The aim of the study was to compare clinical manifestations, disease activity, functional capacity, spinal mobility, and radiological findings between men and women from a multicenter, multiethnic Ibero-American cohort of patients with Spondyloarthritis (SpA).This observational cross-section study included 1264 consecutive SpA patients who fulfilled the modified New York criteria for ankylosing spondylitis (AS). Demographic, clinical, and radiologic data were evaluated. Categorical data were compared by X2 or Fisher's exact tests and continuous variables by ANOVA with post-hoc tests.Primary AS was diagnosed in 1072 patients, psoriatic spondylitis in 147, and spondylitis associated to inflammatory bowel disease (IBD) in 45 patients. Overall, male patients were significantly younger, had longer diagnostic delay, lower disease activity, worse spinal mobility, better quality of life, and more severe radiologic damage. Dactylitis and enthesitis, as well as swollen joint count, were significantly more common among women. In primary AS, there was a marked male predominance (76.2%). Among patients with psoriatic spondylitis, male predominance was lower (57.8%), but was also associated with worse spinal mobility and more severe radiologic damage. In the total population, male patients with primary AS referred higher permanent work disability (13.2% vs 6.9%; P < 0.05), although no difference was observed in psoriatic or IBD spondylitis according to the gender.Among Ibero-American SpA patients, there are some differences in clinical and radiological manifestations, men showing more structural damage, whereas women more active disease. These data suggest that the phenotype of SpA differs between genders. This can influence the subsequent diagnostic approach and therapeutic decisions.

The systemic vasculitis is a heterogeneous group of diseases characterized by the inflammation of blood vessels. The development of advanced diagnostic tests and genetic studies have resulted in greater improvement in our understanding of vasculitis pathogenesis and thus in the development of newer therapies. However, there is still an unmet need in the management of systemic vasculitis, focused on developing of new biomarkers that would enable distinction between active disease from damage or infection and predict treatment response and prognosis.

Musculoskeletal symptoms are the most frequent extra-intestinal manifestations of inflammatory bowel disease (IBD), ranging between 10 and 40 % of cases. Pathogenesis is still unclear, although several factors have been associated (genetic, environmental, and immunologic pathways). Rheumatic manifestations in IBD patients are heterogeneous, including axial and peripheral involvement, dactylitis, enthesitis, uveitis, as well as skin involvement. Currently, magnetic resonance imaging and ultrasonography are important tools for detecting early pathological changes in IBD patients with suspected rheumatic disease. New advances into the genetics and pathophysiology have provided more effective and targeted therapy for IBD patients with rheumatic manifestations. Given the high prevalence, awareness of the musculoskeletal symptoms is essential to avoid a misdiagnosis. Finally, an interdisciplinary approach of IBD patients, including rheumatologist and gastroenterologist, will improve the quality of life these patients.

Magnetic resonance imaging is useful in evaluating patients with active PsA, particularly when suspecting inflammation and radiographic findings are unhelpful. In some cases, it can be used as an adjunct to clinical examination in determining treatment change.

Psoriatic arthritis (PsA) is the second most common chronic inflammatory joint disease. Ankylosing spondylitis (AS) is another less common but equally chronic and disabling spondyloarthritis (SpA). Therapeutic agents for the treatment of these diseases have been somewhat lacking as compared with those available for rheumatoid arthritis, which represents a significant challenge for both the treating physician and the pharmaceutical industry. A promising development for our understanding of the physiopathology of PsA and AS involves new targets to interrupt IL-17 and IL-12/IL-23 pathways. Up to 30-40 % of SpA patients have inadequate or poor response, or are intolerant to anti-TNF therapies. Therefore, there has been a clear unmet medical need in an important group of these patients. As a result, new therapeutic targets have emerged for the treatment of both axial and peripheral SpA. Interleukin 17 (IL-17) is a pro-inflammatory cytokine that is increased in psoriatic lesions as well as in the synovial fluid of patients with PsA and in sites of enthesitis in SpA. IL-23 has been shown to play an important role in the polarization of CD4+ T-cells to become IL-17 producers. Based on these evidences, blockade of the cytokine IL-17 or its receptors was considered to have therapeutic implications for the treatment of psoriasis, as well as PsA and AS.This article presents a thorough review of an IL-17 A blocking agent, its mechanism of action, its clinical efficacy and its therapeutic safety.

BackgroundThe association between smoking and radiographic progression has been established in axial spondyloarthritides and rheumatoid arthritis (RA) but this association has not been established in psoriatic arthritis (PsA).ObjectivesThe aim of this study was to determine the effects of cigarette smoking on clinical joint damage in patients with psoriatic arthritis.MethodsFrom 1306 PsA patients followed prospectively between 1978 and 2014 as part of an observational cohort, a total of 1107 that started treatment after the first visit was included in the current study. We defined clinical damage as limitation of movement of more than 20% of the range that is not related to a joint effusion, the presence of flexion contractures, fused or flail joints, or evidence of surgery in a particular joint. We used clinical damage as it is assessed at each protocol visit and we have previously demonstrated that clinical joint damage in linked to radiological joint damage. We evaluated the smoking status at the baseline visit up until the first development of clinical joint damage. Smoking status was defined as “non-smoker”, “past smoker” and “current smoker”. Time to development of joint damage was assessed using a Cox Regression Analysis to determine the factors predictive of clinical damage, including age, sex, dactylitis and smoking status, joint counts, treatment and HLA B*27 status.ResultsAmong the 1107 patients, 55.6% were males, with a mean age of 46 years, duration of psoriasis 17.4 years and the duration of PsA 8.4 years at baseline. 55.6% of the patients were non-smokers, 24.4% were past-smokers and 12.4% were current smokers. 7.9% of the patient had clinical joint damage and 26% had dactylitis at baseline. Males, HLA-B*27 positivity, higher age at diagnosis of PsA, clinical damage at baseline, dactylitis and swollen joints were associated with a higher probability of developing clinically damaged joints whereas current and past-smokers at baseline were associated with a lower probability of developing clinically damaged joints compared to nonsmokers.ConclusionsUnlike what occurs in RA and ankylosing spondylitis, the clinical damage in PsA was not associated with smoking status but was associated with disease-specific features.Disclosure of InterestNone declared

Background Several classification criteria for Psoriatic Arthritis (PsA) have been proposed, being CASPAR criteria the most accepted at present. Recently ASAS has proposed classification criteria for patients with axial and peripheral spondyloarthritis, which have not been assessed in patients with psoriasis. Objectives To determine the prevalence of PsA according to CASPAR criteria, and to compare such prevalence with that resulting from the use of ASAS peripheral and axial criteria, and New York criteria for AS. Methods The first 100 patients that consecutively attended a Psoriasis clinic of a Dermatology Service were assessed. Demographic and clinical data were collected, and all patients were questioned and examined by a rheumatologist for joint manifestations. In all cases, rheumatoid factor was determined and radiographies of hands, feet, cervical spine and pelvis for sacroiliac joints were obtained. All X-rays were read independently by two observers in blind fashion. Patients with objective joint manifestations, both axial and peripheral, were considered to fulfill CASPAR, ASAS peripheral and axial, and New York criteria. Correlations were calculated by Spearman’s test. Categorical variables were compared by x2, and continuous variables were compared by Student’s test Results Of the 100 patients included(62 males), median age was 48 years and median duration of psoriasis of 11 years. 93% of patients presented psoriasis vulgaris, and 56% nail involvement. Seventeen patients had peripheral arthritis, mono or oligoarticular in 9 and polyarticular in 8. Median time of arthritis duration was of 8 years. Seven patients had chronic neck pain while 6 had chronic back pain. 13 patients had cervical limitation and 6 patients lumbar limitation. Radiographic sacroiliitis grade 2 and 3 was fiund in 12% of patients, and grade 4 in 2%, being symmetric in 7% of patients. At a cervical level, 10 patients had syndesmophytes whereas 3 had interapophyseal ankylosis. Of all patients, 17% fulfilled CASPAR and ASAS peripheral criteria, 6% New York and 5% ASAS axial criteria. Patients who met CASPAR criteria showed significantly higher time of psoriasis duration compared to those without arthritis (m 16 vs 10 years p=0.02), and a higher frequency of nail disease (88.2% vs 49.4% p=0.003). Five patients (29.4%) fulfilled ASAS axial criteria; all of them had peripheral involvement: mono/oligoarticular in 3 and polyarticular in 2 patients. Patients with peripheral and axial involvement presented a significantly higher frequency of erythrodermic psoriasis compared to the other patients (35.3% vs 1.2% p=0.0006 and 80% vs 16.7% p=0.02). Among the 95 patients without ASAS axial criteria, 9 showed sacroiliitis grade 2 or higher. Among the 83 patients without arthritis, only 1 presented peripheral radiological changes, whereas 5 presented sacroiliitis grade 2 or 3 Conclusions Prevalence of PsA, for both CASPAR and ASAS peripheral criteria, was 17%. According to ASAS criteria, 5% of patients presented axial involvement, while 6% had axi...