Objective. To investigate the validity, reproducibility, and responsiveness of a simplified power Doppler ultrasound (PDUS) assessment of joint inflammation compared with a comprehensive 44-joint PDUS assessment in patients with rheumatoid arthritis (RA) who started therapy with a biologic agent. Methods. A total of 160 patients with active RA who started a biologic agent were prospectively recruited in 18 Spanish centers. The patients underwent clinical and laboratory assessment and blinded PDUS examination at baseline and 6 months. A PDUS examination of 128 synovial sites in 44 joints was performed. US synovitis and PD signal were semiquantitatively graded from 1 to 3 in all synovial sites. US count and index for synovitis and PD signal were obtained. PDUS intraobserver and interobserver reliability were evaluated. A process of data reduction based on the frequency of involvement of synovial sites by both synovitis and PD signal was conducted. Construct and discriminant validity of a simplified PDUS assessment was investigated. Results. A PDUS simplified assessment including 24 synovial sites from 12 joints detected 100% of patients with synovitis and 91% of patients with PD signal. There was a highly significant correlation between the 44-joint count and index for synovitis and PD signal and the 12-joint count and index for synovitis and PD signal at baseline and 6 months (r ‫؍‬ 0.84 -0.90, P < 0.0005). The smallest detectable difference was lower than the mean change in simplified PDUS variables. Conclusion. A 12-joint PDUS assessment of RA joint inflammation may be a valid, feasible method for multicenter monitoring of therapeutic response to biologic agents.

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Entheseal morphologic abnormalities, PD signal, and bursitis were US abnormalities that were responsive to anti-TNF therapy in SpA. PDUS can be a reproducible method for multicenter monitoring of therapeutic response in enthesitis of SpA.

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To define and give priory to standards of care in patients with spondyloarthritis (SpA). A systematic literature review on SpA standards of care and a specific search in relevant and related sources was performed. An expert panel was established who developed the standards of care and graded their priority (high, mild, low, or no priority) following qualitative methodology and Delphi process. An electronic survey was sent to a representative sample of 167 rheumatologists all around the country, who also gave priority to the standards of care (same scale). A descriptive analysis is presented. The systematic literature review retrieved no article specifically related to SpA patients. A total of 38 standards of care were obtained-12 related to structure, 20 to process, and 6 to result. Access to care, treatment, and safety standards of care were given a high priority by most of rheumatologists. Standards not directly connected to daily practice were not given such priority, as standards which included a time framework. The standards generated for the performance evaluation (including patient and professionals satisfaction) were not considered especially important in general. This set of standards of care should help improve the quality of care in SpA patients.

Background Currently, the use of standards of care (SoC) could be the first step to achieve optimal care in patients with spondyloarthritis (SpA). Objectives The aim of this project (2e) was to develop evidence-based and user-focused SoC for SpA. Methods A RAND-modified Delphi method was applied. First, a systematic literature review of national and international documents covering SOC for SpA was conducted. This included consensus, clinical guidelines and care management documents. Social leagues and health professionals were contacted. All the information retrieved was evaluated by two expert methodologists and, subsequently, adapted and classified according to the three categories of SOC: structure, process and outcomes. A group of 23 experts on SpA was selected and a consensus meeting was held where these SOC were discussed. Afterwards, a first questionnaire round was sent to the experts panel and the SOC were modified according to the results of this round. Finally, a second questionnaire round with the final set of SOC was sent to 167 rheumatologists all around Spain to assess their agreement grade about every SoC. Results A total of 38 SoC were set (12 for structure, 20 for process and 6 for outcomes). A selection with the SoC that got highest priority is shown in the table. In general, standards of process achieved high priority whereas standards of result got the lowest grade of agreement. Image/graph Conclusions The implementation in clinical practice of this set of SoC could help assess and improve the quality of care for patients with SpA. Disclosure of Interest None Declared