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The Spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic diseases, in which 5-10% of extra-articular manifestations are gastrointestinal such as the inflammatory bowel disease. Objective: To apply the clinical criteria for the screening of inflammatory bowel disease (IBD) in patients with SpA with gastrointestinal symptoms and its association with disease activity and function. A Cross-sectional study included 82 patients with SpA, according to ASAS classification criteria without diagnosis of IBD. We applied the Screening criteria for IBD developed by Sanz et al, in the SpA patients. Clinical evaluation by rheumatologist and in patients with ≥ 2 gastrointestinal symptoms clinical evaluation by gastroenterologist and IBD screening criteria were performed. Digital chromoendoscopy, magnification colonoscopy, and histological analysis were performed. Lab tests included, C-reactive protein, sedimentation rate, serum levels of transferrin, ferritin and vitamin B12. The association between clinical variables and colonoscopy and histological variables were evaluated using the Chi-square or Fisher's exact test (Ethical / Cod. 2017-023). Of the 82 individuals evaluated, 58 of them were referred to gastroenterology with a direction to perform colonoscopy with chromeondospia, and 41 of them were able to intervene to whom the IBD screening criteria were applied. 53.7% are men, 7.3% actively smoke. 100% of the population presented some gastrointestinal symptoms, the most frequent being diarrhea of more than 4 weeks in 61%. 68.3% had at least one of the three major criteria. Rectorrhagia was associated with BASFI>4, p=0.050, axial compromise p = 0.043, diagnosis of PsA p = 0.090 and alterations in the architecture of the ileum p=0.034. Diarrhea was associated with ESR> 20, p = 0.050, BASFI>4 p = 0.012. In addition, 70.75 of the patients had at least one of the minor screening criteria associated with higher BASFI levels, p = 0.01. Aphthous stomatitis was reported as extra-intestinal manifestations in 7.3% and abdominal pain in 87.8% of the patients, which was associated with BASDAI>4 p = 0.023, ASDASCRP> 2.1, p = 0.043 and inflammation in the ileum, p = 0.046. No patients with positive iron deficiency anemia were found. However, ferritin alteration was observed in 22% associated with chronic inflammation of the colon, p = 0.042. There were no cases of fever or family history of IBD. Noting that in 17.1% of the cases a decrease in vitamin B12 levels was detected, associated with the presence of ulcers (p = 0.035) and acute inflammation in the ileum, p = 0.032. Weight loss was found in 31.7% of the cases and was associated with smoking history p = 0.039. We found a high frequency of major and minor symptoms of IBD, both of which were associated with a high activity of spondyloarthritis and an important functional compromise as well as inflammation markers in this group of patients. The application of the screening criteria for IBD in SpA without IBD reflects a high frequency of intestinal symptoms of sufficient intensity that affect quality of life and disease activity. Early detection of gastrointestinal compromise allows patients to benefit from comprehensive treatment of the disease in its initial stages.

Spondyloarthritis (SpA) is a heterogeneous group of chronic autoinflammatory disorders that can present extra-articular gastrointestinal manifestations. Among them is mainly inflammatory bowel disease (IBD). Although IBD mainly affects the intestinal tract, it can include early manifestations evident in the oral cavity. No comparative data on these oral manifestations in patients with SpA were found in the literature. To identify oral clinical manifestations due to changes in the oral mucosa associated with IBD in patients with SpA without a diagnosis of IBD and associate them with endoscopic and histological findings. 80 patients with SpA and 52 healthy controls were evaluated. They were assessed intra- and extra-orally, following the modified World Health Organization guideline. In addition, by clinical parameters of rheumatological, gastrointestinal and laboratory activity. Ileocolonoscopy was performed with digital chromoendoscopy with magnification and histological analysis. Comparative analyzes were performed by Chi square tests, Fisher's exact tests, confirmed by univariate regression and discriminant analysis of multiple correspondences. Institutional ethics committee approval cod-2017-023. The patients with SpA had 56% male gender, mean age of 42.8 years (SD ± 10.4) and a BMI in the range of 23.9 - 28.4. The healthy controls, 54% of the male gender with an average age of 41 years (SD ± 13.6) and a body mass index-BMI in the range of 22.9 - 27.6. The patients reported smoking only in 6.2%, however as a smoking history in 31% and passive smokers (15%), the majority employed (41%), married (56%) and professionals (49%). Of the healthy controls, they smoked (15%), with a history of smoking (31%), passive smokers (21%), the majority employed (77%), with their own home (67%), and professionals (54%). The patients with SpA reported a greater presence of some signs and symptoms of gastrointestinal origin 69%, while in the controls it was 7.7% (p = 0.001). Forty one of them were referred to colonoscopy with magnification being in 17.1 % changes in the mucosa of the rectum and in the same frequency changes in the mucosa of the sigmoid colon. Regarding the ileum, changes in the mucosa were evidenced in 41.5% of the cases. The presence of oral lesions was evident and predominated in them (63%) compared to controls p = 0.050. The main oral lesions associated with IBD were gingivitis (55%) (p = 0.001), followed by aphthous stomatitis (3.8%), angular cheilitis (2.6%) and perioral erythema with scaling (1.3%). 100% of the patients who presented alteration of the colonic mucosa presented oral lesions associated with IBD (p = 0039), which was also significantly associated with the presence of gingivitis/aphthous stomatitis (p = 0.029). Patients with SpA without a diagnosis of IBD have more oral signs and symptoms compared to healthy controls. Gingivitis is important given its association with early endoscopic and histological findings. Manifestations in the oral cavity can precede intestinal manifestations, therefore the clinical assessment by the oral pathologist in conjunction with gastroenterology and rheumatology allows a timely referral to gastroenterology and an endoscopic and histological evaluation, impacting the quality of life of patients.

Digital chromoendoscopy (Narrow Band Imaging By Olympus) or BLI (Blue Light Imaging By Fujifilm), with the magnification endoscope, allows a detailed evaluation of the mucosal surface and its vascular network, which facilitates the diagnosis and monitoring of early lesions. This technique has demonstrated a better detection, which allows optical diagnosis during a colonoscopy examination. Patients with SpA with nonspecific gastrointestinal symptoms, subclinical intestinal inflammation are defined as endoscopic and histologically. The aim was to detect early structural inflammatory changes by chromoendoscopy and magnification colonoscopy in colonic/ileum digestive mucosa, and establish its association with clinical variables in SpA and gastrointestinal symptoms. Study approved by Institutional Ethics Committee, code HMC 2017-023. Clinical evaluation by rheumatologist in SpA patients (ASAS/criteria), fecal calprotectin levels, and HLA-B*27 were evaluated. In patients with ≥2 gastrointestinal symptoms, clinical evaluation by gastroenterologist, digital chromoendoscopy (NBI) or (BLI), magnification colonoscopy, and histological analysis were performed. The association between clinical and colonoscopy variables were established using the Chi-square or Fisher's exact test. In total, 62 SpA patients were included, with mean age of 45.1 ± 11.3 years, axial SpA (77.4%) peripheral SpA (12.9%), biological treatment (69.4%), ASDAS-CRP>2,1 (67.7%), presence of HLA-B*27 (41.9%). Patients with ≥2 gastrointestinal symptoms were found in 67.7%. The most important symptoms were abdominal pain (66.1%), abdominal distension (64.5%), and food intolerance (59.7%). 22.6% of patients showed high level of calprotectin. In those patients with gastrointestinal symptoms, chromoendoscopy and magnification colonoscopy were performed. The mean age of those patients was 45.4 ± 10.5, 57.6% were male, BMI>25 in 69.7%, presence of HLA-B*27 in 39.4%, 33.3% were former smokers, axial SpA in 84.8% and ASDAS-CRP>21 in 78.8%. In total, 27.27% of the patients presented high levels of calprotectin, of which 66.0% had more than two gastrointestinal symptoms (p = 0.015). 77.8% presented alterations in ileal mucosa (p=0.060). The most frequent alteration was the loss of vascular pattern (p = 0.002). By histological analysis, 5 patients had acute inflammation in the ileum, of which 4 had increased levels of fecal calprotectin (p = 0.013). 30.8% of patients positive for HLAB*27:05:02 had ulcers in ileum (p = 0.017) and 61.5% had chronic inflammatory patterns (p=0.020). Chromoendoscopy provided an enhanced, detailed contrast of the gastrointestinal mucosa surface, mainly in the loss of vascular pattern in ileum. The active search for symptoms, signs, and biomarkers of gastrointestinal involvement in addition to an objective endoscopic and histological evaluation may offer new perspectives at the evaluation of SpA patients and may provide guidance for specific clinical and therapeutic management.

Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis associated with psoriasis, affecting multiple domains, including peripheral joints, axial skeleton, enthesis, dactylitis, and skin. Several multinational organizations, including European Alliance of Associations for Rheumatology (EULAR), Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), and Pan American League of Associations for Rheumatology (PANLAR), have established treatment recommendations to optimize patient care. However, differences may exist in their guidelines, reflecting methodology regional differences, expert consensus, and evolving evidence. This review compares the treatment recommendations for PsA established by EULAR, GRAPPA, and PANLAR, highlighting similarities, differences, and challenges in achieving standardized treatment strategies worldwide. A comparative literature review analyzing key aspects of each guideline was performed. A systematic evaluation of the latest three multinational treatment recommendations was conducted, focusing on pharmacological and nonpharmacological management approaches. Differences in treatment sequencing, targeted therapies, and emphasis domains were examined. While all three organizations emphasize a multidisciplinary and personalized approach to PsA treatment, some variations exist in the preferred sequencing of therapies, the role of targeted synthetic disease-modifying antirheumatic drugs, and the approach to extra-musculoskeletal manifestations. PANLAR provides a regional perspective with emphasis on access constraints, EULAR integrates real-world evidence and long-term safety data, and GRAPPA emphasizes domain-based treatment. While PANLAR, EULAR, and GRAPPA guidelines align in core treatment principles, key differences persist, influencing clinical decision-making. Greater international collaboration may enhance the harmonization of treatment recommendations, ensuring optimal patient outcomes globally.

The role of Blastocystis in intestinal health is an open controversy, and little is known about the potential effect of this microorganism in autoinflammatory diseases such as spondyloarthritis (SpA). Here, we analyzed the gut microbiome of 36 SpA patients and 13 control individuals and demonstrated that the richness, diversity, and taxonomic composition between these two groups are different. We also showed that colonization by Blastocystis in control individuals increases the richness and diversity of the intestinal microbiome, whereas in SpA patients, it does not seem to have any impact. This may reflect a potential role of Blastocystis in sculpting the gut microbiome architecture in control individuals, whereas in subjects with SpA, the modulation of the microbiome may be governed by disease-dependent factors that cannot be overcome by Blastocystis . Regarding taxonomic characterization, SpA patients colonized by Blastocystis showed significant increases in the phylum Pseudomonadota , class Gammaproteobacteria , family Succinivibrionaceae , and genus Succinivibrio . Simultaneously, there were significant increases in the class Bacilli , order Lactobacillales , families Lactobacillaceae and Clostridiaceae, and genera Lactobacillus and Clostridium in non-colonized SpA patients. On the other hand, PICRUSt analysis in Blastocystis -positive SpA patients showed elevations in pathways that may enhance antioxidant capacities and alleviate intestinal inflammation, while Blastocystis -negative SpA patients showed significant changes in pathways that promote cell division/proliferation and can lead to larger changes in the gut microbiome. Our analyses lead us to believe that these changes in the gut microbiome of SpA patients may trigger protective mechanisms as an initial response to inflammation in an attempt to restore balance in the intestinal environment.

Spondyloarthritis (SpA) correlates with elevated serum secretory-IgA (sSIgA). Retrotranscytosis, mediated by CD71 and Dectin-1, is linked to high sSIgA levels. This research investigated retrotranscytosis in the gut of SpA patients and its relationship with sSIgA, ileocolonoscopic findings, and activity indices. A cohort of 82 was derived from 180 patients based on selection criteria; 41 consented to DCE colonoscopy assessment. Measurements included CD71, Dec-1, sSIgA, and disease scores. Samples exhibiting apical CD71, Dec-1, or both were analysed for receptor/SIgA interactions. Apical CD71 and Dec-1 were predominantly found in the ileum. Multivariate analyses indicated CD71’s association with heightened sSIgA ( p  = 0.05) and ASDAS-CRP ( p  = 0.036; OR 1.71; 95% CI 1.00–3.11), Dec-1’s correlation with ileal inflammation ( p  = 0.05; OR 3.06; 95% CI 1.00–10.01), and the CD71/Dec-1 relationship with ileal villi atrophy ( p  = 0.038; OR 4.24; 95% CI 1.00–18.88). Microscopic evaluations demonstrated interactions between CD71/SIgA but not between CD71/Dec-1 or Dec/SIgA. The localised expression of CD71 and its co-localisation with Dec-1 may contribute to systemic increases in serum SIgA and activity scores in SpA patients. The findings suggest that sSIgA levels may serve as a non-invasive biomarker for gastrointestinal involvement in SpA and that retrotranscytosis could be a key mechanism in the gut-joint axis of SpA.

Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases mainly characterized by inflammation in the spine and/or peripheral joints. Although a link between SpA-pathogenesis, intestinal inflammation and gut dysbiosis has been proposed, studies have been focused on bacteria-host interactions and very little has been reported regarding intestinal parasites. Here, intestinal parasitic infection of 51 SpA-patients were evaluated and compared to healthy control individuals. No significant differences in the frequency of any parasite between SpA-patients and control individuals were found. Significantly higher levels of fecal calprotectin (FCP) were found in the SpA-patients compared to the control individuals. However, FCP levels were the same when comparing SpA-patients and control individuals, both colonized by Blastocystis spp. On the other hand, when comparing Blastocystis spp. colonized and Blastocystis spp. free SpA-patients, FCP levels were significantly higher in those Blastocystis spp. free. Without ignoring the small sample size as a study limitation, the results showed that in the SpA-patients colonized by Blastocystis spp., the FCP levels were significantly lower than those in the Blastocystis spp. free group and comparable to those in the control group. These findings seem to suggest a relationship between Blastocystis spp. and intestinal inflammation in SpA-patients, but studies intended to explore that interaction specifically should be designed.

Spondyloarthritis (SpA) presents unique diagnostic challenges in Latin America (LATAM) due to genetic, clinical, healthcare, and sociocultural factors. The Assessment of SpondyloArthritis international Society (ASAS) classification criteria—developed mainly in North America and European populations—may not accurately reflect the LATAM phenotypic variability. Key issues complicating diagnosis include lower human leukocyte antigen B27 (HLA-B27) prevalence, clinical heterogeneity, and inconsistent symptom presentation. Many patients develop symptoms later in life compared to their European counterparts. Extra-articular manifestations like uveitis, enthesitis, and tarsitis are common and may precede the diagnosis, contributing to delays. In addition, inflammatory back pain, often used as a referral criterion, has limited specificity and may lead to misdiagnosis. Healthcare systems in LATAM are often under-equipped to recognize and manage SpA efficiently. General practitioners (GPs) and even non-rheumatologist specialists may lack awareness of hallmark symptoms, leading to prolonged referral processes and multiple misdiagnoses. The average diagnostic delay is around 4.2 years, with women facing even longer delays. Use of classification criteria as diagnostic tools further complicates timely recognition. The ASAS criteria often exclude HLA-B27-negative patients and those without clear imaging findings in sacroiliac joints. This leads to underrepresentation in clinical studies and underestimation of disease burden. To improve diagnosis, a comprehensive clinical evaluation—including history, physical exam, imaging, and laboratory test—by rheumatologists familiar with the local disease spectrum. Tools like magnetic resonance imaging, enthesitis indices (e.g., Mander Enthesis Index, Defining Enthesitis on Ultrasound in Spondyloarthritis Enthesitis Index), and spinal mobility measures (e.g., Bath Ankylosing Spondylitis Metrology Index) should be integrated into clinical practice. There is also a need to validate diagnostic and classification criteria specifically for LATAM populations, incorporating region-specific genetic and clinical profiles. Greater awareness, earlier specialist referral, and locally tailored criteria are essential to reduce diagnostic delays and improve outcomes for patients with SpA in LATAM.

Large epidemiologic and clinical estimates of spondyloarthritis (SpA) in Latin America are not available. In this narrative review, our goal was to descriptively summarize the prevalence and features of SpA in Latin America, based on available small studies. A review of peer-reviewed literature identified 41 relevant publications. Of these, 11 (mostly based on Mexican data) estimated the prevalence of SpA and its subtypes, which varied from 0.28 to 0.9% (SpA), 0.02 to 0.8% (ankylosing spondylitis), 0.2 to 0.9% (axial SpA), and 0.004 to 0.08% (psoriatic arthritis). Demographic and/or clinical characteristics were reported in 31 of the 41 publications, deriving data from 3 multinational studies, as well as individual studies from Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, Uruguay, and Venezuela. Data relating to treatment, disease manifestations (articular and extra-articular), and comorbidities were summarized across the countries. Available data suggest that there is a variability in prevalence, manifestations, and comorbidities of SpA across Latin America. Basic epidemiologic and clinical data are required from several countries not currently represented. Data relating to current treatment approaches, patient outcomes, and socioeconomic impact within this large geographic region are also needed.