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Rheumatoid arthritis (RA) is considered a systemic inflammatory disease marked by polyarthritis which affects the joints symmetrically, leading to progressive damage of the bone structure and eventually joint deformity. Lung involvement is the most prevalent extra-articular feature of RA, affecting 10–60% of patients with this disease. In this review, we aim to discuss the patterns of RA interstitial lung disease (ILD), the molecular mechanisms involved in the pathogenesis of ILD in RA, and also the therapeutic challenges in this particular extra-articular manifestation. The pathophysiology of RA-ILD has been linked to biomarkers such as anti-citrullinated protein antibodies (ACPAs), MUC5B mutation, Krebs von den Lungen 6 (KL-6), and other environmental factors such as smoking. Patients at the highest risk for RA-ILD and those most likely to advance will be identified using biomarkers. The hope is that finding biomarkers with good performance characteristics would help researchers better understand the pathophysiology of RA-ILD and, in turn, lead to the development of tailored therapeutics for this severe RA manifestation.

Introduction: Axial spondyloarthritis (axSpA) is characterized by damage to the axial skeleton and entheses, and is often associated with extra-articular manifestations, in the presence of the human leukocyte antigen (HLA) B27. The aim of our study is to assess the performance of rheumatologists in interpreting the inflammatory and structural damage to sacroiliac joints, in comparison to radiologists. Material and Methods: The present study included a total of 34 patients diagnosed with axSpA, according to the Assessment of SpondyloArthritis International Society (ASAS) criteria for axSpA, examined from January 2021 to November 2021 in the Departments of Rheumatology and Radiology and Medical Imaging of the University of Medicine and Pharmacy of Craiova. All patients underwent physical examination, laboratory tests, and magnetic resonance imaging (MRI) of the sacroiliac joints. The images were interpreted by a senior radiologist (SR), a junior radiologist (JR), a senior rheumatologist (SRh), and a junior rheumatologist (JRh), who were blinded to the clinical and paraclinical data. Results: The overall κ was 0.7 for the JR (substantial agreement), 0.707 for the SRh (substantial agreement), and 0.601 for the JRh (moderate agreement), in comparison with the SR. Regarding the overall inflammatory changes, the SRh and JR were proven to have substantial agreement (κ = 0.708 and 0.742, respectively) with the SR, while the JRh was proven to have moderate agreement (κ = 0.607). The structural damage observed by the JR showed substantial agreement (κ = 0.676) with the SR, while the SRh and JRh had substantial and moderate agreement (κ = 0.705 and 0.596, respectively) with the SR. Conclusions: Our study showed substantial agreement between the senior radiologist, senior rheumatologist, and junior radiologist, and moderate agreement with the junior rheumatologist.

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BackgroundGout represents a frequent inflammatory rheumatic disease affecting peripheral joints with an increasing prevalence in our country. Musculoskeletal ultrasound is an emerging tool of increasing interest able to detect both structural and inflammatory lesions and facilitate disease diagnosis and monitoring.ObjectivesTo demonstrate, assess and quantify the pathological findings associated with chronic gout in the second metacarpophalangeal (MCP) joint through musculoskeletal ultrasound in comparison with conventional radiography.MethodsWe evaluated 24 patients previously diagnosed with chronic gout and at least one episode of hand arthritis. Ultrasound evaluation was performed by a trained rheumatologist unaware of the clinical data using a Prosound α7 equipment with a multifrequency linear probe and using the standardized scanning technique. The following pathological findings were recorded on ultrasound: cortical erosions defined as breaks in the cortical contour of metacarpal head or proximal phalanx, seen in two perpendicular planes, tophaceous deposits defined as hyperechoic crystalline concrements and calcified tophi defined as hyperechoic aggregates with posterior acustic shadow. Conventional radiographs of anteroposterior and lateral view of the hand were assessed by a trained rheumatologist in the absence of the clinical and ultrasonographic data considering as pathological findings suggestive for gout. Both methods evaluated in a qualitative manner the abnormal findings (presence or absence)ResultsWe assessed 24 patients (21 males, 3 females) with a total number of 48 MCP joints evaluated. Compared to conventional radiography musculoskeletal ultrasound detected significantly more erosions (p<0.001). Erosions were detected in 23/48 joints (47.9%) compared to only 5/48 joints (10.4%) through conventional radiography. In addition to structural lesions ultrasound was able to detect inflammatory changes associated with gout. Intra-articular tophaceous deposits were detected in 39/48 joints (81.2%) using ultrasound while conventional radiography could not detect un-calcified tophaceous material. Intra-articular calcification of the tophaceous material was seen in 3/48 joints (6.2%) using ultrasound and in 2/48 joints (4.16%) using conventional radiography.ConclusionsMusculoskeletal ultrasound is an extremely valuable tool in the evaluation of gouty arthritis of the hand identifying a significantly higher number of erosions compared to radiographic evaluation as well as in visualizing the intra-articular tophaceous deposits. While uncalcified tophaceous deposits are missed by the conventional radiologic evaluation, calcified tophi are seen by both imaging methods.Disclosure of InterestNone declared

Background Management of spondylarthritis (SA) has evolved lately, in part due to new biologic therapies and part because of the new imaging techniques that can depict earlier involvement in joints and tendons. Objectives to evaluate, by ultrasonography (US), the prevalence and type of the ankle tendons involvement in patients with spondylarthritis. Methods Thirty-four patients with SA and ankle pain were included in the study (12 with ankylosing spondylitis - AS, 11 with psoriatic arthritis - PsA and 11 with reactive arthritis -ReA). Twenty healthy age-matched controls without inflammatory diseases were examined as well. The US evaluation included the anterior scan, the medial malleolar, lateral malleolar and posterior scan, for the evaluation of the following tendons: anterior tibialis tendon, extensor halux tendon and extensor common tendons, posterior tibialis tendon, flexor digitorum tendon and flexor hallux tendon, brevis and longus peroneous tendon and Achilles tendon. The presence of US findings indicative of tenosynovitis and tendon damage was investigated. Results Tenosynovitis in at least one site, was statistically significant more frequent in patients with SA than in controls (58,82% vs 10,00%, p<0,001). Between patients with SA, it was more frequent in PsA patients (72,72%), followed by ReA patients (63,63%), compared to those with AS (41,66%). The most frequently involved tendon was tibialis posterior tendon in PsA and ReA patients and Achilles tendon in AS patients. We found partial or complete tears of the tendons in 3 patients from control group (15%) and 4 patients with SA (11,76%). Conclusions This study reveals the high frequency of ankle tendon involvement in patients with spondylarthritis and can guide the further assessment in the evaluation of those patients in daily practice. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5719

La artritis reumatoide (AR) se considera una enfermedad inflamatoria sistémica, caracterizada por una poliartritis que afecta a las articulaciones de forma simétrica, lo que provoca daño progresivo en la estructura ósea y, finalmente, deformidad articular. La afectación pulmonar es la característica extraarticular más prevalente de la AR, y afecta a 10-60% de los pacientes con la enfermedad. En esta revisión discutimos los patrones de la enfermedad pulmonar intersticial (EPI) de la AR, los mecanismos moleculares implicados en la patogénesis de la EPI en la AR, y también los retos terapéuticos en esta particular manifestación extraarticular. La fisiopatología de la AR-EPI se ha relacionado con biomarcadores como los anticuerpos contra proteínas citrulinadas (ACPAs), mutación en MUC5B, los niveles de Krebs von den Lungen 6 (KL-6) y factores ambientales como el tabaquismo. Los pacientes con mayor riesgo de padecer RA-EPI y quienes tengan más probabilidades de evolucionar se identificarán mediante biomarcadores. Se espera que el hallazgo de biomarcadores con buenas características de desempeño ayu­de a los investigadores a comprender mejor la fisiopatología de la AR-EPI y, a su vez, conduzca al desarrollo de terapias personaliza<X00_Del_TrennDivis>­-</X00_Del_TrennDivis>das para esta grave manifestación de la AR.

Vascular injury is the main change the pathogenesis of SSc and occurs earlier, before the appearance of fibrosis. The new scleroderma 2013 criteria increased diagnostic sensitivity and specificity, by including capillaroscopic changes, besides the clinical picture and serological disease. Peripheral microvascular changes in capillaroscopy correlate with the severity of the skin damage but also with systemic involvement. The objective of this paper is to review and describe the current knowledge on nailfold capillaroscopy, as an easy, non-invasive and low cost technique for evaluating the vascular microangiopathy.