BackgroundThe hip joint is a site of involvement in a number of rheumatic conditions. Patients are often complaining of hip pain. The “Hip” as a complaint or a joint involved in disease is being used, as a metric in a number of indices or questionnaires, to evaluate IBP (1) or Spondyloarthropathies (such as BASDAI question 2) (2). However, what patients are describing as “hip” pain is not always referred to the actual hip joint.ObjectivesTo assess which structure(s) patients indicate when they are referring to hip pain.MethodsA diagram has been developed which has been used as a proforma to design on the site of “hip pain” from patients (new and/or follow up) when seen in clinic. After detailed history and examination, an accurate description of the site referred to as “hip” was recorded. Radiological imaging was utilised, for those patients with either multiple sites or clinically unclear causes of “hip” pain, to confirm or exclude the clinical diagnosis for the pain. The study classified as an audit and took place at a single centre between August 2014 and September 2015.ResultsA total of 54 patients (M:F 10:44) have been assessed [mean age of 57.6 years (sd ±14.1)]. Total sites identified and evaluated were 72 as 14 patients of 54 (25.9%) indicated more than 1 site when describing their hip pain [10 patients:2 sites (18.5%), 4 patients (7.4%) 3 sites]. A total of 8 structures have been described by patients as the site of their hip pain. These (in addition to the hip joint) were: trochanterum, iliac crests (including anterior superior, posterior superior and anterior inferior) lumbar spine, sacroiliiac joint. Radiological evaluation performed on 40/54 patients (74%). From those, 23 patients had X-rays (57.5%), 13 patients had ultrasound (32.5%), 4 patients (10%) had MRI.Following clinical and radiologic evaluation the structures identified and confirmed as the source of the hip pain were: Trochanterum (n=19; 26.3%), followed by hip joint (n=15; 20.8%), Iliac crest (n=13; 18%), Lumbo-sacral spine (n=6; 8.3%), posterior superior iliac crest (n=6; 8.3%), anterior superior iliac crest (n=5; 6.9%), Sacro-iliac joint (n=5; 6.9%), and anterior inferior iliac crest (n=3; 4.1%).ConclusionsA total of 80% of patients presented with “Hip pain” were referring to a different structure than the hip joint in our study. The greater trochanter was the most commonly reported anatomical structure of pain from patients when they were referring to hip pain. The hip joint itself was 2nd in the frequency of reported hip pain, seen in only 1 in 5 patients coming to clinic complaining of hip pain. We therefore suggest the “hip pain” item, used in questionnaires that do not include clinical evaluation, has to be interpreted with caution.ReferencesKeeling SO, Mjundar SR, Conner-Spady B. et al. Preliminary validation of a self reported screening questionnaire for IBP. J. Rheumatol 2012;39:822–29Garrett S, Jenkinson T, Kennedy LG, et al. A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing Spondylitis Dis...

Background Anterior uveitis is an extra-articular manifestation of spondyloarthritis (SpA) Objectives To analyze patients data and compare the main musculoskeletal problems as well as clinical characteristics (sacroilitis, enthesitis, psoriasis, night pain, well being), disease activity and function on uveitis vs non uveitis in HLAB27 positive SpA cohort aiming to establish the axial SpA uveitis cohort characteristics. Methods SpA patients were asked to complete a questionnaire assessing their disease type, age at diagnosis, clinical presentation, disease-activity (BASDAI score) and functional-indices (BASFI score). Only HLA-B27 positive patients' responses were analysed, with those reporting an ophthalmological anterior uveitis diagnosis (current or past) compared to those without uveitis. Means and standard errors were calculated. Statistical significance was determined using unpaired t-tests or Pearson's chi-squared tests. Results Of 67 HLA-B27 positive patients, 24 (35.8%) had a history of uveitis (M:F =9:15; mean age, 46.1 ± 3.2 years) and 43 (64.2%) (M:F =20:23; 42.7 ± 2.0 years) did not. All had axial disease. 7/24 (29.1%) uveitis and 11/43 (25.5%) non-uveitis patients also had peripheral SpA (ASAS criteria; p>0.05). No significant differences in the proportions of patients with undifferentiated SpA (6/24 versus 7/43; ESSG criteria), Ankylosing Spondylitis (AS) (13/24 versus 18/43; AS mod. New York Criteria) or psoriatic arthritis (PsA) (5/24 versus 12/43; CASPAR), or of patients with arthritis (5/24 versus 10/43), enthesitis (4/24 versus 6/43), radiographic sacroiliitis (9/24 versus 14/43), or psoriasis (3/24 versus 12/43) were found between the two groups. There were also no differences in night pain (5.54 ± 0.63 versus 5.20 ± 0.46), well-being over the past week (4.7 ± 0.6 versus 4.8 ± 0.4), disease activity (BASDAI, 5.92 ± 0.43 versus 5.80 ± 0.30) or functional limitation (BASFI, 4.51±0.57 versus 4.50 ± 0.43). Mean age at diagnosis was lower (31.7 ± 2.3 versus 36.3 ± 1.9) and the mean disease duration was longer in the uveitis group (15.5 ± 2.3 versus 11.3 ± 1.4) but this was also not significant (p>0.05). Lower back pain and stiffness (n=15 for both; representing 65.2%) was the predominant MSK manifestations of the uveitis positive group, followed by neck pain (13; 56.5%) joint pains (n=12; 52.2%), fatigue (n=10; 43.5%) upper back pain and enthesitis (n=8; 34.2% for both). In the non-uveitis HLAB27+ group lower back pain was also the predominant manifestation (28; 66.7%) followed by fatigue (n=24; 56.1), stiffness (n=23; 54.8%), joint pains (n=23; 54.8%), neck pain (n=19; 45.2) upper back pain (n=18;42.9) and enthesitis (n=17; 40.5%). There was no statistically significant difference between the uveitis and the non uveitis group with regards to their predominant musculoskeletal manifestations. Conclusions Uveitis SpA patients are younger at disease presentation and have the diagnosis earlier than the non uveitis ax-SpA group. No other differences have been identified. Disclosure of Interest...

Objectives Aiming to assess the ASAS criteria for Spondyloarthritis (SpAs) in patients with Fibromyalgia (FM) we applied all items of the ASAS criteria (for both axial and peripheral disease) to 84 patients with FM. Methods Patients with FM attending regular out patients clinics were assessed clinically by physician and given questionnaire with FM indices. Routine blood tests obtained and radiographic evaluation to exclude other diseases. individual item of Inflammatory back pain (IBP) criteria and of the ASAS criteria were also applied. Sensitivity and specificity tests have been calculated. Results A total of 84 patients (M:F = 5:79) were assessed. They had a mean age of 47.3 years (y) (sd ± 11.2), mean age of symptom onset of 33 y (± 11.8) and mean age of diagnosis 41.9 (±10). The mean CRP of the group was 6.7 (sd ± 4). FM patients fulfilled both 1990 (tender point evaluation) and 2011 criteria. When items from the ASAS criteria were applied to the patients with FM, 6 patients (all females) had more than 1 of the items seen in the ASAS criteria (7.1%). More specifically, 6 patients had back pain onset below the age of 45 y of age and lasting for more than 3 months. Five out of 6 were positive for IBP criteria, 3 patients were HLAB27 (+), 3 patients had good response to NSAIDs, 3 patients had positive Fx of SpA (2 of Psoriasis, 1 of Crohn's disease) 2 patients had elevated CRP and 2 patients had confirmed enthesitis by ultrasound. From those patients fulfilling the ASAS criteria for SpAs, 3 patients fulfilled criteria for axial disease, 3 fulfilled criteria for peripheral disease and 1 patient fulfilled the criteria for both axial and peripheral disease. Upon scrutinized the history and clinical evaluation 2 patients have subsequently classified as SpA while the other 4 although they could be classified as SpA they still remained under the FM umbrella requiring follow up evaluation. The specificity and sensitivity for the ASAS criteria among FM patients have been calculated which showed a sensitivity of 2% and a specificity of 91.7% for the ASAS criteria. The positive predictive value showed to be 25% while the negative predictive value was 48%. Conclusions Although IBP is commonly seen in patients with FM the ASAS criteria for SpAs showed low sensitivity and high specificity among FM patients which supports their discriminatory capacity among patients with these diseases. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.6081

ObjectivesTo assess the differences in the occurrence of co-morbidities from cardiovascular, respiratory, renal/urological and Central nervous systems (CNS) between patients with spondyloarthritis (SpA) not having headache as presenting symptom and those having headache assuming that those describing headache represent secondary (s) fibromyalgia (FM). (previous submitted abstract provides justification on headache as presenting symptom associated with secondary sFM).MethodsData obtained through a questionnaire from 776 patients seen in clinic with SpA was analysed with reference to headache as symptom at presentation. From the total 776 patients 13 patients did not record an answer to the question and were hence excluded. The remaining 763 patients were divided in 2 groups: Those having headache at presentation (n=117) considered having sFM, and those not having headache at presentation (n=656).The data of patients with sFM were compared with the data of patients who did not report headache as a presentation symptom therefore not having FM with regards to age, disease duration, delay in diagnosis, disease activity (BASDAI) functional ability (BASFI), ESR, CRP and associated co morbidities from cardiovascular, respiratory, renal/urinary, and CNS systems. Central nervous system was evaluated by symptoms of dizziness and numbness.Independent sample T test was used to explore differences between the 2 groups and confidence intervals obtained.ResultsTable shows demographics and disease characteristics as well as differences between SpA patients presenting with headache (indicating secondary FM), and those not presenting with headache. A greater proportion of patients with SpA and headache (sFM) report cardiovascular and CNS co-morbidities. There was no significant difference noted in the respiratory or renal/ urological co-morbidities amongst the 2 sub-groups.Headache at presentation (n=117)No headache at presentation (n=656)Statistical significance (p)CI Age (mean ± SD)47.7 (13.16)48.3 (14.3)0.1-5.757 to 0.912Gender (M:F) ratio28:89 1:3.1219:419 1:1.90.3-0.025 to 0.077Disease duration11.4 (12.1)10.9 (10.8)0.4-1.905 to 4.470Delay in diagnosis6.43 (8.9)6.3 (8.1)0.7-3.151 to 2.151ESR15.5 (14.8)18.2 (18)0.07-11.064 to 0.582CRP10.4 (36)8.2 (9.8)0.4-6.106 to 12.536BASDAI score7.31 (3.7)6.06 (2.08)0.000 (<0.005)0.783 to 2.624BASFI score5.6 (2.7)5.04 (2.7)0.09-0.143 to 1.626Main problemFatigue77/116 (66.4%)340/608 (55.9%)0.0180.029 to 0.299Pain with pressure71/117 (61.2%)257/807 (42.4%)0.0000.122 to 0.378Co-morbiditiesHeart16/100 (16%)59/479 (12.3%)0.0020.44 to 0.196Lungs11/99 (11.1%)52/475 (10.9%)0.1-.014 to 0.135Dizziness50 (104) 48.1%147/408 (30.1%)0.0000.220 to 0.453Numbness58 (105) 55.2%199/505 (39.4%)0.0000.188 to 0.441Kidneys/urology23 (102) 22.5%100/479 (20.9%)0.1-0.31 to 0.188ConclusionsA significantly higher proportion of patients described cardiovascular and CNS co-morbidities in the sFM group of SpA. No significant difference was noted in the 2 sub-groups with regards to the respiratory or renal systems.Disclosur...

ObjectivesTo evaluate the symptom of headache as being able to clinically distinguish associated secondary fibromyalgia in patients with spondyloarthropathies (SpA). To compare the incidence of MSK complaints (related to SpA) in patients with headache to those that did not. To assess headache during the SpA disease course.MethodsRegistry data from 776 patients seen in clinic with SpA were analysed with reference to headache as symptom at presentation. The data of those patients presented with headache were compared with data of those patients who did not report headache with regards to demographics and disease characteristics. In addition, other MSK complaints, fatigue and pain during disease course were also analysed.ResultsFrom a total of 776 patients (m: f=265:508) age 48.3 ( SD +14.1), 13 were excluded as no answer was recorded. 117/ 763 patients (15.08%) representing 28 males and 89 females (23.9% vs 76.1% ratio 1:3.1) reported headache at disease onset.During the disease course, 13 patients out of the initial 117 did not record an answer to the question and were excluded. From remaining 104 patients, 95 patients (91.3%) continued to describe headache as a symptom.From those not reporting headache as initial symptom, (n=659) 148 did not record an answer and were excluded. From the remaining 511 patients, 194 (37.9%) reported headache during the disease course.On the data obtained from these 2 sub-groups, comparison took place using paired sample t-test.Table shows demographics and disease characteristics as well as differences between the 2 SpA sub-groups. Those presenting with headache describe worse disease, more fatigue and a greater percentage describe pain at pressure points and MSK system.Headache at presentationNo headache at presentationStatistical significanceCI (n=117)(n=656)(p) Age (mean ± SD)47.7 (13.16)48.3 (14.3)0.1-5.757 to 0.912Gender (M:F) ratio28:89 (1:3.1)219:419 (1:1.9)0.3-0.025 to 0.077Disease duration (y) (mean ± SD)11.4 (12.1)10.9 (10.8)0.4-1.905 to 4.470Delay in diagnosis (y) (mean ± SD)6.43 (8.9)6.3 (8.1)0.7-3.151 to 2.151ESR (mean ± SD) mmHg15.5 (14.8)18.2 (18)0.07-11.064 to 0.582CRP (mean ± SD) mg/dL10.4 (36)8.2 (9.8)0.4-6.106 to 12.536BASDAI score (mean ± SD)7.31 (3.7)6.06 (2.08)<0.0050.783 to 2.624BASFI score (mean ± SD)5.6 (2.7)5.04 (2.7)0.09-0.143 to 1.626Buttock pain (%)31.612.80.0010.083 to 0.293Back pain (%)82.958.8<0.0050.125 to 0.337Neck pain (%)72.624.4<0.0050.340 to 0.583Knee pain (%)63.230.6<0.0050.284 to 0.520Shoulder (%)70.923<0.0050.312 to 0.559Foot (%)57.222<0.0050.279 to 0.524Hip (%)55.519.9<0.0050.217 to 0.467Eye (%)234.3<0.0050.102 to 0.274Fatigue77/116 (66.4%)340/608 (55.9%)0.0180.029 to 0.299Pain with pressure71/117 (61.2%)257/807 (42.4%)0.0000.122 to 0.378Headache as co-morbidity95 (109) 87.2%195/509 (38.3%)0.0000.808 to 0.935ConclusionsHeadache can clinically represent secondary FM among SpA patients. A proportion of patients (representing 15%) report headache at presentation. The majority of those patients (>90%) continue to describe headache during the dis...

Background Ankylosing Spondylitis (AS) disease status is assessed using BASMI [1] which is derived from 5 measures, including intermalleolar distance (IMD), each scored as 0, 1 or 2. Originally, IMD was measured on the floor with the patient supine and knees extended. In practice it is often measured with the patient on a couch. Objectives To assess whether patient position affected IMD (and its BASMI scoring) in axial-SpA patients by comparing IMD measurements obtained on-the-couch (OC) and on-the-floor (OF). To assess whether there are differences between underlying diseases predominantly AS and Psoriatic arthritis of the AS type (axial PsA). Methods OC (utilising a 62 cm wide couch) and OF measurements (in duplicate) were attempted on 54 SpA patients (23 male: 31 female) with axial-involvement attending rheumatology clinics. 22 patients had AS and 32 patients had Psoriatic Spondylitis (ax-PsA). Additionally age, gender, height, weight, BMI, and disease duration were also collected. Statistical analyses were performed using unpaired t-tests Results OC was measured for all patients. Of these 12 (22.2%) resulted in a BASMI-IMD score of 0 (>100 cm; i.e. “mild disease”), 23 (42.6%) scored 1 (70-100 cm; i.e. “moderate disease”) and 19 (34.8%) scored 2 (<70 cm, indicating “severe” axial impairment). Importantly, OC-derived IMDs of patients with AS were significantly greater than those with ax-PsA in our study population (87.7±4.0 cm versus 66.7±5.1 cm; p<0.05). Furthermore, markedly more ax-PsA patients had a BASMI score indicative of severe disease: BASMI-IMD score was 2 for 15% AS versus 46.9% ax-PsA patients. Overall, OF measurements were not significantly different from OC measurements in the 45 patients in whom both these values were obtained (78.5±4.0 cm versus 79.3±4.4 cm; p>0.05). Similarly, there was no significant difference between average OC and OF measurements in patients scoring 1 or 2 (i.e. with IMDs <100 cm). In contrast, OC measurements of patients with IMDs >100 cm were 6.1±1.3% less than OF measurements (p<0.05) but only resulted in a change to one AS patient's BASMI-IMD score (from 0 to 1). As for OC-derived IMDs, OF measurements of patients with AS were apparently greater than those with ax-PsA, although this was not significant (90.7±5.8 cm versus 72.1±6.0 cm; p>0.05). Markedly more ax-PsA patients had a “severe disease” OF-derived BASMI scores however: 12.5% AS versus 48.1% ax-PsA patients. There was no significant relationship between IMD (either OC- or OF-derived) and patient age, gender, height, weight, BMI or disease duration. Conclusions Average BASMI-IMD scores are the same whether the patient is positioned on the floor or on the couch. IMD measurements and BASMI scores are worse in PsA patients with axial disease than in AS patients, probably reflecting greater hip involvement in ax-PsA disease. References Jenkinson et al. (1994). J Rheumatol 21: 1694-1698. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5987

The aim of this study was to assess whether axial spondyloarthritis (axial SpA) patients' supine position on the couch (OC) or on the floor (OF) affects intermalleolar distance (IMD) measurement and its Bath Ankylosing Spondylitis Metrology Index (BASMI) scoring, using all three versions of BASMI index. OC- and OF-IMDs were obtained for 43 axial SpA patients (M:F = 19:24). Age, gender, height, weight, body mass index (BMI), disease type and disease duration were also collected. Statistical analyses and correlations were performed as appropriate. Mean IMD measurements obtained with individuals in the two distinct measuring positions were not significantly different in the patients studied. Furthermore, there was a significant correlation between OC-IMD and OF-IMD values. There was no significant relationship between IMD and patient age, gender, height, weight, BMI, or disease duration. However, looking at disease type, IMDs of patients with ankylosing spondylitis (AS) were ~30 % greater than those with psoriatic arthritis (PsA) in our study population (p < 0.05). There were no significant differences between the measured patient characteristics that accounted for the greater IMDs of those diagnosed with AS. IMD measurements and resultant BASMI scores were the same whether the patient was positioned OC or OF in our axial SpA cohort. Unexpectedly, IMD measurements were significantly greater (~30 %) in AS patients than in axial PsA patients.