Background: Clinical experience has shown that a single measure is not sufficient to assess disease activity in rheumatoid arthritis (RA). Various clinimetric tools are necessary to address the many clinical situations that can arise. Methods: In order to develop a comprehensive measurement tool, the Pan American League of Associations for Rheumatology searched for the most frequent measures of disease activity applied in RA by means of a semi-systematic review of the available literature. Results: We found that the most frequently reported measures of disease activity were the 28-joint Disease Activity Score, C-reactive protein, and the erythrocyte sedimentation rate, followed by patient-reported measures of pain and stiffness and many other composite indices and patient-reported outcome measures. The most frequent physician-reported sign of disease was the swollen joint count, and the most frequently self-reported feature was the increase in disease activity or flares. Conclusion: In this article, we present a new clinimetric tool developed based on expert consensus and on data retrieved from our search. Disease activity can be better assessed by combining various data sources, such as clinical, laboratory, and self-reported outcomes. These variables were included in our novel clinimetric tool. Key Points• The goal of treatment of RA is to achieve the best possible control of inflammation, or even remission; therefore, disease management should include systematic and regular evaluation of inflammation and health status.• Clinimetric tools evaluate a series of variables (e.g., symptoms, functional capacity, disease severity, quality of life, disease progression) and can reveal substantial prognostic and therapeutic differences between patients.• Our clinimetric tool, which is based on a combination of data (e.g., clinical variables, laboratory results, PROMs), can play a relevant role in patient assessment and care.

Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) has multiple pathogenic mechanisms that cause diverse manifestations and whose diagnosis is challenging because of the absence of appropriate diagnostic tests. In the present study the application of proteomics using two-dimensional electrophoresis (2D) and mass spectrometry (MS) allowed the comparison of the protein profile of the serum low and high abundance protein fractions of NPSLE patients (NPSLE group) and SLE without neuropsychiatric syndromes (SLE group), Neuropsychiatric syndromes not associated with SLE (NPnoSLE groups), and healthy controls (CTRL group). The gels obtained were digitalized and analyzed with the PDQuest software. The statistical analysis of the spots was performed using the nonparametric Kruskal Wallis and Dunn's multiple comparison tests. Two spots showed significant differences and were identified by MS. Spot 4009 was significantly lower in NPSLE with regard to NPnoSLE (p= 0,004) and was identified as apolipoprotein A1 (APOA1) (score 809-1132). Spot 8001 was significantly higher in NPSLE regarding CTRL and NPnoSLE (p= 0,01 y 0,03, respectively) and was identified as serum amyloid A (SAA) (score 725-2488). The proinflammatory high density lipoproteins (HDL) have been described in SLE. In this HDL the decrease of APOA1 is followed by an increase in SAA. This altered level of both proteins may be related to the inflammatory state that is characteristic of an autoimmune disease like SLE, but this is not specific for NPSLE.

Introduction: Given the ongoing debate surrounding the validity of Autoimmune/ Inflammatory Syndrome Induced by Adjuvants (ASIA), this study aimed to evaluate the clinical evidence related to this syndrome, with particular emphasis on its major diagnostic criteria and methodological quality. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Extracted data included demographic characteristics, exposure types, fibromyalgia-related symptoms, latency, histopathological findings, and autoantibody profiles. The risk of bias was assessed using validated tools appropriate to the study design. Results: Between 1983 and 2024, 51 studies were identified: 27 case series, 18 case reports, 4 cohort studies, 1 case-control study, and 1 cross-sectional study. Silicone was the most frequent exposure. Only 61% of case reports fulfilled ASIA criteria, while 59% of case series described fibromyalgia-compatible features. Complete improvement after removal was reported in 67% of case reports and 33% of case series. Comparative studies yielded inconsistent findings, and substantial outcome heterogeneity precluded meta-analysis. Discussion: The predominance of descriptive studies, heterogeneity in exposures, clinical manifestations, and study populations, as well as methodological limitations, restrict causal interpretation. Although symptomatic improvement following prosthesis removal was commonly reported, responses were variable and frequently incomplete. This uncertainty does not preclude the possibility that specific materials may trigger immune-mediated responses in susceptible individuals. Potential circularity may arise if clinically derived criteria identify cases that are subsequently used as evidence for the syndrome. Conclusion: Current evidence is insufficient to establish that manifestations grouped under ASIA constitute a distinct clinical entity with a common causal mechanism. Robust analytical, population-based studies with clearly defined exposures and appropriate comparison groups are warranted.

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