATION:Doppler signal in any metacarpophalangeal, proximal interphalangeal, wrist, and metatarsophalangeal joints are likely to be abnormal in all age groups. Normal ultrasound thresholds for synovial effusion and synovial hypertrophy differed by joint type and age. The development of age-specific and joint-specific reference values is an important step towards precision medicine using ultrasound imaging in rheumatology. FUNDING:None.

Objective Conventional radiography (CR) and ultrasound (US) are used interchangeably for identification of calcium pyrophosphate deposition (CPPD). The aim of this study was to assess whether combining US and CR offers greater accuracy over either modality alone for the identification of CPPD. Methods Consecutive patients scheduled for knee replacement surgery for osteoarthritis were enrolled. Before surgery, patients underwent CR and US of the knee. Menisci and hyaline cartilage were collected and analyzed using polarized light microscopy to confirm the presence of CPPD (gold standard). CR and US were assessed for absence/presence of CPPD by expert radiologists and sonographers. Diagnostic performance statistics were calculated. Poisson models with robust variance estimators were used to determine the likelihood of identifying CPPD. Results Fifty-one patients (63% female, mean age 71.4 [SD 8] years) were enrolled. US demonstrated higher overall accuracy than CR for CPPD identification (0.78 vs 0.73). Sequential use of both modalities provided an advantage when only 1 knee site was positive in 1 of the 2 techniques; however, when 2 or 3 sites were positive, no additional advantage was observed. When US was negative, subsequent CR did not improve CPPD detection, but in cases of a negative CR, a positive US increased the likelihood of CPPD by 4.21 times, whereas a negative US substantially reduced the probability of CPPD, increasing the likelihood of its absence by 76%. Conclusion US was more accurate than CR for identification of CPPD. Performing both exams can be an added value for CPPD identification only in a few specific cases.

OBJECTIVES:To evaluate whether patients with systemic lupus erythematosus (SLE) have different nailfold videocapillaroscopy (NVC) findings compared with healthy controls (HCs) and whether there is an association between NVC abnormalities and disease activity, clinical and/or laboratory features in SLE. METHODS:This is an observational, multicentre, international, matched case-control study. 381 subjects (203 patients with SLE and 178 HCs) were enrolled from 16 centres in 10 countries. Clinical and laboratory data were collected using ad hoc forms. 5861 NVC images were acquired, coded and uploaded for central blinded analysis. RESULTS:A normal NVC pattern was observed in most patients with SLE (86.6%) and, a significantly higher frequency of NVC abnormalities such as enlarged and giant capillaries, microhaemorrhages and irregular nail bed architecture (p<0.001) were found in the remaining patients. Multiple correspondence analysis outlined two NVC patterns, one of which, the more severe (cluster 2), present in 12% of patients, was characterised by a higher prevalence of lower capillary density, abnormally shaped and enlarged capillaries and irregular nail bed architecture. NVC cluster 2 had significantly higher disease activity compared with cluster 1 for both Systemic Lupus Erythematosus Disease Activity Index cut-off points ≥3 and ≥4 (p=0.016 and p=0.028, respectively). SLE with 'more severe' NVC pattern (cluster 2) have a significantly higher frequency of arthritis, renal involvement and ongoing glucocorticoid therapy, whereas serositis was significantly associated with 'less severe' NVC pattern (cluster 1). CONCLUSIONS:This study has shown that changes in NVC patterns are associated with important aspects of SLE disease activity. Future prospective studies are needed to further support the use of NVC in SLE monitoring. TRIAL REGISTRATION NUMBER:NCT02801812.

Background: Interstitial lung disease (ILD) is a complication in patients with systemic sclerosis (SSc). Accurate strategies to identify its presence in early phases are essential. We conducted the study aiming to determine the validity of ultrasound (US) in detecting subclinical ILD in SSc, and to ascertain its potential in determining the disease progression. Methods: 133 patients without respiratory symptoms and 133 healthy controls were included. Borg scale, Rodnan skin score (RSS), auscultation, chest radiographs, and respiratory function tests (RFT) were performed. A rheumatologist performed the lung US. High-resolution CT (HRCT) was also performed. The patients were followed every 12 weeks for 48 weeks. Results: A total of 79 of 133 patients (59.4%) showed US signs of ILD in contrast to healthy controls (4.8%) (p = 0.0001). Anti-centromere antibodies (p = 0.005) and RSS (p = 0.004) showed an association with ILD. A positive correlation was demonstrated between the US and HRCT findings (p = 0.001). The sensitivity and specificity of US in detecting ILD were 91.2% and 88.6%, respectively. In the follow-up, a total of 30 patients out of 79 (37.9%) who demonstrated US signs of ILD at baseline, showed changes in the ILD score by US. Conclusions: US showed a high prevalence of subclinical ILD in SSc patients. It proved to be a valid, reliable, and feasible tool to detect ILD in SSc and to monitor disease progression.

ObjectivePsoriatic 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.MethodsWe 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.ResultsTheses 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.ConclusionHere 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: The screening strategy for interstitial lung disease (ILD) in patients with rheumatoid arthritis is currently debated. Although high-resolution CT (HRCT) imaging is the gold standard for diagnosing ILD, its systematic use as a screening tool is not yet recommended. The role of lung ultrasound (LUS) in assessing ILD has been previously explored. RESEARCH QUESTION: What is the performance of LUS for ILD diagnosis in asymptomatic patients with rheumatoid arthritis? STUDY DESIGN AND METHODS: We conducted a multicenter, cross-sectional study involving 203 asymptomatic patients with rheumatoid arthritis from outpatient clinics in Argentina, Greece, France, and Mexico. Participants underwent clinical evaluations, pulmonary function tests, and LUS. An HRCT scan was performed on each patient within 30 days of the LUS. Statistical analyses included sensitivity, specificity, and predictive values for LUS and pulmonary function tests. RESULTS: Of the participants, 26% were diagnosed with ILD. The median age was 63 years (52-89 years), and 161 (79.3%) patients were female. The median duration from rheumatoid arthritis diagnosis to inclusion was 7 years (range, 2-16 years). LUS exhibited a sensitivity of 83% (95% CI, 70.2%-91.9%) and a specificity of 81.2% (95% CI, 74.2%-87.2%), with a negative predictive value of 93.1% (95% CI, 87.4%-96.8%) and a positive predictive value of 61.1% (95% CI, 58.9%-72.4%). LUS outperformed pulmonary function tests, underscoring its potential as a primary screening tool. INTERPRETATION: Our results suggest that LUS is a promising tool for ILD screening in asymptomatic patients with rheumatoid arthritis, offering high sensitivity and negative predictive value. Its incorporation into routine clinical practice could optimize ILD screening strategies and enhance patient outcomes through early detection and intervention.

Voronoi diagrams are structures that have many applications. Parallel formation of Voronoi diagrams in cell colonies is a process that would enable to study a larger array of computational and biological problems using synthetic biology on cell colonies. In this study, we propose a spatial-resolution-based solution that demonstrates the power of combining computational biology with spatial awareness. By exploring metaheuristics and defining nodes within the colony, we showcase a feasible way to address these complex problems. Our approach emphasizes the potential for Voronoi diagram construction bearing spatial considerations in bio-inspired computing, offering a novel perspective for developmental biology and potentially leading to more efficient solutions in the future. The generation of a hexagon-based pattern reminiscent of a beehive exemplifies the nature-inspired outcomes of our methodology. To achieve this, we utilize a node definition bounded by the Moore neighborhood and then assign different roles to each bacterium through cell-cell communication, allowing them to greedily color the nodes without repetition among its neighbors. To test the designed system, we utilized simulation software. The results obtained from this simulation indicate that the system approaching the Voronoi pattern relies on CRISPR for maintaining color persistence in a specific zone, irrespective of the presence of the initiating stimulus. This integration highlights its essential role in enhancing the efficiency and stability of the spatial-resolution-based approach. ### Competing Interest Statement The authors have declared no competing interest.

Sensors used in precision agriculture for the detection of heavy metals in irrigation water are generally expensive and sometimes their deployment and maintenance represent a permanent investment to keep them in operation, leaving a lasting polluting footprint in the environment at the end of their lifespan. This represents an area of opportunity to design new biological devices that can replace part, or all of the sensors currently used.In this article, a novel workflow is proposed to fully carry out the complete process of design, modeling, and simulation of reprogrammable microorganisms in silico. As a proof-of-concept, the workflow has been used to design three whole-cell biosensors for the detection of heavy metals in irrigation water, namely arsenic, mercury and lead. These biosensors are in compliance with the concentration limits established by the World Health Organization (WHO). The proposed workflow allows the design of a wide variety of completely in silico biodevices, which aids in solving problems that cannot be easily addressed with classical computing.The workflow is based on two technologies typical of synthetic biology: the design of synthetic genetic circuits, and in silico synthetic engineering, which allows us to address the design of reprogrammable microorganisms using software and hardware to develop theoretical models. These models enable the behavior prediction of complex biological systems. The output of the workflow is then exported in the form of complete genomes in SBOL, GenBank and FASTA formats, enabling their subsequent in vivo implementation in a laboratory.The present proposal enables professionals in the area of computer science to collaborate in biotechnological processes from a theoretical perspective previously or complementary to a design process carried out directly in the laboratory by molecular biologists. Therefore, key results pertaining to this work include the fully in silico workflow that leads to designs that can be tested in the lab in vitro or in vivo, and a proof-of-concept of how the workflow generates synthetic circuits in the form of three whole-cell heavy metal biosensors that were designed, modeled and simulated using the workflow. The simulations carried out show realistic spatial distributions of biosensors reacting to different concentrations (zero, low and threshold level) of heavy metal presence and at different growth phases (stationary and exponential) that are backed up by the whole design and modeling phases of the workflow.

OBJECTIVES:Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images. METHODS:Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics. RESULTS:After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75). CONCLUSION:Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual and standardized protocol to scan such patients.

Background Ultrasound (US) has elicited considerable interest among rheumatologists because of its usefulness in clinical practice. Recently, it has been demonstrated its ability to assess interstitial lung disease (ILD) in rheumatic patients. While a solid and still growing body of evidence supports its use in daily rheumatologic practice, operator dependency and the long learning curve represent the main limitations. Objectives To describe the learning curve of rheumatologists with limited experience using US attending an intensive disease-oriented training program focusing on the skills required to obtain and interpret US signs of ILD in patients with autoimmune rheumatic diseases. Methods A total of 5 investigators participated in a seven-day training program involving 15 patients with autoimmune rheumatic diseases. The expert sonographer was a Rheumatologist with >15 years of US experience, whose assessments were used as the gold standard to evaluate the US findings obtained by the remaining 4 investigators. Two beginner sonographers were fellows in rheumatology with 5 months of global US experience, whereas the other 2 beginner sonographers were fellows in rehabilitation and rheumatology with a very basic knowledge of musculoskeletal US (<3 months) and no direct US experience in ILD. The training program lasted for 7 days (at least 5 hours per day) following specific aims and activities for each day during the training program. The agreement between the expert and beginners was calculated in 4 sessions involving 15 patients (13 females and 2 males; 4 rheumatoid arthritis, 6 systemic sclerosis, 3 Sjogren syndrome, 2 dermatomyositis). The US assessment was performed according the previously proposed 14-intercostal spaces (IS) scanning protocol using the following semiquantitative scale [0 = normal (≤5 B-lines); 1 = slight (≥6 and ≤15 B-lines); 2 = moderate, (≤16 and ≥30 B-lines); 3 = severe (≥30 B-lines)] [1]. Additionally the pleural irregularity in each IS was dichotomously recorded. Results A total of 210 lung IS were studied. Kappa values and overall agreement percentages of qualitative and dichotomist assessments of US ILD findings (B-lines and pleural irregularity) at the end of the exercise showed moderate to excellent agreement (between 0.769 and 0.895), while in the first session they showed poor/fair agreement (between 0.325 and 0.435). The comparison between the expert (gold standard) and beginners' examinations at the fourth and final session, including the kappa values, sensitivity, specificity, and negative and positive predictive value were also improved. Conclusion After 1 week of the disease-oriented training program, physicians with limited experience in US were satisfactorily able to detect and interpret the main US signs indicative of ILD in patients with autoimmune rheumatic diseases. Reference [1]Gutierrez M, Salaffi F, Carotti M, et al. Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders–preliminary results. Arthritis Res Ther. 2011.18;13:R134. Acknowledgements To the fellows who participated in this exercise: Dr. Ana Mabel Quiroz, and Dr. Betsy Condori. Disclosure of Interests None Declared.

El compromiso de la articulación coxofemoral en la artritis reumatoide se asocia a discapacidad y menor calidad de vida. En la actualidad no existen estudios que evalúen sus alteraciones en etapas subclínicas. Determinar la prevalencia del compromiso subclínico de cadera mediante el uso del ultrasonido. Estudio descriptivo de corte transversal, enfocado en pacientes con diagnóstico establecido de artritis reumatoide, según los criterios clasificatorios de la EULAR/ACR 2010, que presentaron o no dolor en la articulación coxofemoral durante el examen físico, comparados con individuos sanos. Se investigó la presencia de distensión de la cápsula articular, bursitis del iliopsoas, erosiones, osteofitos, remodelación articular y señal Doppler de poder. Las imágenes fueron interpretadas por un reumatólogo experto en US, cegado a las variables clínicas, demográficas y de laboratorio. Se evaluaron en total 234 caderas; 37 (31,6%) pacientes con artritis reumatoide sintomáticos de la cadera, 40 (34,1%) pacientes con artritis reumatoide subclínica y 40 (34,1%) sujetos sanos. La prevalencia de sinovitis de la cápsula articular fue del 48,6% para los pacientes con artritis reumatoide sintomática, del 20% para los pacientes con artritis reumatoide subclínica y del 15% para los sujetos sanos. El grupo de pacientes con artritis reumatoide subclínica presentó una mayor frecuencia de osteofitos y remodelación articular. Se confirmó el valor del ultrasonido en el diagnóstico subclínico de la patología inflamatoria de la articulación coxofemoral. No se evidenciaron asociaciones significativas entre los hallazgos del US con la actividad de la enfermedad, ni con los valores de estudios de laboratorio. Hip joint involvement in rheumatoid arthritis has been related to disability and lower quality of life. Currently, not enough studies provide information for subclinical hip involvement. To determine the prevalence of subclinical hip joint involvement in rheumatoid arthritis, characterizing it by ultrasound. A descriptive cross-sectional study in rheumatoid arthritis patients with an established diagnosis of rheumatoid arthritis according to EULAR/ACR 2010 classification criteria, without hip pain or abnormalities during a clinical examination (subclinical group), this group was compared with a group of symptomatic patients with rheumatoid arthritis of the hip (pathological control group), and with healthy control individuals matched by age and body mass index. The presence of joint capsule distension, osteophytes, joint remodelling process, erosions, iliopsoas bursitis, and power Doppler signal was assessed. The images were interpreted by an experienced rheumatologist blinded to clinical and laboratory variables. 234 hips were studied; 37 (31.6%) symptomatic hip patients, 40 (34.1%) asymptomatic hip patients and 40 (34.1%) healthy individuals. The prevalence of joint capsule distension was 20%, while symptomatic hip patients and healthy individuals had a prevalence of 48.6% and 15%, respectively. The asymptomatic group presented higher values for osteophytes and joint remodelling. Ultrasound is a sensitive tool to identify subclinical hip joint synovitis in rheumatoid arthritis patients, reaffirming the value of ultrasound in preclinical diagnosis. The presence of erosions and iliopsoas bursitis was low; we observed no power Doppler signals nor significant associations between ultrasound findings with disease activity and laboratory test results.

Objective To assess the reliability and diagnostic accuracy of new radiographic imaging definitions developed by an international multidisciplinary working group for identification of calcium pyrophosphate deposition (CPPD). Methods Patients with knee osteoarthritis scheduled for knee replacement were enrolled. Two radiologists and 2 rheumatologists twice assessed radiographic images for presence or absence of CPPD in menisci, hyaline cartilage, tendons, joint capsule, or synovial membrane, using the new definitions. In case of disagreement, a consensus decision was made and considered for the assessment of diagnostic performance. Histologic examination of postsurgical specimens under compensated polarized light microscopy was the reference standard. Prevalence‐adjusted bias‐adjusted kappa values were used to assess reliability, and diagnostic performance statistics were calculated. Results Sixty‐seven patients were enrolled for the reliability study. The interobserver reliability was substantial in most of the assessed structures when considering all 4 readers (κ range 0.59–0.90), substantial to almost perfect among radiologists (κ range 0.70–0.91), and moderate to almost perfect among rheumatologists (κ range 0.46–0.88). The intraobserver reliability was substantial to almost perfect for all the observers (κ range 0.70–1). Fifty‐one patients were included in the accuracy study. Radiography demonstrated an overall specificity of 92% for CPPD, but sensitivity remained low for all sites and for the overall diagnosis (54%). Conclusion The new radiographic definitions of CPPD are highly specific against the gold standard of histologic diagnosis. When the described radiographic findings are present, these definitions allow for a definitive diagnosis of CPPD, rather than other calcium‐containing crystal depositions; however, a negative radiographic finding does not exclude the diagnosis.

Introduction: Hip joint involvement in rheumatoid arthritis has been related to disability and lower quality of life. Currently, not enough studies provide information for subclinical hip involvement. Objectives: To determine the prevalence of subclinical hip joint involvement in rheumatoid arthritis, characterizing it by ultrasound. Materials and methods: A descriptive cross-sectional study in rheumatoid arthritis patients with an established diagnosis of rheumatoid arthritis according to EULAR/ACR 2010 classification criteria, without hip pain or abnormalities during a clinical examination (subclinical group), this group was compared with a group of symptomatic patients with rheumatoid arthritis of the hip (pathological control group), and with healthy control individuals matched by age and body mass index. The presence of joint capsule distension, osteophytes, joint remodelling process, erosions, iliopsoas bursitis, and power Doppler signal was assessed. The images were interpreted by an experienced rheumatologist blinded to clinical and laboratory variables. Results: 234 hips were studied; 37 (31.6%) symptomatic hip patients, 40 (34.1%) asymptomatic hip patients and 40 (34.1%) healthy individuals. The prevalence of joint capsule distension was 20%, while symptomatic hip patients and healthy individuals had a prevalence of 48.6% and 15%, respectively. The asymptomatic group presented higher values for osteophytes and joint remodelling. Conclusions: Ultrasound is a sensitive tool to identify subclinical hip joint synovitis in rheumatoid arthritis patients, reaffirming the value of ultrasound in preclinical diagnosis. The presence of erosions and iliopsoas bursitis was low; we observed no power Doppler signals nor significant associations between ultrasound findings with disease activity and laboratory test results. (c) 2021 Asociacion Colombiana de Reumatologia. Published by Elsevier Espana, S.L.U. All rights reserved.

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.

OBJECTIVES:This study aimed to determine the prevalence of ultrasound-detected tendon abnormalities in healthy subjects (HS) across the age range. METHODS:Adult HS (age 18-80 years) were recruited in 23 international Outcome Measures in Rheumatology ultrasound centres and were clinically assessed to exclude inflammatory diseases or overt osteoarthritis before undergoing a bilateral ultrasound examination of digit flexors (DFs) 1-5 and extensor carpi ulnaris (ECU) tendons to detect the presence of tenosynovial hypertrophy (TSH), tenosynovial power Doppler (TPD) and tenosynovial effusion (TEF), usually considered ultrasound signs of inflammatory diseases. A comparison cohort of patients with rheumatoid arthritis (RA) was taken from the Birmingham Early Arthritis early arthritis inception cohort. RESULTS:939 HS and 144 patients with RA were included. The majority of HS (85%) had grade 0 for TSH, TPD and TEF in all DF and ECU tendons examined. There was a statistically significant difference in the proportion of TSH and TPD involvement between HS and subjects with RA (HS vs RA p<0.001). In HS, there was no difference in the presence of ultrasound abnormalities between age groups. CONCLUSIONS:Ultrasound-detected TSH and TPD abnormalities are rare in HS and can be regarded as markers of active inflammatory disease, especially in newly presenting RA.

Background Conventional radiography (CR) is widely used as the first-line investigation for calcium pyrophosphate deposition (CPPD) disease, given its widespread use and the low cost. Next to it a series of advanced imaging techniques have been evaluated for accuracy and reliability. Among them, ultrasound (US) has been thoroughly tested and demonstrated to be accurate and reliable for CPPD diagnosis. However, even if there are data on the diagnostic accuracy of US and CR alone, it is not clear if performing both diagnostic tests and in which sequential order provides an added value for the diagnosis of CPPD. Objectives The aim of this study was to assess which diagnostic test performs better for the diagnosis of CPPD and if a combination of the two exams provides an additional value. Methods This is an ancillary study of the criterion validity of US in CPPD study 1 . Consecutive patients with knee osteoarthritis requiring total joint replacement were enrolled in 8 centres. Participants underwent US and CR of the affected knee prior to surgery. US was performed by experienced sonographers following the same scanning protocol described in the main study, while CR were performed in weight bearing AP and lateral views and were read by 2 experienced radiologists that reached a consensus on the presence/absence of CPPD. The evaluation of CPPD at the level of menisci and hyaline cartilage (HC) was based on the OMERACT definitions for US and on the new definitions developed by the ACR/EULAR CPPD classification criteria working group for CR [paper under submission]. Patients were classified as having CPPD considering histological examination as reference standard. Diagnostic indexes were calculated for US and CR alone and combined. Poisson models with robust estimation were used to estimate the best sequence of these diagnostic methods for a more accurate diagnosis of CPPD. Results 51 pts were enrolled (63% F, mean age 74y ± 8). Diagnostic indexes of US and CR alone and combined are indicated in Table 1. Compared to histology, US demonstrated to be a sensitive tool for identification of CPPD at the knee, with a good sensitivity in all sites and in the overall evaluation. Instead, CR was less sensitive, but it was a highly specific exam for CPPD identification. Combining US and CR led to a higher sensitivity compared with CR alone, but a lower specificity compared to both CR and US alone, and it offered no additional increase in diagnostic accuracy. The Figure 1 shows the results of the appropriate sequence of use of US and CR in patients with suspected CPPD: in case of a positive CR at any of the 3 sites (menisci and HC) no additional exam is necessary, and the same in case of a positive US in at least two sites; however in case of a negative CR, US could help in a statistically significant way to identify CPPD patients, and further in case of a positive US in a single site CR can offer additional information. Table 1. diagnostic indexes of US, CR and US + CR in the identification of CPPD. MM: medial meniscus, LM: lateral meniscus, HC: hyaline cartilage, SN: sensitivity, SP: specificity, PPV: positive predictive value, NPV: negative predictive value, ACC: accuracy. US SN SP PPV NPV ACC MM 0.88 0.81 0.82 0.88 0.84 LM 0.88 0.73 0.76 0.86 0.80 HC 0.78 0.86 0.82 0.83 0.82 Overall 0.92 0.64 0.73 0.89 0.78 CR MM 0.32 1 1 0.61 0.67 LM 0.40 0.96 0.91 0.63 0.69 HC 0.48 0.93 0.85 0.68 0.73 Overall 0.54 0.92 0.88 0.66 0.73 US + CR MM 0.88 0.81 0.82 0.88 0.84 LM 0.92 0.69 0.74 0.90 0.80 HC 0.87 0.82 0.80 0.89 0.84 Overall 0.92 0.56 0.67 0.88 0.75 Figure 1. evaluation of sequence of US and CR Conclusion US confirmed a high diagnostic accuracy in identifying patients affected by CPPD at knee level, while CR demonstrated a high specificity but a low sensitivity. Performing both diagnostic tests could make sense in case of a negative CR or in case of an inconclusive US (only one positive site). To our knowledge, this is the first study that investigates the role of the combination of the two exams in CPPD. Further studies in a large number of patients and in different joints would be helpful to address this point. References [1]Filippou G. et al, Ann Rheum Dis, 2020 Disclosure of Interests None declared

Objective: To investigate the potential role of US in the detection of ILD in a cohort of patients with RA. Methods: Patients with diagnosis of RA were consecutively enrolled. All patients underwent pulmonary examination, laboratory data, DLCO measure, chest HRCT and radiographs, and US examination. A healthy group was included as control group. US was performed according the 14-intercostal space scanning protocol using the following semiquantitative scale [0 = normal (< 5 B-lines); 1 = slight (> 6 and < 15 B-lines); 2 = moderate, (< 16 and > 30 B-lines); 3 = severe (> 30 B-lines)]. Results: A total of 74 RA patients and 74 healthy controls were included. Thirty of 74 patients (40.5%) showed US signs of ILD with respect to the healthy controls (3 subjects, 4.1%) (P < 0.001); whereas HRCT showed ILD in 27 (36.4%) of 74 patients. Among the 30 patients that showed US findings of ILD, 17 (56.6%) were asymptomatic from respiratory view-point. The sensitivity and specificity of US were 92% and 89% respectively. A positive correlation between US and HRCT findings were found (P < 0.001) whereas no correlation was found with chest radiographs and DLCO findings. Positive association between US findings and DAS28-ESR, anti-CCP and RF (P < 0.01 for each respectively) was found. Feasibility, represented by the mean time spent to perform the pulmonary US assessment was 7.8 minutes (+/- SD 1.2, range 6 to 10 minutes). Conclusions: Our results support the potential of US in detect accurately ILD in patients with RA and provide a rationale to consider it as a friendly screening tool to be implemented in early phases of the disease.(c) 2022 Socie acute accent te acute accent franc , aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.