Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an ‘overarching’ treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.

Chikungunya infection is a febrile illness, which currently is afflicting the Caribbean islands including the Dominican Republic. We would like to report our experience with Chikungunya-related musculoskeletal manifestations in our arthritis clinics in the Dominican Republic. A total of 514 patients presented for the first time to our arthritis clinic exhibiting musculoskeletal manifestations, 473/514 (92%) exhibiting symmetric polyarthralgias, 344/514 (67%) arthritis, and 385 (75%) skin rash. The great majority 457.46 (89%) exhibited very good clinical response to nonsteroidal anti-inflammatory drugs (NSAIDs), 370 (72%) require low-dose steroids, and only 5 patients (0.97%) required methotrexate therapy. In addition, of a total of 328 patients with rheumatoid arthritis on biological treatment, 53 exhibited Chikungunya-related musculoskeletal manifestations; 51/53 (96.2%) exhibited symmetric polyarthralgias, 25/53 (47.1%) arthritis, and 13/53 (24.5%) tendinopathy. Of most patients, 51/53 responded to NSAIDs, of which, 23 patients only responded partially, and in total 25 (47.1%) required low-dose steroids. Disease-modifying antirheumatic drug (DMARD) therapy including biologics remained unchanged in this population.

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This study aimed to perform an overview of how ultrasound (US) is being used, implemented, and applied in rheumatologic centers in Latin America (LA). A retrospective, multicenter 1-year experience study was undertaken. Eighteen centers from eight countries were involved. The following information were collected: demographic data, indication to perform an US examination, physician that required the examination, and the anatomical region required for the examination. A total of 7167 patients underwent an US examination. The request for US examinations came most frequently from their own institution (5981 (83.45 %)) than from external referral (1186 (16.55 %)). The services that more frequently requested an US examination were rheumatology 5154 (71.91 %), followed by orthopedic 1016 (14.18 %), and rehabilitation 375 (5.23 %). The most frequently scanned area was the shoulder in 1908 cases (26.62 %), followed by hand 1754 (24.47 %), knee 1518 (21.18 %), ankle 574 (8.01 %), and wrist 394 (5.50 %). Osteoarthritis was the most common disease assessed (2279 patients (31.8 %)), followed by rheumatoid arthritis (2125 patients (29.65 %)), psoriatic arthritis (869 patients (12.1 %)), painful shoulder syndrome (545 (7.6 %)), connective tissue disorders (systemic sclerosis 339 (4.7 %), polymyositis/dermatomyositis 107 (1.4 %), Sjögren's syndrome 60 (0.8 %), and systemic lupus erythematosus 57 (0.8 %)). US evaluation was more frequently requested for diagnostic purposes (3981 (55.5 %)) compared to follow-up studies (2649 (36.9 %)), research protocols (339 (4.73 %)), and invasive guided procedures (198 (2.76 %)). US registered increasing applications in rheumatology and highlighted its positive impact in daily clinical practice. US increases the accuracy of the musculoskeletal clinical examination, influence the diagnosis, and the disease management.

BackgroundThe MEFV gene encodes the pyrin protein, which regulates IL-1b and IL-18 production, two cytokines that participate in the innate immune response. Mutations in the MEFV gene are associated with familial Mediterranean fever (FMF), but our group identified these mutations in patients with intermittent hydrarthrosis (IH) and palindromic rheumatism (PR). (1, 2).ObjectivesTo analyse the clinical usefulness of MEFV gene mutation analysis in patients with undifferentiated arthritis (UA).MethodsDescriptive, retrospective study including patients with UA who underwent systematic screening for MEFV gene mutations, and were followed at the Rheumatology Department, Hospital Clínic, Barcelona, between 2000 to 2014. The following clinical and demographic data were collected; age, sex, age at onset of disease, disease duration, joint swelling characteristics: frequency, duration, number of joints involved (monoarthritis, oligoarthritis or polyarthritis), location pattern (upper or lower extremities); seropositivity (rheumatoid factor and/or ACPA), final diagnosis and clinical response to colchicine.ResultsNinety five patients were included (68% female, mean age 39.9±14.7 years, follow up 8.5±6 years). MEFV gene mutational analysis was positive in 21 patients (22%) and negative in 74 (78%).In patients with mutations, the duration of arthritis was <7 days in 72% patients; 86% had intermittent arthritis, frequently oligoarticular (53%) and commonly affecting the lower extremities (48%). The final diagnosis was: FMF (29%), IH (14%), RA (10%), PR (10%), PsA (10%), Behçet (5%), self-limited arthralgia (10%) and undifferentiated oligoarthritis (5%). 29% patients were RF and/or ACPA positive. 71% patients were treated with colchicine, of whom 86% had a good response.In patients without mutations, the duration of arthritis was <7 days in 63% patients; 76% had intermittent arthritis, 39% oligoarthritis, and lower extremities were involved in only 28%. The final diagnosis was: RA (22%), PR (22%), Behçet (7%), undifferentiated oligoarthritis (7%) and FMF (3%). 31% patients were RF and/or ACPA positive. Two patients with a diagnosis of FMF had a negative mutational analysis and had a good response to colchicine.ConclusionsMEFV gene mutational analysis may be useful in the differential diagnosis of patients with undifferentiated arthritis, especially those with <7 days of duration, intermittent flares and involvement of the lower extremities. However, due to the difficulty in carrying out mutational analysis and the relatively low percentage of patients with mutations (22%) observed in our cohort, we recommend starting with a therapeutic strategy with colchicine in suspected patients, with only patients with a good clinical response being analysed for the MEFV gene mutation.ReferencesCañete JD, et al. Arthritis Rheum 2006;54:20:2334–2337.Cañete JD, et al. Arthritis Rheum. 2007;56:2784–2788.Disclosure of InterestNone declared