Based on the results of our exercise, the OMERACT US definitions for the identification of CPPD demonstrated to be reliable when applied to the TFC and AC. Other sites reached good kappa values in the web-based exercise but failed to achieve good reproducibility at the patient-based exercise, meaning the scanning method must be further refined.

The burden of entheseal sonographic changes was significantly higher in SLE patients than in healthy subjects, especially as regards active inflammation. The presence of power Doppler signal at the enthesis may represent a potential biomarker of SLE disease activity.

Background Musculoskeletal involvement is extremely common in patients with systemic lupus erythematosus (SLE). Continuing the research initiated in patients with inflammatory arthritis, recent studies have shown the potential role of musculoskeletal ultrasound (MSUS) in the evaluation of clinical and subclinical lupus synovitis. The inflammatory process in SLE is traditionally considered to be localized at synovial tissue areas while enthesis is not included among the possible targets of the disease. Patients and methods Entheses included in the Glasgow Ultrasound Enthesitis Scoring System were scanned in a cohort of 20 SLE patients serving as disease controls in an MSUS study aimed at assessing enthesitis in patients with psoriatic arthritis. We describe in detail four cases with unexpected and unequivocal expressions of MSUS enthesitis according to the OMERACT definition. Three out of four patients had no predisposing factors for enthesopathy. Case no. 2 was treated with a variable-dose prednisone regimen. Results In the four cases MSUS examination revealed relevant grey-scale and power Doppler abnormalities at the entheseal level, most commonly at the distal insertion of the patellar tendon. Signs of clinical enthesitis were detected in only one patient. Conclusions This case series shows for the first time the presence of clearly evident MSUS findings indicative of enthesitis in four out of 20 SLE patients (20%), raising the hypothesis that enthesis could be a missing target in the clinical evaluation of SLE patients. Our case series justifies further investigations for a better evaluation of the prevalence, characteristics and clinical relevance of entheseal involvement in SLE.

Objectives To investigate the reliability of the OMERACT ultrasound (US) Task Force definition of US enthesitis in spondyloarthritis (SpA). Methods In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA [hypoechoic areas, entheseal thickening, power Doppler signal (PD) at the enthesis, enthesophytes/calcifications, bone erosions] were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter and intra-observer reliability of the US components of enthesitis was calculated using Light’s kappa, Cohen’s kappa, Prevalence and Bias Adjusted Kappa (PABAK) and their 95% confidence intervals. Results Bone erosions and PD showed the highest overall inter-reliability [Light’s kappa: 0.77 (0.76–0.78), 0.72 (0.71–0.73), respectively; PABAK: 0.86 (0.86–0.87), 0.73 (0.73–0.74), respectively], followed by enthesophytes/calcifications [Light’s kappa: 0.65 (0.64–0.65), PABAK: 0.67 (0.67–0.68)]. This was moderate for entheseal thickening [Light’s kappa: 0.41 (0.41–0.42), PABAK: 0.41 (0.40–0.42)], and fair for hypoechoic areas [Light’s kappa: 0.37 (0.36–0.38); PABAK: 0.37 (0.37–0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. Conclusions The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, PD, and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.

BackgroundIn rheumatoid arthritis (RA) the “window of opportunity” has a crucial role for better long-term outcomes.1 The ACR/EULAR remission criteria for RA are mostly represented by clinical parameters, while ultrasound (US) is not included.2 However, in early diagnosed and early treated patients, who fulfil the remission criteria, residual US modifications can be identified.3 ObjectivesThe aim of this study was to investigate whether significant US-detectable differences between early RA (ERA) patients treated for one year and healthy controls (HC) are present.MethodsWe enrolled in this cross-sectional study consecutive patients with ERA at 1 year after having initiated RA disease-modifying (DMARD) therapy and who had received treatment following RA recommendations. Only patients who had fulfilled EULAR/ACR 2010 criteria for RA4 and with symptoms duration of less than 1 year at treatment initiation were included. US exams were performed in 10 joints bilaterally (wrist, MCP II-V) by using both gray-scale and Doppler for evaluating synovitis was graded according to a semi-quantitative 4-point scale (0–3). A total US score for synovitis was calculated by adding the values recorded at each joint site. The presence of erosions was also recorded. Finally, US results obtained in patients were compared to those detected in HC.Results84 subjects were enrolled – 45 ERA patients and 39 HC. In ERA patients the mean duration of symptoms prior to diagnosis was 3.5±3.5 months. The demographic, clinical and US data are reported in table 1.Abstract SAT0672 – Table 1Demographic, clinical and US data for ERA patients and HC [n (%), mean±SD or median (IQR)]ParametersERA (n=45)HC (n=39)p Gender (Female)28 (62.2%)25 (64.1%)0.859Age56.16±19.9146.59±12.930.003VAS pain19 (10.25–30)0 (0–2)<0.001US score4 (1.5–6.5)1 (0–3)<0.001Erosions23 (51.11%)0 (0%)<0.001As expected, the values of visual analogue scale (VAS) for pain and of the total US score and the incidence of erosions were significantly higher in ERA patients than in HC. The values of the US score correlated with the presence of erosions (rs=0.427, p<0.001) as well as with the values of acute phase reactants (CRP: rs=0.539, p=0.412 and ESR: rs=0.412, p=0.005), VAS of disease activity reported by patients (rs=0.473, p≤0.001) and physician (rs=0.412, p<0.001).ConclusionsPatients with RA, who had been early diagnosed and early treated, after 1 year of tight control had still US inflammatory and erosive changes compared to HC. US assessment gives an added value to clinical evaluation in ERA, for its capacity to detect residual inflammatory abnormalities, even under optimised treatment and consequent structural lesions.References[1] van Nies JAB, et al. Ann Rheum Dis2015;74:806–812.[2] Bykerk VP1, Massarotti EM. Rheumatology2012;51(Suppl 6):vi16–20.[3] Vergara F, et al. Reumatol Clin2017Mar 18.[4] Aletaha D, et al. Arhritis Rheum2010;62:2569–2581.Disclosure of InterestNone declared

Background: Osteoarthritis (OA) and rheumatoid arthritis (RA) can overlap and the presence of OA can interfere with the evaluation of patients with RA.Objectives: The aim of this study was to evaluate the possible impact of OA on the clinical, laboratory and ultrasound parameters currently evaluated in patients with early RA (ERA).Methods: We have evaluated the data obtained from patients with ERA referred to our Early Arthritis Research Center (EARC). Only data from patients who fulfilled EULAR/ ACR 2010 criteria for RA and had symptom duration of less than 12 months were analyzed. All patients underwent clinical examination, laboratory tests and ultrasound (US) examination.Results: There was a clear predominance of women (62.8%). The mean age was 55.47±13.71 years. At baseline, 21 patients (48.8%) were diagnosed with OA. Hand OA did not influence the values of any of the parameters assessed (p>0.05). For patients with knee OA, significantly higher values were observed only for DAS28 at baseline (p=0.018) as well as after 12 months of observation (p=0.031).Conclusions: Significantly higher values of DAS28 were observed in patients with ERA who associated knee OA, while the values of SDAI were not influenced, suggesting that SDAI may be superior to DAS28 in evaluating patients with ERA and knee OA. The values of patient’s VAS were not influenced by the presence of hand or knee OA suggesting that these types of OA do not influence the patients’ perception of the disease activity. Moreover, the values of ultrasound scores were not influenced by the presence of OA.

Background:Rheumatoid arthritis (RA) is a chronic inflammatory disease, which affects approximately 1% of the population. Although diagnostic, monitoring and treatment strategies have improved noticeably over the last decades, allowing an early and sustained clinical and radiological remission, both direct and indirect costs of treatment and disease still create an economic burden for patients and society. The last few years have brought many therapeutic options and knowledge about them, which has led to the 2019 updated EULAR recommendations for the management of RA (1).Objectives:This study aimed to evaluate the trends in prescribing of biologic therapies in RA over time, the factors that influenced them and the persistence of patients on these treatments.Methods:In this retrospective study we evaluated patients with RA treated with biologic therapies in the last 18 years, who presented for routine clinical and biological evaluation, performed according to the standard of care principles in RA.Results:244 patients were enrolled in this study. Baseline characteristics are presented in Table 1.Table 1.Baseline characteristics of the 244 patients evaluatedParametersRA patients (n=244)Gender (Female); n(%)202 (82,8%)Age (Mean±SD)61,09±11,86Age at RA onset (Mean±SD)46,16±13,12Disease duration (years); (Mean±SD)14,93 ±8,78Number of biologic therapies received; n(%)1 line244 (100%)2 lines152 (62,29%)3 lines31 (12,70%)4 lines2 (0,81%)5 lines1 (0,40%)There is a significant decrease in the persistence period on the first biological therapy after 2010 (60.67 ± 50.53 months before 2010 vs. 37.02 ± 34.92 months after 2010, p <0.001, 95% CI = - 34,464 - -12,838).There is a significant increase in the period from diagnosis to the initiation of biological therapy after 2012 (6.88 ± 6.75 years before 2012 vs. 9.25 ± 9.33 years after 2012, p <0.001, 95% CI = 0.341-4.406).Overall, regardless of the therapeutic line in which they were used, persistence on anti-CD20 (44,89±43,02 months (mean±SD)) therapies was significantly higher than that on TNFi (81,85±42,17 months (mean±SD)) (p<0,001, CI=27.806-46.129). (Image 1)Figure 1.Image 1. Persistence on TNFi and anti CD20 therapiesConclusion:The two trends observed in this study: the decrease in persistence on biologic therapy, in 2010, and the increase of the period between RA diagnosis and the initiation of a biologic therapy, in 2012, were generated by the appearance of new molecules, thus reducing the boundaries generated by the previously limited number of options, and by the major changes in national health insurance system regulations.Anti-CD20 therapy proved to be non-inferior to TNFi therapies regarding persistence on therapy and did not result in higher adverse events than TNFi, justifying the inclusion of RTX therapy as one of the biological therapies used in the first line in 2019 RA treatment recommendations.A limitation of this study is the small number of patients who received other therapies (JAKi, T cell co-stimulation blockers, anti IL6), which did not allow a correct analysis of other therapeutic lines compared to those previously mentioned.References:[1]Smolen JS, et al. Ann Rheum Dis 2020;0:1–15. doi:10.1136/annrheumdis-2019-216655Disclosure of Interests:None declared

BackgroundThe early phase of rheumatoid arthritis (RA), known as “window of opportunity” was considered to be represented by the first years of evolution, but nowadays this period is considered to be very short and therapeutic intervention at this point is very important for better long-term outcomes (1).ObjectivesThe aim of this study is to describe the epidemiology of early RA (ERA) in a population of Romanian patients from an Early Arthritis Research Center (EARC).MethodsWe have evaluated the data obtained from patients diagnosed with ERA in the EARC of “Dr. I. Cantacuzino” Hospital. Only data form patients who fulfilled EULAR/ACR 2010 criteria for RA (2) and had symptom duration less than 12 months were analyzed.Results217 patients were referred to the EARC between 2010 and 2015, among whom only 47 patients fulfilled the EULAR/ACR criteria for RA and had a duration of symptoms for less than 12 months. There was a clear predominance of women (61.7%). The mean age was 55.17±14.62 years and the difference wasn't statistically significant between sexes (p=0.311). 17 patients (36.2%) were smokers and they presented higher values of ACPA but the difference wasn't significant between smokers and non-smokers (p=0.466). The mean duration of symptoms was 3.48±3.32 months and 36 patients (76.59%) had a duration of symptoms less or equal to 3 months which classifies them as very ERA (VERA). Patient positives for RF and ACPA were 87.2% and 82.1%, respectively. The vast majority of patients (74.5%) presented with polyarticular involvement. 68.1% of patients administered treatment with NSAIDs, while 23.4% didn't receive any treatment and no patient was treated with DMARDs previously. Patients with no previous treatment had higher values of disease activity indices than those who had administered NSAIDs, but the difference assessed by Wilcoxon test wasn't significant (p>0.05 for all disease activity indices). The median value and interquartile range for lab tests and for disease activity indices are shown in Table 1.Table 1.Lab tests and disease activity indices resultsLab testMedian (Interquartile range)CRP (mg/l)8.63 (2.63–18.44)ESR (mm/h)27 (11–44)RF (IU/ml)34.00 (10.08–79.30)ACPA (IU/ml)34.50 (5.00–134.77)DAS284.75 (3.63–5.35)CDAI22.80 (14.70–29.55)SDAI26.12 (14.94–32.13)The level of acute phase reactants didn't correlate with the level of RF or ACPA (p>0.05 for each Spearman correlation). CDAI and SDAI identified more patients with high disease activity than DAS28.ConclusionsThere are large variations in epidemiologic parameters of different populations with early RA and knowing the particularities of the population treated is important to improve clinical practice. Although the majority of patients presented very early in the course of the disease, they had polyarticular involvement and very active disease. NSAIDs were administered by the majority of patients before the first presentation and this can lead to a decrease in disease activity parameters. This is an ongoing study and we have to see if this results are maint...