Higher cross-sectional areas were found in the arthritic patients with CTS than in RA patients and healthy persons without CTS. This supports previous studies of idiopathic CTS in which increased cross-sectional areas have been found. Thus, as in idiopathic CTS, arthritic patients may be examined by US of the median nerve when CTS is suspected.

Bilateral assessments of ECU, TB, and FDL tendons were as sensitive to change as the sum scores of all tendons, and scoring of this reduced number of tendons is suggested to be included in US scorings for follow-up of RA patients.

This is the first study that shows significant associations between the levels of calprotectin and anti-CCP, IgA-RF, and IgM-RF in very early RA. In addition, significant correlations were found between calprotectin and markers of disease activity.

Background The global power Doppler ultrasound (PDUS) scoring system combining synovial hypertrophy, joint effusion and PD signal developed by the OMERACT-EULAR-US Task Force has good intra- and inter-observer reliability in metacarpophalangeal (MCP) and non-MCP joints and demonstrates consistency between PDUS machines.1 We present the first international, Phase IIIb study using the global PDUS synovitis score to assess early impact of IV abatacept (ABA) on synovial inflammation. Objectives Primary objective: to evaluate early response to ABA, defined by improvement of synovitis assessed by global PDUS of affected MCP joints bilaterally. Methods This 6-mth, single-arm, open-label study enrolled active MTX-IR RA patients (pts) defined as DAS28 (CRP) >3.2 or ≥6 tender and swollen joints and CRP >ULN. Pts had a total synovitis PDUS score >1 for ≥2 MCPs and ≥1 for ≥1 other MCP (out of MCP 2–5 bilaterally; i.e. 8 joints) at screening and baseline (BL). Global PDUS was scored over 8 MCP joints (range 0–24 units) at BL, Days 7, 15, 29, 43 and 57 then monthly by a PDUS reader blinded from clinical assessments. Early signs of improvement were defined as the earliest timepoint when 95%CI for mean change from BL in global PDUS score did not contain 0 for that and all later timepoints. DAS28 (CRP) and safety were assessed for all pts who received ≥1 dose of ABA. Results 104 pts were enrolled; 89 completed the trial. Demographic, clinical and PDUS data are shown (Table). Early signs of improvement in global PDUS score were observed at Day 7. Mean change from BL in global PDUS score and its components increased to Day 169. By Day 57, threshold for clinically meaningful improvement of 1.2 was not included in the 95% CI for mean change from BL in DAS28 (CRP). There were no deaths; 6 (5.8%) pts developed a SAE (atrial fibrillation, bursitis, dementia, endometriosis, pleural effusion and pulmonary fistula, and hypertension), 62 (59.6%) an AE, and 20 (19.2%) an infection. Demographics  Females (%); Mean (SD) age, yrs83.7; 56.4 (14.1) BL characteristics, mean (SD)  Disease duration, yrs7.3 (9.1)  DAS28(CRP)5.29 (1.11)  Global PDUS score12.6 (4.1) Mean (95%CI) change from BL in global PDUS score (LOCF)  Day 7–0.7 (–1.2, –0.1)  Day 169–4.8 (–5.8, –3.9) Mean (95%CI) change from BL in DAS28(CRP)  Day 7–0.55 (–0.70, –0.39)  Day 169–2.13 (–2.39, –1.86) Pts (%), Day 169  Remission (DAS28 <2.6)40/98 (40.8)  Low disease activity status (DAS28 ≥2.6 & ≤3.2)56/98 (57.1)  Clinically meaningful improvement (DAS28 change >1.2)72/97 (74.2) Conclusions The study showed that the OMERACT-EULAR-US global PDUS score detected early signs of improvement in synovitis, demonstrating a significant response to abatacept at Day 7, which increased to Mth 6. Efficacy and safety data were consistent with a previous abatacept trial in MTX-IR pts.2 References Naredo E et al. J Rheumatol 2011;38:2063–7; Conaghan P et al. Ann Rheum Dis 2011;70(S3):151. Disclosure of Interest M. D’Agostino: None Declared, R. Wakefield: None Declared, H. Berner Hammer: None D...

A gout attack may evolve after a purine-rich diet or alcohol and after starting urate-lowering therapy (ULT). The relationships between fluctuation and change in serum urate (SU) with the occurrence of flares were investigated in this study. In the prospective NOR-Gout study, gout patients with increased SU and a recent flare were treated to target with ULT over 1 year, with follow-up at year 2 with SU and flare as outcomes. SU and flares were assessed at both monthly and 3-monthly intervals until target SU was reached. Fluctuation over periods and changes in SU between two time points were assessed and compared in patients with and without flares. At year 1, 186 patients completed follow-up (88.2%) and 173 (82.0%) at year 2. Mean age (SD) at baseline was 56.4 (13.7) years, disease duration was 7.8 (7.6) years, and 95.3% were men. The first-year SU fluctuation and change were related to flare occurrence during year 1 (both p < 0.05). High fluctuation with an absolute sum of all SU changes during the first 9 months was related to flares over 3-month periods (all p < 0.05), and high fluctuation during the first 3 months was related to flares in months 3–6 (p = 0.04). Monthly and high SU changes or again reaching higher SU levels > 360 µmol/l were not related to flares. Fluctuation and change in SU were related to flare occurrence during the first year of ULT, while changes between visits and reaching SU levels > 360 µmol/L were not related to flares. Key Points • Urate-lowering therapy seeks to achieve a treatment target and prevent gout flares, and changes in serum urate are related to gout flares. • Fluctuation and changes in serum urate were associated with gout flares, suggesting that fluctuation in serum urate is unfavourable during gout treatment. • During urate-lowering therapy in gout in clinical practice, fluctuation of serum urate, for example, due to lack of adherence, should be observed and avoided.