Our results suggest that US bilateral assessment of one joint, three articular cartilages and two tendons may be valid for diagnosing gout with acceptable sensitivity and specificity.

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BackgroundClinical remission is the treatment target for patients with rheumatoid arthritis (RA). However, different definitions have been proposed. Still, damage and/or subclinical inflammation (eg, positive Doppler signal) may persist despite apparent clinical remissionObjectivesTo examine the validity of different definitions of remission and Doppler ultrasound using X-Ray progression as the gold standardMethodsData were obtained from an observational, prospective, multicenter study in RA patients with moderate disease activity (3.2≤DAS28(CRP)≤5.1) who started anti-TNF therapy, conducted under conditions of daily practice. At recruitment and at months 6 and 12, patients were scheduled for a clinical examination, laboratory data collection and reduced 12-joints Power Doppler (PD) ultrasound examination of the wrist, 2nd and 3rd MCP, elbow, knee, and ankle bilateral joints. Synovitis grey scale and PD counts were obtained, and each joint was semi-quantitatively assessed (0 – 3) to obtain grey scale synovitis and PD scores. DAS28 (ESR/CRP), SDAI, CDAI, and ACR/EULAR remission criteria were collected. At baseline and month 12, radiographs of hands and feet were obtained and assessed by an independent observer in pairwise, chronological order and scored according to Sharp-van der Heijde method. X-Ray progression was defined as an increase >1 point and non-progression as ≤0. Patients with doubtful X-ray progression (progression =1), were excluded from independent tests of X-ray progression and US findingsResultsThe sample consisted of 129 patients, 107 women (82.9%), with median (IQR) age of 56.0 (44.0-66.0) years, median time from diagnosis of 5.0 (3.0-11.5) years, and positive rheumatoid factor in 82 patients (63.6%). At 12 months, Sharp-van der Heijde's score median increase was 3.0 (0.0-6.5) points, with 36 patients not progressing and 79 with progression (14 patients with doubtful X-ray progression). Remission rates at 6 and 12 months according to different clinical criteria were: CDAI, 10.5% and 15.9%, SDAI, 12.3% and 15.7%; ACR/EULAR, 12.6% and 14.2%, DAS28ESR, 21.1% and 33.9%; DAS28CRP, 45.9% and 56.7%, respectively. Disease activity at any study time by any composite index (DAS28ESR, DAS28CRP, SDAI, CDAI and ACR/EULAR) was not significantly associated with X-Ray progression. PD score ≥1 at baseline and persistence of PD score ≥1 at 6 months were associated with X-Ray progression: OR=5.067 (IC95%: 1.162 – 21.576; p=0.017), and OR=7.474 (IC95%: 2.644 – 21.123; p<0.0005), respectively.ConclusionsA short 12 joints PD US score shows better predictive validity for structural damage progression in RA than composite indices of disease activity. PD signal, but not clinical disease activity, can predict X-ray progression at 6 and 12 months. Probably in the near future Ultrasound may need to be considered as a component of RA remission criteria.AcknowledgementsThe authors wish to thank Jesus Garrido for providing medical writing and editing services in the development of this abstract and poster. The financial support ...

Background: Hepatic osteodystrophy is a frequent complication of chronic hepatopathies, although its knowledge in immune mediated chronic liver disease as primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune cholangitis (AIC) is scarce. Objectives: 1. To study the prevalence of fragility fractures, osteoporosis (OP) and osteopenia and its association with the severity of hepatopathy (ChildPugh, MELD) and the hepatic fibrosis stage (FibroScan ® ) in this population. 2. To assess whether a T-score <-1.5 could be a cut-off point that identifies an increased risk of fracture in these patients. 3. To estimate their absolute risk of fracture using the FRAX ® tool. 4. To analyze if clinical practice is in compliance with treatment recommendations of OP proposed by the European Association for the Study of the Liver (EASL) and FRAX guidelines. Methods: Preliminary cross-sectional observational study of bone density and fragility fractures in patients with PBC, PSC and AIC attended at our hospital during last year. Among 107 eligible patients, 45 (53%) fulfilled the inclusion criteria of having bone mineral density (BMD) evaluation by dual X-ray absorptiometry (DXA) using an Hologic QDR 4500-Elite ® densitometer at lumbar spine and total hip. The protocol included a questionnaire for sociodemographic variables, fractures and OP risk factors. Results: Mean age was 57 yrs (range: 28-81 yrs) and 84% were women (31% postmenopausal). Disease distribution was: 89% PBC, 6.7% AIC and 4.4% PSC. BMD assessment is shown in Table. Region DXA Cholangiopathies* General population* p Lumbar spine OP 24% (10-39) 9% (5-13) 0.01 Osteopenia 49% (32-65) 42% (35-48) NS Normal 27% (12-42) 49% (42.5-56) 0.01 Femoral neck OP 11% (4-24) 1% (0.3-4) 0.002 Osteopenia 60% (45-75) 39% (32-45) 0.006 Normal 29% (14.5-43) 60% (53-66) 0.0001 *Data are shown as n (95% CI). NS: non-significant. Prevalence of global fractures was 38% (non vertebral 38% and vertebral 7%). We found an association between vertebral fractures and serum bilirubin >1.3 mg/dL, serum albumin <3.4 g/dL and F4 stage by FibroScan ® (p<0.05), which remained significant after adjustment for possible confusion factors. Likewise, hip fracture was associated with early menopause, F3 stage and lumbar spine and femoral neck OP (p<0.05). A T-score <-1.5 in lumbar spine (58.5% [95% CI: 42-75]) and femoral neck (53% [95% CI: 48-69]) did not correlate with prevalent fractures. The mean 10 yrs absolute risk of fractures obtained by FRAX ® was 6% for major fractures and 2% for hip fracture. Doctors younger than 40 yrs had ordered DXA more frequently (68%) than doctors over 40 yrs (46), p=0.05. OP prevention and treatment was in compliance with EASL guidelines in 58% of eligible patients. FRAX ® recommendations identified 22% patients eligible for OP treatment whereas EASL guidelines identified 58% (p=0.001).Conclusions: Prevalence of OP in cholangiopathies was greater than described for general Spanish population of the same age. A T-score <-1.5 was not associated wi...

BackgroundThere is growing evidence in rheumatoid arthritis (RA) that ultrasound assessments (UA) have a better predictive value for X-ray progression than clinical assessmentsObjectivesTo analyze the association between UA with a reduced 12-joint ultrasound (US) power Doppler (PD) examination and X-ray progression at 12 monthsMethodsPatients were included with available X-ray examination in a multicenter, observational, prospective cohort of RA patients with moderate disease activity (3.2≤DAS28≤5.1), conducted under conditions of routine daily practice (ECO-DAIStudy) 12-joint PDUS assessments were performed at baseline, 6 and 12 months. Synovitis grey scale (SGS) and PD counts were obtained, and each joint was semi-quantitatively assessed (0 – 3) to obtain SGS and PD scores. X-ray examinations were performed at baseline and at 12 months. An independent, blinded observer read paired films in chronological order and scored them according to Sharp-van der Heijde method. X-ray progression was defined as an increase >1 point and non-progression as ≤0. In order to increase contrast, patients with doubtful X-ray progression (>0 - ≤1) were excluded from association analyses of X-ray progression and US findings. Several cutoffs for SGS and PD were tested, and sensitivity (Se) and specificity (Sp) were computed when a significant association was foundResultsThe sample consisted of 129 patients, including 107 women (82.9%), with median (IQR) age of 56.0 (44.0-66.0) yrs, median time from diagnosis of 5.0 (3.0-11.5) yrs, and rheumatoid factor positivity in 82 patients (63.6%). At baseline, 6 and 12 months, the median (IQR) values of SGS counts were 5.0 (4.0-8.0), 5.0 (2.0-7.0) and 4.0 (2.0-6.0); SGS scores were 8.0 (5.0-11.0), 5.0 (3.0-8.0) and 5.0 (2.0-7.8); PD counts were 4.0 (2.0-6.0), 2.0 (1.0-4.0) and 2.0 (1.0-3.0); and PD scores were 6.0 (2.0-9.0), 3.0 (1.0-6.0) and 2.0 (1.0-5.0), respectively 3.5±3.9 (Friedman test; p<0.0005 all). At baseline and 12 months, median Sharp -van der Heijde's scores were 16.0 (3.5-45.0) and 20.0 (6.0-51.0) (p<0.0005). A total of 79 patients (61.2%) experienced x-ray progression; 36 patients (27.9%) had no sign of x-ray progression and it was doubtful (progression =1) in 14 patients (10.9%). X-ray progression was not significantly associated with grey scale synovitis counts or scores for any cut-off between 0.5 and 5.5 but was significantly associated with PD counts for cut-offs of 0.5 (Se, 80.3 – 96.2; Sp, 16.7 – 42.4) and 1.5 (Se, 57.9 – 88.6; Sp, 16.7 – 42.4) as well as with PD scores for cutoffs of 0.5 (Se, 80.3 – 96.2; Sp, 16.7 – 42.4) and 1.5 (Se, 69.7 – 94.9; Sp, 27.8 – 55.6)ConclusionsPower Doppler joint counts or cumulative scores greater than 0.5 or 1.5 in a 12-joint PDUS assessment are significantly associated with X-ray progression. Cutoff of 1.5 performed slightly better for PD-scores than for PD-counts. Grey scale synovitis counts or scores were not significantly associated with X-ray progressionAcknowledgementsThe authors wish to thank Jesus Garrido for providing medical writi...