Early diagnosis and prompt treatment initiation are essential in the management of axial spondyloarthritis (axSpA), also known as ankylosing spondylitis, remembering that underdiagnosis and overdiagnosis of axSpA are common. These South African guidelines offer screening tools and details of useful investigations, including imaging. Care of the axSpA patient requires a multidisciplinary holistic approach emphasising lifestyle interventions, particularly exercise, smoking cessation and psychosocial support. The ankylosing spondylitis disease activity score is recommended as a measure of disease activity, and a stepwise algorithm for therapy is provided. Screening for comorbidities and vaccination is advised.

SUMMARY OBJECTIVE: This study aimed to assess the prevalence of temporomandibular dysfunction in ankylosing spondylitis patients and healthy controls, examining the relationship between temporomandibular dysfunction and disease activity in ankylosing spondylitis patients, as well as associations with psychosocial factors. METHODS: The study included 113 ankylosing spondylitis patients and 110 healthy individuals aged 18–75. Temporomandibular dysfunction presence was evaluated using Diagnostic Criteria for Temporomandibular Disorders Axis I. Disease activity was assessed with the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, and Bath Ankylosing Spondylitis Functional Index. RESULTS: Among healthy individuals, 60.9% did not receive a temporomandibular dysfunction diagnosis, while 39.1% received at least one diagnosis. In contrast, 69.9% of the 113 ankylosing spondylitis patients received at least one temporomandibular dysfunction diagnosis, and only 30.1% were not included in any diagnosis group (p<0.001). Joint (p=0.001) and pain disorders (p=0.008) were significantly more common in the ankylosing spondylitis group than in the healthy controls. Significant associations emerged between Bath Ankylosing Spondylitis Disease Activity Index (p<0.001) and Bath Ankylosing Spondylitis Functional Index (p=0.005) scores and pain disorders. CONCLUSION: Temporomandibular dysfunction is more prevalent in ankylosing spondylitis patients than in healthy individuals, linked to increased joint issues and pain associated with disease activity. ClinicalTrials.gov ID: NCT05839925. OBJECTIVE controls factors METHODS 11 1875 18 75 18–75 I RESULTS 609 60 9 60.9 391 39 1 39.1 contrast 699 69 69.9 301 30 30.1 p<0.001. p0001 p p<0.001 . 0 001 p=0.001 (p=0.001 p=0.008 p0008 008 (p=0.008 (p<0.001 p=0.005 p0005 005 (p=0.005 CONCLUSION ClinicalTrialsgov ClinicalTrials gov ID NCT05839925 NCT 187 7 18–7 6 60. 3 39. 69. 30. p000 p<0.00 00 p=0.00 (p=0.00 (p<0.00 NCT0583992 18– p00 p<0.0 p=0.0 (p=0.0 (p<0.0 NCT058399 p0 p<0. p=0. (p=0. (p<0. NCT05839 p<0 p=0 (p=0 (p<0 NCT0583 p< p= (p= (p< NCT058 (p NCT05 NCT0

ABSTRACT Background: Monoclonal antibodies have proven efficacy in the management of several conditions and infliximab (IFX) is one of the most important drugs of the class. Some recent data have shown low rates of both persistence and adherence to several available biologics. Objective: The objective of this study was to describe adherence and persistence rate to IFX treatment and also persistence in the patient support program (PSP), among patients diagnosed with inflammatory bowel diseases (IBD) or rheumatic diseases (RD) enrolled in the program of a large pharmaceutical company in Brazil. Methods: Retrospective observational analysis using the PSP database. IBD or RD patients using IFX enrolled on the PSP database between September 2015 and August 2019 were retrospectively evaluated to identify the persistence rate and adherence and followed up until March 1, 2020. Patients were excluded if treatment start date was prior to program entry; first infusion prior to September 1st, 2015 or after August 31st, 2019; the patients did not started treatment; and patients with “OTHERS” in “Indication” field. Persistence was assessed considering both persistence in the program (“PSP persistence”) and persistence on IFX in the PSP (“IFX persistence in the PSP”). PSP persistence was defined as the proportion of patients remaining in the program at 6, 12, 24, 36 and 48 months after initiating IFX. To determine IFX persistence in the PSP, censoring was defined at the time the patient left the program, died, or was lost to follow-up. Adherence to treatment was measured by medication possession ratio ((MPR) - All days supply / elapsed days from first prescription to last day of medication possession)). Descriptive statistics were initially used. Kaplan-Meier curve, the median time estimated by the survival function, Cox regression model, and restricted mean survival time (RMST) were used to evaluate the treatment persistence time at 24 months and the logistic regression model was performed aiming to identify variables associated with adherence (MPR ≥80%). Results: A total of 10,233 patients were analyzed, 5,826 (56.9%) with the diagnosis of RD and 4,407 (43.1%) of IBD. At the end of the follow-up (median 9.1 months from PSP entry to the last infusion), persistence in the PSP was 65.6%, 48.2%, 31.0%, 20.7% and 13.1% at 6, 12, 24, 36 and 48 months, respectively. Considering persistence on IFX in the PSP, estimates were 93.7%, 87.8%, 77.0%, 62.4% and 53.0% at 6, 12, 24, 36 and 48 months, respectively. Variables associated with the risk of non-persistence were gender, country region and diagnosis of rheumatoid arthritis and ankylosing spondylitis. Median MPR was 94.2%, while the percentage of patients with MPR ≥80% was 91.0%. Variables associated with MPR≥80% were country region and diagnosis of Crohn’s disease. Conclusion: Many patients leave the program without discontinuing IFX, since the 12-month persistence were very different between program and medication estimates, while high adherence rates were observed among patients enrolled in the PSP. Data highlights the benefits of a PSP. Background (IFX class biologics Objective , (PSP) (IBD (RD Brazil Methods 201 1 2020 1st st 31st OTHERS “OTHERS Indication “Indication field persistence” . PSP”) 6 12 3 4 died followup. followup follow up. ((MPR possession. possession)) KaplanMeier Kaplan Meier curve function RMST (RMST 2 ≥80%. 80 ≥80%) Results 10233 10 233 10,23 analyzed 5826 5 826 5,82 56.9% 569 56 9 (56.9% 4407 407 4,40 43.1% 431 43 (43.1% 91 9. infusion, infusion) 656 65 65.6% 482 48.2% 310 31 0 31.0% 207 20 7 20.7 131 13 13.1 respectively 937 93 93.7% 878 87 8 87.8% 770 77 77.0% 624 62 62.4 530 53 53.0 nonpersistence non gender spondylitis 942 94 94.2% ≥80 910 91.0% MPR80 MPR≥80 Crohns Crohn s disease Conclusion 12month month (PSP 202 PSP” possession) 1023 23 10,2 582 82 5,8 56.9 (56.9 440 40 4,4 43.1 (43.1 65.6 48.2 31.0 20. 13. 93.7 87.8 77.0 62. 53. 94.2 ≥8 91.0 MPR8 MPR≥8 102 10, 58 5, 56. (56. 44 4, 43. (43. 65. 48. 31. 93. 87. 77. 94. ≥ 91. MPR≥ (56 (43 (5 (4 (

RESUMO Contexto: Os anticorpos monoclonais têm eficácia comprovada no manejo de diversas condições e o infliximabe (IFX) é um dos medicamentos mais importantes da classe. Alguns dados recentes demonstram baixas taxas de persistência e adesão a vários dos biológicos disponíveis. Objetivo: O objetivo deste estudo foi descrever a adesão e persistência ao tratamento com IFX e a persistência no programa de suporte ao paciente (PSP), entre pacientes diagnosticados com doenças inflamatórias intestinais (DII) ou doenças reumáticas (DR) inscritos no PSP de uma grande indústria farmacêutica no Brasil. Métodos: Análise observacional retrospectiva utilizando o banco de dados do PSP. Pacientes com DII ou DR usando IFX inscritos no banco de dados do PSP entre setembro de 2015 e agosto de 2019 foram avaliados retrospectivamente para identificar a taxa de persistência e adesão e acompanhados até 1º de março de 2020. Os pacientes foram excluídos se a data de início do tratamento fosse anterior à entrada no programa; primeira infusão antes de 1º de setembro de 2015 ou após 31 de agosto de 2019; o paciente não iniciou o tratamento; e pacientes com “OUTROS” no campo “indicação”. A persistência foi avaliada considerando tanto a persistência no programa (“persistência PSP”) quanto a persistência em uso de infliximabe no PSP (“persistência IFX no PSP”). A persistência no PSP foi definida como a proporção de pacientes que permaneceram no programa aos 6, 12, 24, 36 e 48 meses após o início do IFX. Para determinar a persistência do IFX no PSP, a censura foi definida quando o paciente deixou o programa, morreu ou perdeu o acompanhamento. A adesão ao tratamento foi medida pela razão de posse do medicamento (MPR)): todos os dias de fornecimento / decorridos da primeira prescrição ao último dia de posse do medicamento). A estatística descritiva foi inicialmente utilizada. A curva de Kaplan-Meier, o tempo mediano estimado pela função de sobrevida, o modelo de regressão de Cox e o tempo de sobrevida médio restrito (RMST) foram utilizados para avaliar o tempo de persistência do tratamento em 24 meses e o modelo de regressão logística foi realizado para identificar variáveis associadas à adesão (MPR ≥80%). Resultados: Foram analisados 10.233 pacientes, 5.826 (56,9%) com diagnóstico de DR e 4.407 (43,1%) de DII. Ao final do seguimento (mediana de 9,1 meses desde a entrada no PSP até a última infusão), a persistência no PSP foi de 65,6%, 48,2%, 31,0%, 20,7% e 13,1% aos 6, 12, 24, 36 e 48 meses, respectivamente. Considerando a persistência no IFX no PSP, as estimativas foram de 93,7%, 87,8%, 77,0%, 62,4% e 53,0% aos 6, 12, 24, 36 e 48 meses, respectivamente. As variáveis associadas ao risco de não persistência foram sexo, região do país e diagnóstico de artrite reumatoide e espondilite anquilosante. A mediana do MPR foi de 94,2%, enquanto o percentual de pacientes com MPR ≥80% foram de 91,0%. As variáveis associadas a MPR ≥80% foram região do país e diagnóstico de doença de Crohn. Conclusão: Muitos pacientes abandonam o programa sem interromper o IFX, pois a persistência em 12 meses foi muito diferente entre as estimativas do programa e da medicação, enquanto altas taxas de adesão foram observadas entre os pacientes inscritos no PSP. Os dados destacam os benefícios de um PSP. Contexto (IFX classe disponíveis Objetivo , (PSP) (DII (DR Brasil Métodos 201 º 2020 3 OUTROS “OUTROS indicação. indicação . “indicação” PSP” 6 4 acompanhamento (MPR)) medicamento. medicamento) utilizada KaplanMeier, KaplanMeier Kaplan Meier, Meier Kaplan-Meier RMST (RMST 2 ≥80%. 80 ≥80%) Resultados 10233 10 233 10.23 5826 5 826 5.82 56,9% 569 56 9 (56,9% 4407 407 4.40 43,1% 431 43 1 (43,1% 91 9, infusão, infusão) 656 65 65,6% 482 48,2% 310 0 31,0% 207 20 7 20,7 131 13 13,1 respectivamente 937 93 93,7% 878 87 8 87,8% 770 77 77,0% 624 62 62,4 530 53 53,0 sexo anquilosante 942 94 94,2% ≥80 910 91,0% Crohn Conclusão medicação (PSP 202 “indicação (MPR) 1023 23 10.2 582 82 5.8 56,9 (56,9 440 40 4.4 43,1 (43,1 65,6 48,2 31,0 20, 13, 93,7 87,8 77,0 62, 53, 94,2 ≥8 91,0 102 10. 58 5. 56, (56, 44 4. 43, (43, 65, 48, 31, 93, 87, 77, 94, ≥ 91, (56 (43 (5 (4 (

ABSTRACT BACKGROUND AND OBJECTIVES: The feet may be involved in patients with ankylosing spondylitis (AS), causing pain and walking difficulties. This research aimed to study the involvement of the foot in a sample of Brazilian patients with AS. METHODS: The Brazilian version of the Foot Function Index (FFI-BR) was applied to 103 individuals (57 AS patients and 46 controls). Clinical profiles were obtained in AS patients as well as the measurement of disease activity by the ASDAS (Ankylosing Spondylitis Disease Activity Score)-ESR (erythrocyte sedimentation rate), ASDAS-CRP (C reactive protein) and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and function by BASFI (Bath Ankylosing spondylitis functional score). RESULTS: Only 19.2% of AS patients did not have any foot complaints and the FFI-BR score presented worse results than the control group (p = 0.02). The "pain" domain of FFI-BR scored highest in AS patients, followed by "disability". There was no association between the results of the FFI-BR and the clinical profile of patients with AS, but there was an association between the score and the disease activity indexes (r = 0.50, p = 0.003 with ASDAS-ESR; r = 0.44, p = 0.005 with ASDAS-CRP; and r = 0.60, p < 0.0001 with BASDAI). The BASFI also showed a positive correlation (r = 0.72; p < 0.0001). CONCLUSION: Pain and disability are common in AS patients and these symptoms are associated with disease activity. OBJECTIVES , (AS) difficulties METHODS FFIBR FFI BR (FFI-BR 10 57 (5 4 controls. controls . controls) ScoreESR Score ESR erythrocyte rate, rate rate) ASDASCRP CRP C protein Bath score. score) RESULTS 192 19 2 19.2 0.02. 002 0.02 0 02 0.02) "pain disability. "disability" 050 50 0.50 0003 003 0.00 ASDASESR ASDAS-ESR 044 44 0.44 0005 005 060 60 0.60 00001 0001 0.000 BASDAI. BASDAI) 0.72 072 72 0.0001. 0.0001) CONCLUSION (AS 1 5 ( 19. 00 0.0 "disability 05 0.5 000 04 0.4 06 6 0.6 0000 0.7 07 7 0.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os pés podem ser acometidos em pacientes com espondilite anquilosante (EA), causando dor e dificuldade de locomoção. O objetivo deste trabalho foi estudar o envolvimento do pé em uma amostra de pacientes brasileiros com EA. MÉTODOS: A versão brasileira do Foot Function Index (FFI-BR) foi aplicada a 103 indivíduos (57 pacientes com EA e 46 controles). O perfil clínico foi obtido para pacientes com EA, bem como a medição da atividade da doença por meio do ASDAS (Ankylosing Spondylitis Disease Activity Score)-ESR. (velocidade de hemossedimentação), ASDAS-CRP (proteína C reativa) e BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) e função pelo BASFI (Bath Ankylosing Spondylitis Functional Score). RESULTADOS: Apenas 19,2% dos pacientes com EA não apresentaram queixas nos pés e o escore FFI-BR apresentou resultados piores do que os do grupo controle (p = 0,02). O domínio "dor" do FFI-BR apresentou a maior pontuação nos pacientes com EA seguido pelo domínio "disfunção". Não se observou associação dos resultados do FFI-BR com o perfil clínico dos pacientes com EA, mas houve associação do escore com os índices de atividade da doença (r = 0,50, p = 0,003 com ASDAS-ESR; r = 0,44, p = 0,005 com ASDAS-CRP; e r = 0,60, p < 0,0001 com BASDAI). O BASFI também apresentou correlação positiva (r = 0,72; p< 0,0001). CONCLUSÃO: Dor e disfunção são comuns em pacientes com EA e estes sintomas se associam com atividade de doença. OBJETIVOS , (EA) locomoção MÉTODOS FFIBR FFI BR (FFI-BR 10 57 (5 4 controles. controles . controles) ScoreESR. ScoreESR Score ESR. ESR Score)-ESR velocidade hemossedimentação, hemossedimentação hemossedimentação) ASDASCRP CRP proteína reativa Bath Score. Score) RESULTADOS 192 19 2 19,2 0,02. 002 0,02 0 02 0,02) "dor disfunção. "disfunção" 050 50 0,50 0003 003 0,00 ASDASESR ASDAS-ESR 044 44 0,44 0005 005 060 60 0,60 00001 0001 0,000 BASDAI. BASDAI) 0,72 072 72 0,0001. 0,0001) CONCLUSÃO (EA 1 5 ( 19, 00 0,0 "disfunção 05 0,5 000 04 0,4 06 6 0,6 0000 0,7 07 7 0,

Abstract Background The diagnostic and prognostic relevance of Human Leukocyte Antigen B-27 (HLA-B27) in Axial Spondyloarthritis (AxSpA) is undeniable, with 70% of Ankylosing Spondylitis (AS) patients carrying the B27 gene, contrasted with a mere 4.35% in the general population. Flow cytometry (FC) and Polymerase Chain Reaction (PCR) have emerged as the predominant techniques for routine HLA-B27 typing. While various studies have compared these methods, none have catered to the unique characteristics of the Brazilian demographic. Therefore, this research aims to compare FC and PCR in a Brazilian cohort diagnosed with AxSpA. Methods An analytical cross-sectional study was undertaken involving 62 AxSpA outpatients from a Brazilian University Hospital. Both FC and PCR-SSP assays were utilized to ascertain HLA-B27 typing. The outcomes (either confirming or refuting the allele’s presence) underwent rigorous scrutiny. Agreement between the methodologies was assessed using the kappa statistic. A p-value of < 0.05 was deemed statistically significant. Results Of the participants, 90.3% (n= 56) were HLA-B27 positive according to FC, while 79% (n= 49) were identified as positive using the PCR method. FC exhibited a sensitivity rate of 98% paired with a specificity of 38.5%. The Positive Predictive Value for FC stood at 85.7%, and the Negative Predictive Value was 83.5%. Consequently, the overall accuracy of the FC method was gauged at 85.5%. A kappa coefficient of κ = 0.454 was derived. Conclusions FC demonstrated noteworthy sensitivity and satisfactory accuracy in HLA-B27 detection, albeit with a reduced specificity when contrasted with PCR-SSP. Nevertheless, given its cost-effectiveness and streamlined operation relative to PCR, FC remains a pragmatic option for preliminary screening in clinical practice, especially in low-income regions. To optimize resource allocation, we advocate for a refined algorithm that initiates by assessing the relevance of HLA-B27 typing based on Choosing Wisely recommendations. It then leans on FC, and, if results are negative yet clinical suspicion persists, advances to PCR. This approach aims to balance diagnostic accuracy and financial prudence, particularly in regions contending with escalating medical costs. B 27 B-2 HLAB27 HLAB HLA (HLA-B27 (AxSpA undeniable 70 AS (AS B2 gene 435 4 35 4.35 population (FC (PCR HLA-B2 methods demographic Therefore crosssectional cross sectional 6 Hospital PCRSSP SSP either alleles allele s presence scrutiny statistic pvalue p value 005 0 05 0.0 significant participants 903 90 3 90.3 n= n (n 56 79 49 98 385 38 5 38.5% 857 85 7 85.7% 835 83 83.5% Consequently 855 85.5% 0454 454 0.45 derived detection PCRSSP. SSP. Nevertheless costeffectiveness cost effectiveness practice lowincome low income allocation recommendations persists prudence costs 2 B- HLAB2 (HLA-B2 43 4.3 HLA-B 00 0. 9 90. 38.5 8 85.7 83.5 85.5 045 45 0.4 (HLA-B 4. 38. 85. 83. 04

Abstract Background There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE). Methods The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age ≥18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical. Results A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (±13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility. Conclusions Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population. HLAB27 HLAB HLA B27 B HLA-B2 SpA, , (SpA) worldwide However mixedrace mixed race populations RBE. . (RBE) multicenter observational 4 Brazil follow 1 (1 rheumatologist 2 (2 18 ≥1 years 3 (3 axial protocol historical 109 included 734 73 73.4 444 44 44. ±13.2 132 13 (±13.2 uveitis Conversely psoriasis activity mobility world Furthermore HLAB2 B2 HLA-B (SpA (RBE ( ≥ 10 7 73. ±13. (±13. ±13 (±13 ±1 (±1 ± (±

Abstract Objectives To evaluate the tuberculin skin test (TST) conversion in chronic inflammatory arthropathies (CIA) patients on TNFα inhibitors (TNFi) and without previous latent tuberculosis infection (LTBI) treatment. Methods Patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) with negative LTBI were retrospectively evaluated for TST conversion and active tuberculosis (TB) after six months of exposition to TNFi. Two groups were compared: patients who repeated TST (TST-repetition) during the follow-up and patients who did not (non-TST-repetition). Results A total of 355 CIA patients on TNFi were screened and 138 (38.9%) did not fulfill the inclusion criteria. Of the remaining 217 CIA patients, 81 (37.3%) repeated TST during TNFi treatment. TST conversion rate was observed in 18 (22.2%) patients without significant differences among CIA (p = 0.578). The number of TB cases was low (n = 10; 4.6%) and was similar in TST-repetition and non-TST-repetition groups [2 (2.5%) vs. 8 (5.9%), p = 0.328]. Of note, 30% of active TB occurred early (6–12 months of TNFi exposure) and the median (full range) time to incident TB was 1.3 (0.6–10.6) years, whereas the median (full range) time to TST repetition was later [3.3 (0.5–13.4) years]. The incidence of active TB was lower among RA patients than AS patients [342 (95% CI 41 − 1446) vs. 1.454 (95% CI 594-2993)/100,000 patient-years, p = 0.049]. Conclusion These results indicate that TST repetition is associated with a high conversion rate, suggesting the need for recommended treatment. The delayed repetition of TST and low number of active TB cases hampered the evaluation of this strategy effectiveness to prevent active infection. Larger studies with systematic repetition patterns are necessary. In addition, the study highlights the need for a greater surveillance for TB in AS patients. Key messages TST repetition is associated with a high conversion rate for positive LTBI after long-term TNFi. Active tuberculosis diagnosis occurs early (1.3 years) during TNFi therapy. AS patients require greater surveillance for incident TB. (TST (CIA (TNFi (LTBI treatment RA, , (RA) (AS PsA (PsA (TB compared TSTrepetition (TST-repetition followup follow up nonTSTrepetition. nonTSTrepetition non . (non-TST-repetition) 35 13 38.9% 389 38 9 (38.9% criteria 21 37.3% 373 37 3 (37.3% 1 22.2% 222 22 2 (22.2% 0.578. 0578 0.578 0 578 0.578) n 10 4.6% 46 4 6 [ 2.5% 25 5 (2.5% vs 5.9%, 59 5.9% (5.9%) 0.328. 0328 0.328 328 0.328] note 30 6–12 612 12 (6–1 exposure full range 1. 0.6–10.6 06106 (0.6–10.6 years 3.3 33 [3. 0.5–13.4 05134 (0.5–13.4 years. years] 342 [34 95% 95 (95 1446 1454 454 1.45 5942993/100,000 5942993100000 594 2993 /100,000 100 000 594-2993)/100,00 patientyears, patientyears patient patient-years 0.049. 0049 0.049 049 0.049] necessary addition longterm long term (1. therapy (RA (non-TST-repetition 38.9 (38.9 37.3 (37.3 22.2 (22.2 057 0.57 57 4.6 2.5 (2.5 5.9 (5.9% 032 0.32 32 6–1 61 (6– 0.6–10. 0610 (0.6–10. 3. [3 0.5–13. 0513 (0.5–13. 34 (9 144 145 45 1.4 5942993 5942993/100,00 594299310000 299 100000 /100,00 00 594-2993)/100,0 004 0.04 04 (1 38. (38. 37. (37. 22. (22. 05 0.5 4. 2. (2. 5. (5.9 03 0.3 6– (6 0.6–10 061 (0.6–10 0.5–13 051 (0.5–13 ( 14 594299 5942993/100,0 59429931000 29 10000 /100,0 594-2993)/100, 0.0 (38 (37 (22 0. (2 (5. 0.6–1 06 (0.6–1 0.5–1 (0.5–1 59429 5942993/100, 5942993100 1000 /100, 594-2993)/100 (3 (5 0.6– (0.6– 0.5– (0.5– 5942 5942993/100 594299310 /100 594-2993)/10 0.6 (0.6 (0.5 5942993/10 59429931 /10 594-2993)/1 (0. 5942993/1 /1 594-2993)/ (0 5942993/ / 594-2993) 594-2993 594-299 594-29 594-2 594-

Abstract Background Ankylosing spondylitis (AS) has been known to have auto-inflammatory nature; hence, the efficacy of autoantibodies is low. However, studies on autoantibodies are ongoing, with some studies showing associations. Previous studies showed that anti-protein phosphatase magnesium-dependent 1A (PPM1A) IgG was increased in patients with AS and associated with radiographic progression. However, the diagnostic usefulness was limited due to relatively low sensitivity and specificity. This pilot study evaluated the diagnostic utility of anti-PPM1A-IgM and anti-PPM1A-IgG in patients with active AS. Methods Serum samples were obtained from the registry cohort of a single tertiary center in Korea. Serum levels of anti-PPM1A-IgG/IgM were measured by direct ELISA. Receiver operating characteristic (ROC) analysis was used to predict the diagnostic sensitivity and specificity of serum anti-PPM1A-IgG/IgM. Results Samples were collected from 28 patients with active AS, 16 healthy controls (HCs), and 28 patients with rheumatoid arthritis (RA). Although total serum IgM was lower in the RA and AS groups than in the HC group, anti-PPM1A-IgM was significantly lower in the AS group than in the other groups. In evaluating the diagnostic utility of anti-PPM1A-IgG/IgM for AS patients compared with HCs, the area under the curve (AUC) of anti-PPM1A-IgM was 0.998 (sensitivity 96.4%, specificity 100.0%). When ROC analysis of anti-PPM1A-IgM for AS patients compared with RA patients was conducted, sensitivity was 78.6% and specificity was 71.4%, with an AUC of 0.839. Conclusion Decreased anti-PPM1A-IgM levels in AS patients suggests a potential role for anti-PPM1A-IgM in the diagnosis of active AS. (AS autoinflammatory auto inflammatory nature hence However ongoing associations antiprotein anti protein magnesiumdependent magnesium dependent A PPM1A PPMA PPM (PPM1A progression antiPPM1AIgM antiPPMAIgM antiPPM1AIgG antiPPMAIgG Korea antiPPM1AIgG/IgM antiPPM1AIgGIgM antiPPMAIgGIgM IgG/IgM ELISA (ROC antiPPM1AIgG/IgM. IgG/IgM. 2 1 HCs , (HCs) RA. . (RA) (AUC 0998 0 998 0.99 964 96 4 96.4% 100.0%. 1000 100.0% 100 100.0%) conducted 786 78 6 78.6 714 71 71.4% 0839 839 0.839 antiPPM AIgM AIgG AIgGIgM IgGIgM (HCs (RA 099 99 0.9 9 96.4 100.0 10 7 78. 71.4 083 83 0.83 09 0. 96. 100. 71. 08 8 0.8

Abstract Background Spondyloarthritis (SpA) encompasses a spectrum of immune-mediated inflammatory conditions primarily affecting the axial skeleton, including sacroiliitis and spondylitis, each with distinct features. This study aimed to investigate imaging disparities, focusing on sacroiliac magnetic resonance and spine radiography, across phenotypes and between males and females in axial SpA. Method A cross-sectional study was conducted to assess clinical data, laboratory findings, magnetic resonance imaging (MRI) scores of sacroiliac joints using the Spondyloarthritis Research Consortium of Canada (SPARCC) and Sacroiliac Joint Structural Score (SSS), and cervical and lumbar spine radiographs utilizing the Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The study aimed to compare these parameters between two groups: axial spondyloarthritis (axSpA, radiographic and non-radiographic) and axial psoriatic arthritis (axPsA), as well as between males and females. Results Ninety-four patients were included, with 62 patients in the axSpA group and 32 patients in the axPsA group. There were no differences in disease activity, mobility, radiographic damage in the spine (Modified Stoke Ankylosing Spondylitis Spine Score– mSASSS), or sacroiliac magnetic resonance imaging (MRI) scores (Spondyloarthritis Research Consortium of Canada Magnetic Resonance Imaging Index - SPARCC and Sacroiliac Joint Structural Score - SSS) between the two phenotypes. Regarding sex, in imaging exams, men had higher mSASSS (p = 0.008), SSS (p = 0.001), and fat metaplasia (MG) score based on SSS (p = 0.001), while women had significantly higher SPARCC scores (p = 0.039). In the male group, the presence of HLA-B27 allele had an impact on more structural lesions on MRI (SSS), p = 0.013. Conclusion In this study, imaging of sacroiliac joints and spine in patients with axial SpA did not show differences in phenotypes but did reveal differences based on sex, which may have an impact on future diagnostic recommendations. Further studies are needed to confirm these findings. (SpA immunemediated immune mediated skeleton spondylitis features disparities radiography crosssectional cross sectional data findings (MRI (SPARCC SSS, , (SSS) mSASSS. . (mSASSS) groups axSpA, (axSpA nonradiographic non non-radiographic axPsA, (axPsA) Ninetyfour Ninety four included 6 3 activity mobility mSASSS, mSASSS) sex exams 0.008, 0008 0.008 0 008 0.008) 0.001, 0001 0.001 001 0.001) MG (MG 0.039. 0039 0.039 039 0.039) HLAB27 HLAB HLA B27 B HLA-B2 0013 013 0.013 recommendations (SSS (mSASSS (axPsA 000 0.00 00 003 0.03 03 HLAB2 B2 HLA-B 01 0.01 0.0 0.

ABSTRACT: This paper describes, within the framework of a retrospective study, the epidemiological and clinicopathological findings in goats and sheep with compressive lesions of the central nervous system (CNS) in Pará. This study included eight sheep and three goats from 2005 to 2022 by reviewing the clinical files of animals with CNS compressive lesions managed by the team of the Carlos Tokarnia Veterinary Hospital of the Institute of Veterinary Medicine of the Federal University of Pará. The animals with clinical signs were subjected to a general and specific clinical examination of the nervous system. All animals included in the study were necropsied, and the clinical signs were found to vary according to the location of the lesion. At necropsy, changes such as an abscess with osteomyelitis of the vertebral body with pathologic fracture and spinal cord compression, submeningeal abscess in the skull floor, subarachnoid hematoma, and congenital bone changes causing spinal cord compression and ankylosing spondylitis were noted. These findings indicate that a comprehensive clinical examination of the CNS in conjunction with necropsy findings is essential to characterize the clinical picture, localize the lesion, and determine the cause of the disease. The most affected medullary segment was between T3 and L3. Therefore, these diseases should be included in the list of differential diagnoses in farm animals with nervous system symptoms. ABSTRACT describes (CNS Pará 200 202 necropsied lesion floor hematoma noted picture disease T L3 L Therefore symptoms 20 2

RESUMO: O presente trabalho descreve, através de estudo retrospectivo, os achados epidemiológicos e clínico-patológicos em caprinos e ovinos com lesões compressivas no sistema nervoso central (SNC) no estado do Pará. O estudo retrospectivo compreendeu as observações realizadas em oito ovinos e três caprinos no período de 2005 a 2022, por meio da revisão dos arquivos de fichas clínicas de animais com lesões compressivas no SNC, atendidos pelo Hospital Veterinário Carlos Tokarnia do Instituto de Medicina Veterinária da Universidade Federal do Pará. Os animais atendidos com sintomatologia clínica foram submetidos a exames clínicos geral e específico do sistema nervoso. Todos os animais incluídos no estudo foram necropsiados. Os sinais clínicos variaram de acordo com a localização da lesão. Os achados de necropsia revelaram alterações como abscesso com osteomielite do corpo da vértebra com fratura patológica e compressão da medula espinhal; abscesso sub-meningeano no assoalho do crânio; hematoma subaracnoideo e alteração óssea congênita causando compressão medular e espondilite anquilosante. A realização de um minucioso exame clínico do SNC, associado aos achados de necropsia foi importante para caracterizar o quadro clínico, localizar a lesão e determinar a causa da enfermidade. O segmento medular mais acometido foi entre T3-L3. Torna-se importante incluir estas enfermidades na lista de diagnósticos diferenciais em animais de produção que apresentem sintomatologia nervosa. RESUMO descreve clínicopatológicos patológicos SNC (SNC Pará 200 2022 necropsiados espinhal submeningeano sub meningeano crânio anquilosante enfermidade T3L3. T3L3 TL T3 L3. L3 T L T3-L3 Tornase Torna se nervosa 20 202 T3L T3-L 2

BACKGROUND: Ankylosing spondylitis (AS) is characterised as a chronic inflammatory disease of the axial skeleton. The force platform is an option for performing the postural assessment of these individuals OBJECTIVES: To review and evaluate the behaviour of the centre of pressure (CoP) variables during the postural control examination in patients with AS compared to a control group METHOD: A systematic review, registered in PROSPERO, that followed the PRISMA Statement. A search was carried out in the following databases: Medline, Web of Science, Embase, Scopus, and Scielo, from 1945 to 2023. Studies were selected that aimed to understand the use of the force platform for the assessment of postural control. The risk of bias assessment was performed using the AXIS tool RESULTS: Five studies were included, with a total of 247 participants. The assessment of risk of bias presented high scores in the AXIS tool. Patients with a diagnosis of AS presented increased thoracic kyphosis in most of the studies, as well as large displacements in the anteroposterior (AP) and mediolateral (ML) directions, and altered total mean velocity (TMV) and frequency, indicating worse postural stability. Regarding the functional status, the most used questionnaires were the Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Bath Ankylosing Disease Activity Index (BASDAI CONCLUSION: Patients with ankylosing spondylitis present postural instability, verified by means of higher values of centre of posture variables CLINICAL IMPLICATIONS: Individuals with ankylosing spondylitis presented postural instability and balance deficit. Therefore, exercises for balance training and postural control are essential in the clinical management of these patients

Abstract Background Psoriatic arthritis can involve several domains. Due to its multifaceted nature and its frequent comorbidities such as depression, obesity, osteoarthritis and fibromyalgia, it is difficult to monitor these patients because the clinical scores involve subjective data. High-resolution ultrasound probes allowed the evaluation of more superficial structures, such as the nails and their synovio-entheseal framework, in close relationship with the enthesis of the distal extensor digitorum tendon. Nail ultrasound studies vary in terms of the parameters and fingers studied and in their findings. Objectives To describe the most significant sonographic nail changes and the most affected fingers in psoriatic arthritis and to verify the association of nail ultrasound findings with clinical scores (nail psoriasis severity index (NAPSI), ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP), minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA)). Methods This was a cross-sectional study with 52 patients with psoriatic arthritis at the Hospital de Clínicas do Paraná and 50 controls. A total of 1016 nails were analyzed (517 from patients with psoriatic arthritis and 499 from controls). Ultrasonography of the nails of the 10 fingers was performed to assess the trilaminar appearance, measure the distance from the nail bed, identify synovitis of the distal interphalangeal joints and the presence of a power Doppler signal from the nail matrix/nail bed. The captured images were independently evaluated by a rheumatologist with expertise in musculoskeletal ultrasound. Data analysis was performed using IBM SPSS Statistics v.28.0.0 software, and the association of nail plate changes, nail bed distance and power Doppler signal with the NAPSI, DAPSA, MDA and ASDAS-PCR were calculated. Spearman correlation coefficients were estimated to analyze the correlations between pairs of quantitative variables. Student's t test and the Mann–Whitney U test were used to compare quantitative variables, and Fisher's exact test was used to compare categorical variables between patients and controls. The nonparametric Mann–Whitney U and Kruskal–Wallis tests were used to compare groups according to the MDA or DAPSA classification. Results The Doppler signal of the nail matrix and nail bed was more frequently identified in patients (44.2%) than in controls (6%), and the difference in the mean power Doppler signal between the two groups was significant (p < 0.001). Changes in the nail plate were more common in the right thumb (44.2%), left thumb (36.5%) and second finger on the right hand (32.7%). The number of fingers with nail plate changes, enthesitis, paratendinitis, grayscale synovitis and DIP involvement in the distal interphalangeal joints was higher among patients with psoriatic arthritis (p < 0.001). There were found some correlations between US findings and clinical scores: ultrasound nail involvement and the NAPSI score (p = 0.034), the number of fingers and mean change in the nail plate and the ASDAS-CRP (p = 0.030). DAPSA (remission/low activity versus moderate/high activity) was associated to the mean change in the nail plate (p < 0.013). CONCLUSIONS: Nail ultrasound has the potential to assist in the capturing of the actual disease activity status in patients with psoriatic arthritis. domains depression obesity fibromyalgia data Highresolution High resolution structures synovioentheseal synovio entheseal framework tendon , (NAPSI) Creactive C reactive ASDASCRP, ASDASCRP ASDAS CRP (ASDAS-CRP) MDA, (MDA) DAPSA. . (DAPSA)) crosssectional cross sectional 5 101 517 (51 49 controls) 1 appearance matrixnail v2800 v 28 0 v.28.0. software ASDASPCR PCR calculated Students Student s MannWhitney Mann Whitney Fishers Fisher KruskalWallis Kruskal Wallis classification 44.2% 442 44 2 (44.2% 6%, 6 6% (6%) p 0.001. 0001 0.001 001 0.001) 44.2%, 36.5% 365 36 (36.5% 32.7%. 327 32.7% 32 7 (32.7%) enthesitis paratendinitis 0.034, 0034 0.034 034 0.034) 0.030. 0030 0.030 030 0.030) remission/low remissionlow remission low moderatehigh moderate high 0.013. 0013 0.013 013 0.013) CONCLUSIONS (NAPSI (ASDAS-CRP (MDA (DAPSA) 51 (5 4 v280 v.28.0 44.2 (44.2 (6% 000 0.00 00 36.5 3 (36.5 32.7 (32.7% 003 0.03 03 0.01 01 (DAPSA ( v28 v.28. 44. (44. (6 0.0 36. (36. 32. (32.7 v2 v.28 (44 0. (36 (32. v.2 (4 (3 (32 v.

Abstract Introduction: both spondyloarthritis (SpA) and Takayasu arteritis (TAK) are rare diseases, and their association is even rarer. Objectives: to present a series of patients with a concomitant diagnosis of SpA or with features of SpA and TAK in Argentina and review the literature regarding this association. Materials and methods: the demographic, clinical and therapeutic characteristics of patients with a concomitant diagnosis of SpA or with some features of SpA and TAK were collected from different health centers in Argentina. Results: 7 patients are described, of which 4 had SpA, one with juvenile axial involvement (axSpA), another with psoriatic arthritis (PsA), another with ankylosing spondylitis (AS) and the last patient with pure axSpA and 3 of them had features of SpA (Crohn's disease, psoriasis and asymmetric oligoarthritis of large joints). In most cases, SpA features presented a median of 4 years before TAK. Conclusions: several case reports and case series reported overlap between these two diseases. Although they could share a certain common genetic basis, we still do not have solid evidence that allows us to estimate that this association is not coincidental.

Resumen Introducción: tanto las espondiloartritis (EspA) como la arteritis de Takayasu (TAK) son enfermedades infrecuentes y su asociación es aún más rara. Objetivos: presentar una serie de pacientes con diagnóstico concomitante de EspA o con rasgos de EspA y TAK en Argentina, y realizar una revisión de la literatura respecto de esta asociación. Materiales y métodos: se recopilaron las características demográficas, clínicas y terapéuticas de pacientes con diagnóstico concomitante de EspA o con algunos rasgos de EspA y TAK, de distintos centros de salud de la República Argentina. Resultados: se describen 7 pacientes, de los cuales 4 presentaban EspA, uno con compromiso axial (EspAax) juvenil, otro con artritis psoriásica (APs), otro con espondilitis anquilosante (EA) y el último con EspAax pura, y 3 de ellos tuvieron rasgos de EspA (enfermedad Crohn, psoriasis y oligoartritis asimétrica de grandes articulaciones). En la mayoría de los casos, los rasgos de EspA se presentaron con una mediana de 4 años antes de la TAK. Conclusiones: varios reportes y series de casos relatan la superposición entre estas dos enfermedades. Si bien las mismas podrían compartir cierta base genética común, todavía no contamos con evidencia sólida que permita estimar que esta asociación no es casual.

Abstract Background Kidney disease is a rare manifestation of ankylosing spondylitis (AS) and its pathological alterations remain poorly described. The aim of this study was to investigate the clinical presentation and pathological alterations on kidney biopsy of AS patients and review and discuss the current literature on the issue. Methods: We retrospectively studied the clinical presentation and kidney pathological alterations of 15 Caucasian AS patients submitted to kidney biopsy between October 1985 and March 2021. Results: Patients were predominantly male (66.7%) with median age at the time of kideney biopsy of 47 years [IQR 34 - 62]. Median serum creatinine at presentation was 1.3 mg/dL [IQR 0.9 - 3] and most patients also had either proteinuria (85.7%) and/or hematuria (42.8%). The most common indication for kidney biopsy was nephrotic syndrome (33.3%), followed by acute or rapidly progressive kidney injury (20%) and chronic kidney disease of unknown etiology (20%). Chronic interstitial nephritis (CIN) (n=3) and AA amyloidosis (n=3) were the most common diagnosis. Others included IgA nephropathy (IgAN) (n=2), focal segmental glomerulosclerosis (n=2), membranous nephropathy (n=1), and immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN)(n=1). Conclusions: We present one of the largest series of biopsy-proven kidney disease in Caucasian AS patients. We found a lower prevalence of IgAN than previously reported in Asian cohorts. We found a higher prevalence of CIN and a lower prevalence of AA amyloidosis than that described in previous series of Caucasian patients. We also present the first case of AS-associated IC-MPGN. (AS issue Methods 1 198 2021 Results 66.7% 667 66 7 (66.7% 4 IQR 3 62. 62 . 62] 13 1. mgdL mg dL 09 0 9 0. 85.7% 857 85 (85.7% andor 42.8%. 428 42.8% 42 8 (42.8%) 33.3%, 333 33.3% , 33 (33.3%) 20% 20 (20% 20%. (CIN n=3 n3 n (n=3 diagnosis (IgAN n=2, n2 n=2 2 (n=2) n=1, n1 n=1 (n=1) complexmediated complex mediated ICMPGNn=1. ICMPGNn1 ICMPGNn IC MPGN (IC-MPGN)(n=1) Conclusions biopsyproven proven cohorts ASassociated associated ICMPGN. ICMPGN MPGN. IC-MPGN 19 202 66.7 6 (66.7 85.7 (85.7 42.8 (42.8% 33.3 (33.3% (20 n= (n= (n=2 (n=1 ICMPGNn=1 (IC-MPGN)(n=1 66. (66. 85. (85. 42. (42.8 33. (33.3 (2 (n ICMPGNn= (IC-MPGN)(n= (66 (85 (42. (33. ( (IC-MPGN)(n (6 (8 (42 (33 (4 (3

Resumo Antecedentes: A doença renal é uma manifestação rara de espondilite anquilosante (EA) e as suas alterações patológicas permanecem pouco descritas. O objetivo deste estudo foi investigar a apresentação clínica e alterações patológicas na biópsia renal de doentes com EA bem como rever e discutir a literatura atual sobre o assunto. Métodos: Estudamos retrospectivamente a apresentação clínica e alterações patológicas renais de 15 doentes caucasianos com EA submetidos a biópsia renal entre Outubro de 1985 e Março de 2021. Resultados: Os doentes eram predominantemente homens (66,7%) com idade mediana no momento da biópsia de 47 anos [IIQ 34 - 62]. A creatinina sérica mediana na apresentação foi de 1,3 mg/dL [IIQ 0,9 - 3] e a maioria dos pacientes apresentava também proteinúria (85,7%) e/ou hematúria (42,8%). A indicação mais comum para biópsia renal foi a síndrome nefrótica (33,3%), seguida de lesão renal aguda ou rapidamente progressiva (20%) e doença renal crónica de etiologia desconhecida (20%). A Nefrite intersticial crónica (NIC) (n=3) e a amiloidose AA (n=3) foram os diagnósticos mais comuns. Outros incluíram nefropatia por IgA (NIgA) (n=2), glomeruloesclerose segmentar focal (n=2), nefropatia membranosa (n=1) e glomerulonefrite membranoproliferativa mediada por imunocomplexos (GNMP-IC) (n=1). Conclusões: Apresentamos uma das maiores séries de doenças renais comprovadas por biópsia em doentes caucasianos com EA. Encontramos uma prevalência de NIgA menor do que a relatada anteriormente em coortes asiáticas. Encontramos uma maior prevalência de NIC e uma prevalência menor de amiloidose AA do que a descrita em séries anteriores de pacientes caucasianos. Também apresentamos o primeiro caso de GNMP-IC associada à EA. Antecedentes (EA descritas assunto Métodos 1 198 2021 Resultados 66,7% 667 66 7 (66,7% 4 IIQ 3 62. 62 . 62] 13 1, mgdL mg dL 09 0 9 0, 85,7% 857 85 (85,7% eou 42,8%. 428 42,8% 42 8 (42,8%) 33,3%, 333 33,3% , 33 (33,3%) 20% 20 (20% 20%. (NIC n=3 n3 n (n=3 comuns (NIgA n=2, n2 n=2 2 (n=2) n=1 n1 (n=1 GNMPIC GNMP IC (GNMP-IC n=1. Conclusões asiáticas 19 202 66,7 6 (66,7 85,7 (85,7 42,8 (42,8% 33,3 (33,3% (20 n= (n= (n=2 66, (66, 85, (85, 42, (42,8 33, (33,3 (2 (n (66 (85 (42, (33, ( (6 (8 (42 (33 (4 (3

Abstract Background Ankylosing Spondylitis (AS) patients face several challenges due to the nature of the disease and its physical and psychological complications. Sleep disorders are among the most important concerns. Sleep disorders can aggravate the signs and symptoms of the disease and ultimately reduce the quality of patients’ lives. This study uses a systematic review and meta-analysis to pool the reported prevalence of sleep disorders among AS patients. Methods To find related studies, the WoS, PubMed, ScienceDirect, Scopus, Embase, and Google Scholar databases were systematically searched without a lower time limit. Heterogeneity among the identified studies was checked using the I2 index, and the Begg and Mazumdar correlation test examined the existence of published bias. Comprehensive Meta-Analysis (v.2) software was adopted to analyze the data. Results In the review of 18 studies with a sample size of 5,840, the overall pooled prevalence of sleep disorders among AS patients based on the random effects method was found to be 53% (95% CI: 44.9–61). The highest and lowest prevalence was in Egypt at 90% and Australia at 19.2%, respectively. Our meta-regression results show that with the increase in ‘sample size’ and ‘year of publication’, the overall prevalence of sleep disorders in patients with AS decreases (p < 0.05). Conclusion The results of the present study indicate a high and significant prevalence of sleep disorders among AS patients. Thus, health policymakers and healthcare providers must focus on timely diagnosis and effective educational and therapeutic interventions for the prevention and proper treatment of sleep disorders in this population of patients. (AS complications concerns lives metaanalysis meta analysis WoS PubMed ScienceDirect Scopus Embase limit I index bias MetaAnalysis Meta Analysis v.2 v2 v 2 (v.2 data 1 5840 5 840 5,840 53 95% 95 (95 CI 44.9–61. 44961 44.9–61 . 44 9 61 44.9–61) 90 192 19 19.2% respectively metaregression regression year publication, publication , publication’ p 0.05. 005 0.05 0 05 0.05) Thus v. (v. 584 84 5,84 (9 4496 44.9–6 4 6 19.2 00 0.0 (v 58 8 5,8 ( 449 44.9– 19. 0. 5, 44.9 44.