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OBJECTIVE: The objective of this study was to assess the SARS-CoV-2-specific humoral and T cell response after a two-dose regimen of SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA). METHODS: In this observational study, patients with RA who are ≥18 years of age and vaccinated for SARS-CoV-2 according to the Argentine National Health Ministry's vaccination strategy were included. Anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies (ELISA-COVIDAR test), neutralizing activity (cytotoxicity in VERO cells), and specific T cell response (IFN-γ ELISpot Assay) were assessed after the first and second dose. RESULTS: A total of 120 patients with RA were included. Mostly, homologous regimens were used, including Gam-COVID-Vac (27.5%), ChAdOx1 (24.2%), and BBIBP-CorV (22.5%). The most frequent combination was Gam-COVID-Vac/mRNA-1273 (21.7%). After the second dose, 81.7% presented with anti-SARS-CoV-2 antibodies, 70.0% presented with neutralizing activity, and 65.3% presented with specific T cell response. The use of BBIBP-CorV and treatment with abatacept (ABA) and rituximab (RTX) were associated with undetectable antibodies and no neutralizing activity after two doses. BBIBP-CorV was also associated with the absence of T cell response. The total incidence of adverse events was 357.1 events per 1,000 doses, significantly lower with BBIBP-CorV (166.7 events per 1,000 doses, P < 0.02). CONCLUSION: In this RA cohort vaccinated with homologous and heterologous regimens against COVID-19, 2 out of 10 patients did not develop anti-SARS-CoV-2 IgG, 70% presented with neutralizing activity, and 65% presented with specific T cell response. The use of BBIBP-CorV was associated with deficient humoral and cellular response, whereas treatment with ABA and RTX resulted in an impaired anti-SARS-CoV-2 IgG formation and neutralizing activity.

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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.

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.

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Axial spondyloarthritis (axSpA) comprises a spectrum of chronic inflammatory manifestations affecting the axial skeleton and represents a challenge for diagnosis and treatment. Our objective was to generate a set of evidence-based recommendations for the management of axSpA for physicians, health professionals, rheumatologists and policy decision makers in Pan American League of Associations for Rheumatology (PANLAR) countries. Grading of Recommendations, Assessment, Development and Evaluation-ADOLOPMENT methodology was used to adapt existing recommendations after performing an independent systematic search and synthesis of the literature to update the evidence. A working group consisting of rheumatologists, epidemiologists and patient representatives from countries within the Americas prioritized 13 topics relevant to the context of these countries for the management of axSpA. This Evidence-Based Guideline article reports 13 recommendations addressing therapeutic targets, the use of NSAIDs and glucocorticoids, treatment with DMARDs (including conventional synthetic, biologic and targeted synthetic DMARDs), therapeutic failure, optimization of the use of biologic DMARDs, the use of drugs for extra-musculoskeletal manifestations of axSpA, non-pharmacological interventions and the follow-up of patients with axSpA.

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OBJECTIVE: The aim of this study was to provide an evidence-based framework to guide health care professionals treating patients under glucocorticoid (GC) therapy and develop guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis (GIO) in postmenopausal women and men aged ≥50 years. METHODS: An expert panel on bone diseases designed a series of clinically meaningful questions following the PICO (Population, Intervention, Comparator, and Outcome) structure. Using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology, we made a systematic literature review, extracted and summarized the effect estimates, and graded the quality of the evidence. The expert panel voted each PICO question and made recommendations after reaching an agreement of at least 70%. RESULTS: Seventeen recommendations (9 strong and 8 conditional) and 8 general principles were developed for postmenopausal women and men aged ≥50 years under GC treatment. Bone mineral density (BMD), occurrence of fragility fractures, probability of fracture at 10 years by Fracture Risk Assessment Tool, and other screening factors for low BMD are recommended for patient evaluation and stratification according to fragility fracture risk. The treatment of patients under GC therapy should include counseling on lifestyle habits and strict control of comorbidities. The goal of GIO treatment is the nonoccurrence of new fragility fractures as well as to increase or maintain BMD in certain clinical situations. This was considered for the therapeutic approach in different clinical scenarios. CONCLUSIONS: This GIO guideline provides evidence-based guidance for health care providers treating patients.

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Introducción: la pandemia de COVID-19 tuvo un gran impacto en la sociedad en general. El aislamiento impuesto modificó las relaciones interpersonales, incluyendo las consultas médicas. Objetivos: describir las consultas reumatológicas en el Servicio de Reumatología del Instituto de Rehabilitación Psicofísica (IREP) durante la pandemia por COVID-19, y compararlas con las recibidas durante 2019. Materiales y métodos: estudio observacional. Se registraron las consultas recibidas durante marzo-septiembre de 2020. Se recolectaron datos sociodemográficos, número y motivo de las consultas realizadas por paciente. Se llevó a cabo un análisis de regresión logística múltiple para estimar las variables asociadas a la consulta presencial. Resultados: se registraron 1.703 consultas; 798 pacientes consultaron al menos una vez, la mediana de consulta por paciente fue de 3 (RIC 1-12). La principal vía de consulta fue por correo electrónico (57%), solo el 13% fue de forma presencial. El principal motivo fue la solicitud de recetas (60%) seguido por consultas por la enfermedad (23%). Se observó una reducción del total de las consultas con respecto al año previo del 57% (3.961) y una reducción mayor del 94% en el número de consultas presenciales (224). La consulta médica presencial durante la pandemia se asoció independientemente con el sexo masculino (OR: 2.4 IC 95% 1,6-3,6), la consulta por enfermedad de base (OR: 5.8 IC 95% 4,1-8,3) y la ausencia de cobertura social (OR: 2.3 IC 95% 1,6-3,3). Conclusiones: las consultas reumatológicas, especialmente las presenciales, disminuyeron sustancialmente durante la pandemia.

Introduction: COVID-19 pandemic had a great impact on society in general. The imposed isolation modified interpersonal relationships, including medical consultations. Objectives: describe the rheumatologic consultations in the Rheumatology Service from Instituto de Rehabilitación Psicofísica (IREP) during the COVID-19 pandemic and compare them with those received the previous year. Materials and methods: observational study. Consultations during March-September 2020 were recorded. Sociodemographics, numbers, and reasons for consultations made per patient were collected. A multiple logistic regression analysis was performed to estimate variables associated with the in-person consultation. Results: 1,703 consultations were registered. 798 patients consulted at least 1 time, and the median number of consultations per patient was 3 (IQR 1-12). The main method of consultation was by email (57%); only 13% were in person. The main reason was requesting prescriptions (60%) followed by consultations for the disease (23%). We observed a reduction in the total number of consultations compared to the same period in 2019 of 57% (3,961 consultations) and an even greater reduction of 94% in the number of in-person consultations (224 consultations). In-person medical consultation during the pandemic was independently associated with male sex (OR: 2,4, 95%CI 1,6-3,6), consultation due to illness (OR: 5,8, 95%CI 4,1-8,3) and lack of social coverage (OR: 2,3. 95%CI 1,6-3,3). Conclusions: rheumatologic consultations, especially in-person, were substantially reduced during the pandemic.

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Introducción: los pacientes con artritis psoriásica (APs) presentan más comorbilidades. Las guías del Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) establecen lineamientos para los tratamientos de acuerdo a ellas. Objetivos: describir la prevalencia de comorbilidades en pacientes con APs según el Rheumatic Disease Comorbidity Index (RDCI), analizar el efecto sobre la enfermedad y estudiar la adherencia a las guías GRAPPA. Materiales y métodos: estudio observacional. Se incluyeron pacientes con APs de la cohorte RAPSODIA. Se reportaron características sociodemográficas y clínicas. Las comorbilidades se valoraron por RDCI. Se estudiaron variables asociadas a RDCI ≥1 mediante análisis multivariado. Se analizó el cumplimiento de las recomendaciones de tratamiento en relación a las comorbilidades según las guías GRAPPA. Resultados: se incluyeron 170 pacientes. El 67,6% presentó al menos una comorbilidad (RDCI ≥1); estos eran de mayor edad (X 57,3±12,7 años vs. 48,2±13,2 años; p<0,0001), presentaban más sobrepeso u obesidad (84,3% vs. 67,3%; p=0,011) y peor calidad de vida (PsAQoL X 7,6±6,6 vs. 5,2±6; p=0,025). El análisis multivariado evidenció asociación de la edad y el uso de antiinflamatorios no esteroideos (AINEs) con RDCI ≥1. Contrariamente a las recomendaciones de GRAPPA, el 70% de los pacientes con cardiopatía utilizaba AINEs, y la mitad de aquellos con enfermedades hepáticas o renales tomaba AINEs o metotrexato. Conclusiones: la prevalencia de comorbilidades en los pacientes con APs es alta. En algunos casos no se cumplían las recomendaciones de tratamiento en relación a las comorbilidades.

Introduction: comorbidities are common in patients with psoriatic arthritis (PsA). The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) guidelines strengthen the choice of treatments according to them. Objetives: to describe the prevalence of comorbidities in patients with psoriatic arthritis according to Rheumatic Disease Comorbidity Index (RDCI) and to analyze the influence of them on disease activity, functional capacity and quality life and to assess adherence to GRAPPA 2015 treatment recommendations according to the presence of comorbidities. Materials and methods: adult patients with PsA (CASPAR criteria) from the RAPSODIA cohort were included. Sociodemographic and clinical characteristics, disease activity and current treatment were recorded. Comorbidities were assessed by the RDCI. Variables associated with RDCI≥1 were studied by multivariate analysis. Adherence to treatment recommendations in relation to the reported comorbidities was analyzed according to the 2015 GRAPPA guidelines. Results: a total of 170 patients were included. Patients with RDCI ≥1 were reported by 67.6%. These patients were older (57±13 years vs 48±13 years, p<0.0001), had a higher frequency of overweight or obesity (84.3% vs 67.3%, p=0.011), and had a poorer quality of life (PsAQoL 7.6±6.6 vs 5.2±6, p=0.025). The multivariate analysis showed an association between age and the use of NSAIDs with RDCI≥1. Contrary to GRAPPA recommendations, 70% of patients with heart disease were using NSAIDs. Moreover, about half of those with hepatic or kidney disease took NSAIDs or methotrexate. Conclusions: most patients with PsA presented at least one comorbidity. GRAPPA recommendations were not followed in a considerable number of patients.

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BACKGROUND/OBJECTIVE: To evaluate the efficacy and safety of SARS-CoV-2 vaccine in patients with rheumatic and immune-mediated inflammatory diseases (IMIDs) in Argentina: the SAR-CoVAC registry. METHODS: SAR-CoVAC is a national, multicenter, and observational registry. Adult patients with rheumatic or IMIDs vaccinated for SARS-CoV-2 were consecutively included between June 1 and September 17, 2021. Sociodemographic data, comorbidities, underlying rheumatic or IMIDs, treatments received, their modification prior to vaccination, and history of SARS-CoV-2 infection were recorded. In addition, date and place of vaccination, type of vaccine applied, scheme, adverse events (AE), disease flares, and new immune-mediated manifestations related to the vaccine were analyzed. RESULTS: A total of 1234 patients were included, 79% were female, with a mean age of 57.8 (SD 14.1) years. The most frequent diseases were rheumatoid arthritis (41.2%), osteoarthritis (14.5%), psoriasis (12.7%), and spondyloarthritis (12.3%). Most of them were in remission (28.5%) or low disease activity (41.4%). At the time of vaccination, 21% were receiving glucocorticoid treatment, 35.7% methotrexate, 29.7% biological (b) disease modifying anti-rheumatic drugs (DMARD), and 5.4% JAK inhibitors. In total, 16.9% had SARS-CoV-2 infection before the first vaccine dose. Most patients (51.1%) received Gam-COVID-Vac as the first vaccine dose, followed by ChAdOx1 nCoV-19 (32.8%) and BBIBP-CorV (14.5%). Half of them (48.8%) were fully vaccinated with 2 doses; 12.5% received combined schemes, being the most frequent Gam-COVID-Vac/mRAN-1273. The median time between doses was 51 days (IQR 53). After the first dose, 25.9% of the patients reported at least one AE and 15.9% after the second, being flu-like syndrome and local hypersensitivity the most frequent manifestations. There was one case of anaphylaxis. Regarding efficacy, 63 events of SARS-CoV-2 infection were reported after vaccination, 19% occurred during the first 14 days post-vaccination, 57.1% after the first dose, and 23.8% after the second. Most cases (85.9%) were asymptomatic or mild and 2 died due to COVID-19. CONCLUSIONS: In this national cohort of patients, the most common vaccines used were Gam-COVID-Vac and ChAdOx1 nCoV-19. A quarter of the patients presented an AE and 5.1% presented SARS-CoV-2 infection after vaccination, in most cases mild. STUDY REGISTRATION: This study has been registered in ClinicalTrials.gov under the number: NCT04845997. Key Points • This study shows real-world data about efficacy and safety of SARS-CoV-2 vaccination in patients with rheumatic and immune-mediated inflammatory diseases. Interestingly, different types of vaccines were used including vector-based, mRNA, and inactivated vaccines, and mixed regimens were enabled. • A quarter of the patients presented an adverse event. The incidence of adverse events was significantly higher in those receiving mRAN-1273 and ChAdOx1 nCoV-19. • In this cohort, 5.1% presented SARS-CoV-2 infection after vaccination, in most cases mild.

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Las enfermedades reumáticas inflamatorias crónicas autoinmunes (ERICA) son un conjunto de patologías que se caracterizan por compromiso articular y sistémico, que frecuentemente generan dolor, discapacidad funcional y deterioro en la calidad de vida. Entre ellas se destacan: la artritis reumatoidea, el lupus eritematoso sistémico, la esclerodermia, la miopatía inflamatoria, la espondiloartritis, las vasculitis, entre otras. La mayoría de las enfermedades reumáticas tiene un importante componente autoinflamatorio, con una marcada desregulación de varios aspectos del sistema inmune. Uno de estos es la autoinmunidad, la cual puede definirse como la aparición de una respuesta inmune humoral y/o celular contra proteínas propias (autoantígenos) localizadas en diversos tejidos. Actualmente se considera que las enfermedades autoinmunes son desórdenes multifactoriales que muestran una complejidad y heterogeneidad considerable a pesar de tener una patogénesis en común: la pérdida de la autotolerancia.

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