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Background:Early referral of patients with suspicion of progression to rheumatoid arthritis (RA) is of paramount importance in disease prognosis. We had previously described a time delay of 28 months between symptom onset and evaluation by a rheumatologist, and a mean wait time of 9.5 weeks for referral to a secondary-level public hospital (1). The availability of specialized interdisciplinary evaluation of patients in a third-level of care raises the possibility of shortening this time gap, as well as describing patient and physician decisions amidst the referral to a Rheumatology center.Objectives:Describe the diagnosis profile of patients with hand arthralgia and time of referral to Rheumatology in a Family Medicine clinic.Methods:A cohort study was conducted in 110 patients from October 2018 to December 2020 in a Family Medicine clinic within the tertiary-care University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico. Patients with hand arthralgia as their chief complaint were recruited. An observational, descriptive compilation of patient history was retrieved prospectively through medical records. Variables included time of inclusion, number of medical visits until referral and definitive diagnosis. Descriptive statistics, Kaplan-Meier curves and log-rank tests were used to test the association between time of diagnosis and clinical variables of interest.Results:Assessed variables are shown in Table 1. Out of 110 patients with hand arthralgia, a quarter received a final diagnosis within 3 medical visits. Less than half of patients were referred, and only a third attended the referral indication. It takes 39.3 days from the first medical visit to be referred, and 69 days and 2.89 consultations to receive a definitive diagnosis. Around half of patients will have a definitive diagnosis, osteoarthritis being the most common. The log-rank test for categoric variables including a positive squeeze test or ≥4 criteria of clinically suspect arthralgia did not show a significant association for time of referral and definitive diagnosis (data not shown).Table 1.Diagnostic and referral characteristics of patients with hand arthralgia attending a Family medicine clinicPatients recruited in a Family Medicine clinicn = 110Female, n (%)90 (81.8)Age in years, mean ± SD49.69 ± 14.90RF, ACPA, or hand radiography request, n (%)100 (90.9)Diagnosis in Family MedicineDiagnosed patients after 1 medical visit, cumulative n (%)5 (4.6)Diagnosed patients after 2 medical visits, cumulative n (%)22 (20.0)Diagnosed patients after 3 medical visits, cumulative n (%)26 (23.6)Referral to Rheumatology for diagnostic doubt or clinical follow-upPatients referred to a Rheumatology clinic, n (%)49 (44.5)Patients attending Rheumatology referral, n (%)34 (30.9)Time for referral, days ± SD39.37 ± 38.64Global definitive diagnosisPatients with a definitive diagnosis, n (%)51 (46.4)Osteoarthritis diagnosis, n (%)23 (20.9)Rheumatoid arthritis diagnosis, n (%)13 (11.8)Overlap syndrome diagnosis, n (%)5 (4.5)Time for definitive diagnosis, days ± SD68.96 ± 106.57Number of consultations for definitive diagnosis, mean ± SD2.86 ± 1.05RF, rheumatoid factor; ACPA, anticitrullinated protein antibodies; SD, standard deviation.Conclusion:Patients with hand arthralgia evaluated in a tertiary-care Rheumatology center receive a timely referral in one month and a definitive diagnosis after 3 medical visits in around two months.References:[1]Vega-Morales, D., Covarrubias-Castañeda, Y., Arana-Guajardo, A. C., & Esquivel-Valerio, J. A. (2016). Time Delay to Rheumatology Consultation: Rheumatoid Arthritis Diagnostic Concordance Between Primary Care Physician and Rheumatologist. American journal of medical quality: the official journal of the American College of Medical Quality, 31(6), 603.Graphs:Disclosure of Interests:None declared

Objectives We aimed to determine the prevalence of anti-carbamylated protein (anti-CarP) antibodies in Mexican Hispanics with established rheumatoid arthritis (RA) and to assess their relationship with disease activity. Methods A cohort study was conducted in 278 patients with established RA during an 18-month follow-up. We measured IgG/IgM/IgA rheumatoid factor (RF), IgG anticitrullinated protein antibodies (ACPA) and IgG/IgM/IgA anti-CarP antibodies using enzyme-linked immunosorbent assay (ELISA). For disease activity, we performed the 28-joint disease activity score with erythrocyte sedimentation rate (DAS28-ESR). Repeated measures one-way ANOVA was used to test the association between anti-CarP IgG antibody status and longitudinal DAS28-ESR scores. Patients were evaluated at baseline and at 6, 12, and 18 months during follow-up. Results Anti-CarP IgG antibodies were positive in 47.8% of patients and, accounting for all isotypes, in 9.5% of patients with negative RF and ACPA. Triple antibody positivity was present in 42.6% of patients in our sample. Anti-CarP IgG antibody positivity did not show statistically significant differences in mean DAS28-ESR when compared to anti-CarP IgG antibody negative patients at baseline, 6, 12 or 18 months. Conclusion Anti-CarP IgG antibodies are not associated to a higher disease activity in Hispanic patients with established RA. Our findings suggest that the clinical value of measuring anti-CarP antibodies in RA diminishes over time.

Background:The chronic nature of rheumatic diseases has a negative impact in quality of life. Pain and loss of function in the upper extremity cause a progressive difficulty to perform daily activities, often requiring integral physical rehabilitation programs. Anthropometric measurements habitually take prolonged periods of time, given the extensive nature of physical examination in rheumatic patients. It is unknown which factors are most efficient to better reflect the functional status of the rheumatic patient.Objectives:Determine the most efficient anthropometric measurements in the upper extremity to assess the functional status of rheumatic patients in rehabilitation programs.Methods:Thirty-six patients were recruited from Rheumatology consultation of University Hospital “Dr. José Eleuterio González” in Monterrey, Mexico. Patients had a complete physical examination by a board-certified rheumatologist, which referred patients to Physical Rehabilitation consultation if necessary. A cross-sectional study was carried out in these patients with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (1), measurement of ranges of motion (ROM) and hand strength with the Mathiowetz protocol (2). Analysis was performed through Principal Components Analysis including Total Variance Explained (TVE), Rotated Component Matrix (RCM) and dendrograms.Results:From the total of patients, 34 (94.4%) were women with a mean age of 34 years (SD 11.33). The most common diagnosis was rheumatoid arthritis (47.2%) followed by osteoarthritis (8.3%). The mean disability score in DASH was 29.3% (DE 23.36). The TVE analysis found that 3 elements explained 48.6% of the total variance, and 13 elements explained 89.4%. RCM correlations among hand strength parameters ranged from 0.51 to 0.93, whereas ROM correlation values were below 0.4. Graph 1 depicts data dispersion for ROM, grip strength and pinch gauge by dynamometer.Graph 1.Two main clusters are observed in the RCM plot of the data. In the center and superior to the x axis, a conglomeration corresponding to ROM is shown, consisting of radial and ulnar deviation; flexion, extension, abduction and adduction in carpal bones, metacarpophalangeal joints, and proximal and distal interphalangeal joints of the five fingers of both hands, accordingly. To the right and across the x axis, another cluster depicts the grip strength and tip, key, and lateral pinch gauge of the fingers according to the Mathiowetz protocol. Closeness of data points portray a higher similarity among variances in the second cluster.Conclusion:Hand strength is the most efficient parameter to assess the functional status of the upper extremity in rheumatic patients in rehabilitation programs.References:[1]Arreguín Reyes, R., López López, C. O., Alvarez Hernández, E., Medrano Ramírez, G., Montes Castillo, M., & Vázquez-Mellado, J. (2012). Evaluation of hand function in rheumatic disease. Validation and usefulness of the Spanish version AUSCAN, m-SACRAH and Cochin questionnaires. Reumatologia clinica, 8(5), 250–254. https://doi.org/10.1016/j.reuma.2012.03.005[2]Mathiowetz, V., Kashman, N., Volland, G., Weber, K., Dowe, M., & Rogers, S. (1985). Grip and pinch strength: normative data for adults. Archives of physical medicine and rehabilitation, 66(2), 69–74.Disclosure of Interests:None declared