Diagnosis Of Spondyloarthropathy Research Articles

The Risk of Herpes Zoster Events in Patients with Spondyloarthritis and the Effect of BNT162b2 mRNA COVID-19 Vaccine.

The data on the risk of herpes zoster (HZ) in spondyloarthropathy (SpA) patients are sparse, especially regarding its association with the novel mRNA COVID-19 vaccines and immunosuppressants. We aimed to evaluate whether SpA diagnosis and/or immunosuppressant use affect HZ risk and the influence of mRNA COVID-19 vaccination. We assessed the association between SpA (psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) diagnoses and HZ in a large population database with patients matched by age and sex to controls. We also assessed the association between the COVID-19 vaccine and new-onset HZ using two nested case-control studies, identifying all new HZ cases diagnosed from 1 January-31 December 2021 within the SpA and general population cohorts, matched randomly by sex, age and HZ index date to controls without HZ. Exposure to mRNA COVID-19 vaccination was ascertained in the 6 weeks prior to the index date both in cases and controls. In our results, the incidence rate of HZ was higher in PsA patients vs. the general population, at 1.03 vs. 0.64 per 100 person-years, respectively (adjusted HR = 1.55; 95%CI, 1.19-2.02). Within the SpA group, Jak-I treatment was associated with a higher risk of developing new-onset HZ (adjusted OR = 3.79; 1.15-12.5). Multivariable conditional logistic regression models we used showed no association between COVID-19 vaccination and new-onset HZ among the SpA patients (OR = 1.46; 0.68-3.14).

Aktif Sakroiliitin Manyetik Rezonans Görüntülemesinde Gözlemciler Arasındaki Uyum

Introduction 
 Axial spondyloarthritis has characteristic clinical features such as enthesitis, sacroiliitis and spondylitis, and extra-articular manifestations. Sacroiliitis (SI) occurs as a result of inflammation of the sacroiliac joint. Magnetic resonance imaging (MRI) of sacroiliac (SI) joints is used to detect early sacroiliitis. Sometimes, there can be variations in the interpretation of MRI findings of the SI joint among observers. Our aim was to investigate the inter-observer agreement among the observers.
 Materials and methods
 The study included the MRI results of 1150 patients who were diagnosed with active or chronic sacroiliitis based on the findings from sacroiliac MRIs, or whose MRI was deemed indicative of sacroiliitis by the rheumatologist. 1150 MRIs were re-evaluated by a different and expert radiologist.
 Results
 Out of the total 1150 patients investigated within the scope of this study. A statistically significant disparity emerged between the assessments provided by the expert radiologists and those obtained from outsourced radiologist evaluations.
 Conclusion
 The diagnosis of spondyloarthropathy may be delayed for some reasons. If the patient's clinic and MRI report are not consistent, the patient should not be removed from follow-up.

E090 Secondary care collaborative service to reduce time to diagnosis in axial spondyloarthropathy: retrospective study from Leicester combined rheumatology-uveitis service

Abstract Background/Aims The time from symptom onset to diagnosis of axial spondyloarthropathy (SpA) in the UK is 8.5 years. Previous studies show that half of patients with anterior uveitis are HLA-B27 positive and half of those have SpA. At University Hospitals of Leicester, there is a combined rheumatology-ophthalmology clinic to help reduce this diagnostic delay and help foster a collaborative approach. Our aims are to evaluate the cohort of HLA-B27 positive patients presenting with uveitis to University Hospitals of Leicester (UHL), a busy tertiary centre serving a multi-ethnic region. Secondly, to assess what proportion of these patients are diagnosed with SpA. Methods All patients presenting to University Hospitals of Leicester with uveitis between 2011 and 2021 were identified on a database kept by the ophthalmology department. Patient details were examined retrospectively using clinic letters and the electronic reporting system for HLA-B27 status, age, ethnicity, pattern of uveitis, use of systemic therapy, associated rheumatic disease, and whether subsequent imaging was performed to establish a diagnosis of SpA. Results Of 2159 patients presenting with uveitis, 482 were tested for HLA-B27 (213 were positive and 269 negative). Of the 213 HLA-B27 positive patients, mean age was 45.5 years (SD 15.6 years). There were 106 males and 107 females. Right eye, left eye and bilateral uveitis was diagnosed in 73, 66, and 74 patients, respectively. Uveitis was classified as acute, recurrent, chronic, and not stated in 88, 77, 46, and two patients, respectively. Among the HLA-B27 positive patients, systemic treatment was used for the uveitis in 51 patients. This includes oral steroids in 32 patients, and methotrexate, mycophenolate mofetil, azathioprine, adalimumab, sulfasalazine, and hydroxychloroquine used in seven, four, four, two, one, and one patient, respectively. Of the 213 patients positive for HLA-B27, 66 had pre-existing diagnoses. The most common was axial SpA in 48 patients. The remaining included four patients with IBD, four with JIA, four with RA, two with psoriatic arthritis, two with psoriasis, one with reactive arthritis, and one with sarcoidosis. Of the remaining 147 patients without an established rheumatic disease, 43 were referred to rheumatology (six of these to the combined clinic). Of these 43 patients, 32 underwent MRI with inflammatory back pain protocol, and 12 of these showed features consistent with axial SpA. Two patients were diagnosed with peripheral SpA. In the remaining patients, four are awaiting a rheumatology appointment, and five did not attend. In the patients referred to rheumatology, there were 39 Caucasians, two Asians, one mixed-race and one Afro-Caribbean patient. Conclusion We demonstrated a significant improvement in time to diagnosis with this service. It also demonstrated improvement of patient care and quality of life. Disclosure A. Jubber: None. S. Ganguly: None. J. Sabu: None. C. Betteridge: None. P. Kumar: None. A. Moorthy: None.

P009 Biologics prescribing trends over 10 years: a retrospective analysis of 799 patients in routine clinical practice

Abstract Background/Aims To investigate the biologic prescribing trends for a secondary care patient cohort over a 10-year period for rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthropathy (SpA), and compare against current local guidelines. Methods Departmental database holding patient data was interrogated. Labelled data were consolidated into distinct diagnostic categories of rheumatoid arthritis, psoriatic arthritis and spondyloarthropathy. For ease of analysis, biologic drugs were classified based on their mechanism of action into TNF-alpha blockers (TNFi) and non-TNF-alpha blockers (non-TNFi). Data was collated identifying prescribing trends of first, second and third-line therapies for RA, PsA and SpA. This was compared against local NHS guidelines. Overall cost of biologic prescription for first line therapies was calculated Results There were 799 patients with a diagnosis of RA, PsA or SpA. Both RA and PsA had the same general prescribing pattern of TNFi as first-line, another TNFi as second-line and non-TNFi as third-line. In SpA, TNFi were mostly used as first, second and third-line. An adalimumab biosimilar was used first-line in 90 (30.6%) RA patients, 42 (35.1%) PsA patients and 32 (32.3%) SpA patients. Methotrexate was co-prescribed with a TNF-alpha blocker in 128 (58.7%) RA patients, 51 (36.4%) PsA patients and 7 (7.7%) SpA patients. TNFi biosimilar drug prescribing has increased from 33% in 2016 to being the most prescribed drug in 2020 (62%). In the entire database cohort of 926 patients, the vast majority are prescribed biosimilars (Table 1). The overall cost of biologic prescriptions has reduced by 49% from 2019 to 2020 as the proportion of biosimilars prescribed has almost doubled to 69%. Conclusion Biologic prescribing patterns are largely in-keeping with current national and local guidelines. The vast majority of patients are on a biosimilar, which has resulted in significant cost-savings for the department. Disclosure R. Zubairi: None. A. Muhd Adiib Pg Suhaimi: None. L. Olsson: None. R. Smyth: None. D. Baxter: None. A. Laws: None. M.E. Perry: Honoraria; AbbVie, Celltrion Healthcare, Gilead, Lilly, Biogen, Jaansen, Fresenius Kabi.

Quantitative T2 mapping of the sacroiliac joint cartilage at 3T in patients with axial spondyloarthropathies

To evaluate the diagnostic value of T2 mapping of sacroiliac joint cartilage in patients with axial spondyloarthropathies (SpA). Thirty-seven SpA patients and 43 controls (mean age: 36.5 ± 8.2; 20 men) prospectively underwent conventional MRI and T2 mapping of the sacroiliac joints at 3 T. SpA patients and their sacroiliac joints were categorized into active and inactive based on the presence of bone marrow edema on the conventional MRI. T2-relaxation times were measured by drawing six manual ROIs on the cartilaginous part of the joints. T2 values of the bilateral iliac and sacral joint cartilages for each patient (T2subject), iliac and sacral cartilages for each sacroiliac joint (T2joint), iliac cartilage (T2iliac), and sacral cartilage (T2sacral) were calculated and compared between SpA patients and controls, and active and inactive joints. The T2subject of SpA patients (50.48 ± 5.32 ms) was significantly higher than the T2subject of the controls (46.33 ± 3.30 ms, p < 0.001). Selecting an optimal T2subject cut-off value of 48.77 to differentiate SpA patients from controls revealed a sensitivity and a specificity of 62.2% and 81.4% respectively (AUC = 0.739). In SpA patients, T2joint, T2iliac, and T2sacral values of the inactive joints were not significantly different from those of the active joints (p = 0.088, p = 0.179, and p = 0.069). T2joint, T2iliac, and T2sacral values of the inactive joints of SpA patients were significantly higher than those of the controls (p = 0.012, p = 0.029, and p = 0.016). T2 values of both active and inactive sacroiliac joint cartilages of SpA patients were increased. Thus, T2 mapping may be used in the diagnosis of SpA. • Sacroiliac cartilage T2 values of SpA patients increase compared to those of the non-SpA controls. • Sacroiliac cartilage T2 values of active and inactive joints of SpA patients increase compared to those of the non-SpA controls. • Sacroiliac cartilage T2 values of active and inactive joints of SpA patients do not show statistically significant difference.

Serum Immunoglobulin Levels, Complement Components 3 and 4, HLA-B27 Allele and Spondyloarthropathy in Patients with Non-Infectious Anterior Uveites.

To identify the relationship between serum immunoglobulin levels, complement components 3 and 4, the presence of the HLA-B27 allele and diagnosis of spondyloarthropathies in patients with non-infectious anterior uveitis. The participants were 197 patients with a non-infectious anterior uveitis. The concentrations of serum immunoglobulins, and C3 and C4 proteins of the complement were determined by turbidimetry. The personal history of suspected immunodeficiency, ophthalmological complications, arthralgia, family history of spondyloarthropathies and the presence of the HLA-B27 allele were collected. A family history of spondyloarthropathy, axial arthralgias, and ophthalmological complications were more frequent in HLA-B27 positive patients (P=.0005, P≤.0001, and P≤.0001, respectively) and in patients with spondyloarthropathy diagnoses (P≤.0001, P≤.0001, and P≤.0001, respectively). A personal history of recurrent sepsis, and gastrointestinal abnormalities was associated with the presence of the HLA-B27 allele (P≤.0001, and P=.0240, respectively) and with the diagnosis of spondyloarthropathy (P=.0492, and P=.0017, respectively). IgG decrease was observed (χ2=18.5, OR 5.03, 95% CI 2.32-10.89; P=.0001) and IgM (OR 7.13, 95% CI 1.40-36.4; P=.0128) in patients positive for the HLA-B27 allele and in patients with a diagnosis of spondyloarthropathies (P=.0364 and P=.0028, respectively). The decrease of C3 proteins (OR 4.82; CI 95% 1.35-17.11; P=.0328) and C4 (OR 9.09; CI 95% 2.13-38.88; P=.0074) were associated with a spondyloarthropathies diagnosis. Patients with non-infectious anterior uveitis, positive for the HLA-B27 allele and diagnosed with spondyloarthropathies have alterations in serum immunoglobulin levels and complement components 3 and 4, which could contribute to the perpetuation and worse clinical course of this disease.

Serum immunoglobulin levels, complement components 3 and 4, HLA-B27 allele and spondyloarthropathy in patients with non-infectious anterior uveites

ObjectiveTo identify the relationship between serum immunoglobulin levels, complement components 3 and 4, the presence of the HLA-B27 allele and diagnosis of spondyloarthropathies in patients with non-infectious anterior uveitis. Materials and methodsThe participants were 197 patients with a non-infectious anterior uveitis. The concentrations of serum immunoglobulins, C3 and C4 proteins of the complement were determined by turbidimetry. The personal history of suspected immunodeficiency, ophthalmological complications, arthralgia, family history of spondyloarthropathies and the presence of the HLA-B27 allele were collected. ResultsA family history of spondyloarthropathy, axial arthralgias, and ophthalmological complications were more frequent in HLA-B27 positive patients (P=.0005, P≤.0001, P≤.0001 respectively) and in patients with spondyloarthropathy diagnoses (P≤.0001, P≤.0001, P≤.0001 respectively). A personal history of recurrent sepsis, and gastrointestinal abnormalities was associated with the presence of the HLA-B27 allele (P≤.0001, P=.0240 respectively) and with the diagnosis of spondyloarthropathy (P=.0492, P=.0017 respectively). IgG decrease was observed (χ2=18.5, OR=5.03, 95% CI=2.32–10.89, P=.0001) and M (OR=7.13, 95% CI=1.40−36.4; P=.0128) in patients positive for the HLA-B27 allele and in patients with a diagnosis of SpA (P=.0364 and P=.0028 respectively). The decrease of C3 proteins (OR=4.82; CI 95%=1.35–17.11; P=.0328) and C4 (OR=9.09; CI 95%=2.13–38.88; P=.0074) were associated with a spondyloarthropathies diagnosis. ConclusionsPatients with non-infectious anterior uveitis, positive for the HLA-B27 allele and diagnosed with spondyloarthropathies have alterations in serum immunoglobulin levels and complement components 3 and 4, which could contribute to the perpetuation and worse clinical course of this disease.

Evaluation of platelet-rich plasma vs steroid in the treatment of sacroiliitis by ultrasound-guided injection in patients with seronegative axial spondyloarthropathies

ObjectiveThe aim was to evaluate the efficacy of ultrasound-guided (USG) sacroiliac injection of platelet-rich plasma (PRP) for sacroiliitis in seronegative axial spondyloarthropathies (SPAs) vs triamcinolone acetonide injection.BackgroundSacroiliitis is considered a hallmark for the diagnosis of seronegative SPA. Sacroiliac joint steroid injection is a commonly used technique. A novel promising injective treatment is PRP.Patients and methodsThis interventional study included 70 patients with seronegative axial SPA, from 2017 to 2019. The patients were divided into two groups: group I received USG injection of triamcinolone acetonide, and group II received USG injection of PRP. Patients were evaluated for pain intensity by visual analog scale (VAS) and Modified Oswestry Disability Questionnaire (MODQ) 4 and 8 weeks after injection and with MRI 8 weeks after injection.ResultsSteroid and PRP were effective in the treatment of sacroiliitis by USG injection. The improvement was significant and lasted longer in group II (68.6% became with mild pain regarding VAS and 74.3% of minimal disability regarding MODQ) as compared with group I after 8 weeks of injection. Patients who received steroids improved dramatically at 4 weeks (60% of patients experience mild pain regarding VAS and 45.7% became with minimal disability regarding MODQ), with decreased efficacy after 8 weeks. With follow-up with MRI, active sacroiliitis can be fully improved by PRP injection (57.1% with normal MRI result after 8 weeks).ConclusionsSteroid and PRP were effective in the treatment of sacroiliitis in seronegative SPA by USG injection, but PRP had a persistent and long-lasting effect.

Visualization of Enthesitis by Ultrasound: a Key Diagnostic Tool in Spondyloarthropathy Diagnosis and Management.

The purpose of this review is to report on the current status of evaluation of enthesitis with sonography. Sonography can visualize peripheral entheses in great detail since most of them are superficial. Visualization of entheses has provided insights into the pathophysiology of enthesitis and highlighted the interconnectivity of stress dissipation mechanisms about the enthesis. The primary use of entheseal sonography presently revolves around diagnostic use. There is increasing awareness of biomechanical confounders that lead to entheseal changes, which are more prevalent in males, patients with higher body mass index, and those who are more active-though there are several approaches to mitigate biomechanical confounders in sonographic evaluation. Entheseal sonography may also provide prognostic information in predicting the severity of axial syndesmophyte formation. Although entheseal outcome scoring systems are available, there is sparse data on its use as an outcome tool, and hence, this is a fertile area for future research.

Evaluation of plantar fascia thickness in Egyptian patients with spondyloarthropathy

Purpose To measure plantar fascia (PF) thickness in Egyptian patients with spondyloarthropathy (SpA) using high-resolution musculoskeletal ultrasound and to assess its relationship with age, sex, BMI, and clinical and laboratory parameters of disease activity. Patients and methods PF thickness was measured in 50 patients with SpA (diagnosis based on Amor criteria), in addition to 100 healthy volunteers as a control group, using 7–13-MHz linear array transducer. Results The mean PF thickness in patients with SpA was 5.17±1.25 mm, whereas it was 3.06±0.65 mm in the control group, with significant difference (P Conclusion SpA is frequently associated with plantar fasciitis. Plantar fasciitis in patients with SpA may be clinically asymptomatic and early diagnosed with ultrasonography. PF mean thickness was found to be more than 4 mm in most patients with SpA. Its thickness is associated with disease activity and functional impairment.

Spondyloarthropathy - Is sacroiliac joint imaging sufficient? A study of 431 patients.

Background:Sacroiliac (SI) joint involvement (sacroiliitis) is considered as major criteria for diagnosing Spondyloarthropathy (SpA), although involvement of spine and hip can also occur. The aim of our study was to assess the utility of including sagittal short-tau inversion recovery (STIR) sequence of dorsolumbar spine and coronal STIR/proton density (PD) fat saturated sequence through both hips, to routine SI joint magnetic resonance (MR) imaging protocol, in patients clinically suspected to have SpA.Material and Methods:A retrospective observational study was conducted between February 2013 and February 2018 on clinically suspected SpA patients referred to our department for imaging. The images obtained using this new SI joint protocol were evaluated for findings suggesting SpA diagnosis as per the Assessment of SpondyloArthritis international Society criteria. Other differentials for similar symptoms were also looked for.Results:Of the 431 patients (313 M and 118 F), 255 had features confirming the diagnosis of SpA and 176 had no radiological manifestations of SpA (56 were normal and 120 had other findings to suggest clinical symptoms; e.g., degenerative SpA, Pott's spine, skeletal metastases, early AVN of hip, cysticercus, iliofemoral impingement). 19/255 patients had normal SI joints but other findings to suggest diagnosis of SpA, e.g. romanus lesions, costovertebritis/costotransversitis, pubic symphysitis, inflammatory hip arthropathy, enthesitis, iliofemoral/trochanteric bursitis. 33/61 patients with chronic sacroiliitis had disease activity in spine or hip.Conclusion:Inclusion of sections through dorsolumbar spine and both hips to routine SI joint protocol, helped in identifying: (a) early disease in 19 patients, who had normal SI joints and may have otherwise been missed with routine only SI joint imaging, (b) additional findings in SpA-related sacroiliitis, (c) disease activity in chronic sacroiliitis, and (d) other causes of low back pain and thus helped in further patient management.

Cervical Epidural Injection in the Management of Refractory Pain and Stiffness in Spondyloarthropathy: A Case Report Series

The primary objective of this case series was to report the use of cervical epidural steroid injection in the management of neck pain and stiffness secondary to spondyloarthropathy in cases refractory to conservative therapy. This was a case report series on three patients with diagnosis of spondyloarthropathy who presented with severe stiffness and non-radicular axial neck pain refractory to conservative therapy. All patients received cervical epidural steroid injections with significant improvement of their axial neck pain and stiffness. Cervical epidural steroid injections may be effective to improve the axial neck pain and stiffness in patients with diagnosis of spondyloarthropathy refractory to conservative management. Thus, we believe that epidural steroid injections should be considered in the management of patients with spondyloarthopathies.

Human Leukocyte Antigen B27 and Juvenile Idiopathic Arthritis and Classification of Juvenile Spondyloarthropathies by the Assessment of SpondyloArthritis International Society Criteria

Objective. We examined the clinical relationship between human leukocyte antigen B27 (HLA-B27) and juvenile idiopathic arthritis (JIA). Additionally, we assessed the usefulness of the Assessment of SpondyloArthritis International Society (ASAS) criteria for diagnosing juvenile spondyloarthropathies (SpA). Methods. We retrospectively reviewed medical records of 239 patients with JIA classified according to the International League of Associations for Rheumatology (ILAR) classification to analyze the features of the joint involvement site. Results were correlated with the presence of HLA-B27. After that, we classified the 239 JIA patients according to the ASAS criteria to diagnose juvenile SpA. The relationship between the ASAS criteria and a diagnosis of juvenile SpA was analyzed by a chi-squared test. Results. Back pain was associated with HLA-B27 in boys (p=0.002) but not in girls (p=0.616). In both sexes, involvement of the small joints in the lower extremities was highly associated with HLA-B27 (p=0.001 for boys, p=0.021 for girls). In addition, HLA-B27 was associated with enthesitis (p=0.004 for boys, p=0.021 for girls). Eighty-seven (36.4%) patients with JIA fulfilled the ASAS criteria; 2 (0.8%) had axial SpA and 85 (35.6%) had peripheral SpA. HLA-B27 was the most significant factor for diagnosing juvenile SpA (sensitivity 80%, specificity 99.31%, positive likelihood ratio, 116). Conclusion. The ILAR criteria have some weaknesses for diagnosing HLA-B27-positive JIA patients in early stages. The use of the ASAS criteria for juvenile patients will enable pediatric rheumatologists to diagnose juvenile SpA patients earlier. (J Rheum Dis 2016;23:234-240)

A novel evidence-based detection of undiagnosed spondyloarthritis in patients presenting with acute anterior uveitis: the DUET (Dublin Uveitis Evaluation Tool)

BackgroundTo date, there are no formal guidelines or referral pathways for acute anterior uveitis (AAU) patients developed or endorsed by any international or national societies. The objective of our study...

FRI0119 Diclofenac Use and Risk of Myocardial Infarction in Spondyloarthropathy Patients

BackgroundAnkylosing spondylyitis (AS) and Psoriatic arthritis (PsA) have been associated with increased risk of myocardial infarction (MI). Diclofenac use has been associated with MI in the general population and is...

AB0722 Ominous Prognosis of Secondary Amyloidosis in Patients with Spondyloarthropathies

BackgroundSecondary amyloidosis (AAa) is a disorder caused by deposition of insoluble amyloid A fibrils in different tissues and organs. It is a rare and serious complication of rheumatic diseases including...

Value of musculoskeletal ultrasonography in the diagnosis of peripheral enthesopathy in early spondyloarthropathy

The aim of the study was to evaluate peripheral enthesopathy ultrasonography in early spondyloarthritis. A total of 50 patients were divided into two groups: group I included 30 patients who were diagnosed as spondyloarthropathy (SpA) and were divided into two subgroups – axial subgroup (19 patients) and peripheral subgroup (11 patients) – and group II included 20 patients diagnosed as rheumatoid arthritis. All patients were subjected to history taking, clinical examination and laboratory and radiological investigations: plain radiography and musculoskeletal ultrasonography. A significant difference was found between subgroups regarding clinical examination of plantar fascia, distal patellar ligament and proximal patellar ligament. We found a high significant difference between mean of Bath Ankylosing Spondylitis Metrology Index (BASMI) in axial (0.8 ± 0.6) and peripheral (0.09 ± 0.3) patients. A high significant difference was found between group I and group II regarding Madrid Sonographic Enthesitis Index (MASEI). In addition, a significant difference was found regarding the number of abnormal enthesis examined by ultrasonography. We found a highly significant difference between groups regarding structure, bursa, erosion, calcification and power Doppler scores (higher in group I); a significant difference was found between groups regarding distal patellar ligament thickness, calcification and power Doppler signal; proximal patellar ligament thickness, calcification and power Doppler and quadriceps tendon structure, thickness and power Doppler. We found significant difference between subgroups regarding structure score. Enthesis are affected early in spondyloarthritis. MASEI score is a valuable tool for early diagnosis of SpA and can improve diagnostic accuracy of early SpA patients.

Arthritis in a Glyptodont (Mammalia, Xenarthra, Cingulata)

Arthritic lesions have been frequently diagnosed in the fossil record, with spondyloarthropathy (a type of erosive and pan-mammalian arthritis) being one of the most common types described to date for mammals, though not restricted to this group. Here, we identify spondyloarthropathy in fossil bones from the late Pleistocene in Brazil assignable to a large glyptodont individual. Bone erosions in the peripheral joints (viz., the ulna, radius, left femur and tibiae-fibulae) associated with osteosclerosis allow the diagnosis of spondyloarthropathy. The presence of osteophytes in seven bones of the forelimbs (viz., the ulna and radius) and hind limbs (viz., the tibiae-fibulae, left femur and patellae) and a subchondral cyst in one element (viz., the left femur) indicate secondary osteoarthritis. A calcified deposition on the articular surface of the left patella indicates the presence of calcium pyrophosphate deposition disease, which, like the observed osteoarthritic alterations, likely represents a complication of spondyloarthropathy. This is the first report of spondyloarthropathy for xenarthrans.

Classification of spondyloarthritis: A journey well worth

The diagnosis of spondyloarthropathy has improved over the last four decades and now it is possible to diagnose patient early even before the radiological damage accrues. The classification of spondyloarthritis has also undergone a series of change and has provided insight into presentation and outcome of different subsets. Use of HLA B27 and MRI has played a major role in early diagnosis of patients. The rapid stride in early diagnosis in the last decade is fuelled by an excellent response with anti-TNF agents to identify the window of opportunity for better management of patients.

THU0363 Latent tuberculosis infection and viral hepatitis in a colombian cohort of patients with biological therapy

BackgroundBiological therapy have revolutionized the treatment of some autoimmune diseases, such as rheumatoid arthritis (RA), and spondyloarthropathies (SpA). Patients receiving biologics have a increased risk of opportunistic infections, particularly of...