ObjectiveTo develop ultrasound (US) definitions and a US novel scoring system for major salivary gland (SG) lesions in patients with primary Sjögren’s syndrome (pSS) and to test their intrareader and inter-reader reliability using US video clips.MethodsTwenty-five rheumatologists were subjected to a three-round, web-based Delphi process in order to agree on (1) definitions and scanning procedure of salivary gland ultrasonography (SGUS): parotid, submandibular and sublingual glands (PG, SMG and SLG); (2) definitions for the elementary SGUS lesions in patients with Sjögren’s syndrome; (3) scoring system for grading changes. The experts rated the statements on a 1–5 Likert scale. In the second step, SGUS video clips of patients with pSS and non-pSS sicca cases were collected containing various spectrums of disease severity followed by an intrareader and inter-reader reliability exercise. Each video clip was evaluated according to the agreed definitions.ResultsConsensual definitions were developed after three Delphi rounds. Among the three selected SGs, US assessment of PGs and SMGs was agreed on. Agreement was reached to score only greyscale lesions and to focus on anechoic/hypoechoic foci in a semiquantitative matter or, if not possible on a qualitatively (present/absent) evaluation of fatty or fibrous lesions. Intrareader reliability for detecting and scoring these lesions was excellent (Cohen’s kappa 0.81) and inter-reader reliability was good (Light’s kappa 0.66).ConclusionNew definitions for developing a novel semiquantitative US score in patients with pSS were developed and tested on video clips. Inter-reader and intrareader reliabilities were good and excellent, respectively.

BackgroundDiagnostic delay is a major challenge in axial spondyloarthritis(SpA). The 2009 Assessment of SpondyloArthritis international Society classification(ASAS) criteria for axial SpA formally recognised the utility of MRI in diagnosis.1 There are conflicting reports whether there had been any recent improvement in the period of diagnostic delay after application of ASAS criteria.2 ObjectivesTo evaluate the period from symptoms onset to diagnosis in Egyptian patients with axial SpA before and after application of ASAS criteria for axial SpA and to examine possible reasons for delayed diagnosis.MethodsThe study included all axial SpA patients attending a university tertiary referral centre for regular follow up in the period between May 2016 to November 2017. The patients were divided into 2 groups; group 1 included patients with a diagnosis of axial SpA before the beginning of 2010 (when ASAS criteria became widely available and in use) and group 2 included patients with a diagnosis of axial SpA after the beginning of 2010. A face-to-face interview was applied for both groups to take medical history, and a questionnaire that contains some clinical aspects of disease was used. Diagnosis delay was described as the gap between first SpA symptom and correct diagnosis of axial SpA. Clinical and functional assessment of axial SpA measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI). The direct medical cost during years of delay (including costs of medical consultations, medications, investigations, physiotherapy and surgical treatment) had been estimated.ResultsAs presented in table 1; more axial SpA cases were in group 2 (diagnosed after the beginning of 2010) with significantly narrower gap of delay, younger age at diagnosis, lesser number of doctor visits, lesser number of unnecessary spinal surgeries, lower total direct estimated costs and better BASDI, BASFI and BASMI.Abstract AB0858 – Table 1comparison between axial SpA patients diagnosed before and after 2010VariableGroup 1(n=56)(44.4%)Group 2(n=70)(55.6%)p-value Delay in years:Mean±SD 11.3±3.9 4.6±2.8 0.02**Sex:Male:Female: 49 (83.3)7 (16.7) 56 (7.9)14 (92.1) 0.3*Age at diagnosis (years):Mean±SD 34.9±6.4 25.8±4.5 0.03**Cost of delay period by $:Mean±SD 9879.3±3827.2 2373.9±881.8 <0.001**Doctor Visits during years of delay:Mean±SD 14.3±6 5.6±3.4 <0.001** Spinal Surgery: 34 (65.4%) 18 (34.6%) <0.001*Loss of work at time of diagnosis: 36 7 <0.001*BASDAI:Mean±SD 9.1±1.4 4.3±2.2 <0.001**BASFI:Mean±SD 9.1±1.4 3.9±2.2 <0.001**BASMI:Mean±SD 8.9±1.2 2.2±2 <0.001***: Chi-square test. SD: Standard Deviation. **: Independent sample t test.Significance p value<0.05.ConclusionsApplication of ASAS criteria for axial SpA has resulted in a significant decrease in the diagnostic gap which is reflected in a significant decrease in age at diagnosis and in the costs of unnecessary medications. On the other side, the gap is still large and more sensitive c...

Objective: To standardize and assess the reliability of ultrasonographic assessment of inflammatory and structural lesions in patients with hand osteoarthritis (OA). Methods:The Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group selected synovial hypertrophy (SH), joint effusion (JE), and power Doppler (PD) signals as the main inflammatory lesions in hand OA, and suggested osteophytes in the scapho-trapezio-trapezoid (STT) and cartilage defects in the proximal interphalangeal (PIP) joints as novel additions to previous structural scoring systems. A complementary imaging atlas provided detailed examples of the scores.A reliability exercise of static images was performed for the inflammatory features, followed by a patient-based exercise with six sonographers testing inflammatory and structural features in twelve hand OA patients. We used Cohen's kappa (κ) for intra-reader and Light's κ for inter-reader reliability for all features except PD, in which Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) was applied. Percentage agreement was also assessed. Results:The web-based reliability exercise demonstrated substantial intra-and inter-reader reliability for all inflammatory features (κ>0.64). In the patient-based exercise, intra-and inter-reader reliability varied: SH κ=0.73 and 0.45; JE κ=0.70 and 0.55; PD PABAK=0.90 and 0.88; PIP cartilage κ=0.56 and 0.45; STT osteophytes κ=0.62 and 0.36. Percentage close agreement was high for all features (>85%). Conclusion:With ultrasound, substantial to excellent intra-reader reliability was found for inflammatory features of hand OA. Inter-reader reliability was moderate, but overall high close agreement between readers suggest that better reliability is achievable after further training.Assessment of osteophytes in the STT joint and cartilage in the PIP joints achieved less good reliability and the latter is not endorsed.

Objective The aim of this exercise from the OMERACT ultrasound subgroup on Sjögren’s syndrome (pSS) was to develop and assess the reliability of a consensus-based semiquantitative colour Doppler (CD) ultrasound scoring system for pathologic salivary gland vascularization in patients with pSS. Methods Using the Delphi method a CD semiquantitative scoring system for vascularization of bilateral parotid and submandibular glands was developed and tested in static images and on patients (9 pSS patients and 9 sonographers). Intra-reader and inter-reader reliability of grading the salivary glands were computed by weighted Cohen and Light’s kappa (κ) analysis, respectively. Results The consensus-based semiquantitative score was: Grade 0, no visible vascular signals; Grade 1, focal, dispersed vascular signals; Grade 2, diffuse vascular signals detected in &lt; 50% of the gland; Grade 3, diffuse vascular signals in &gt; 50% of the gland. In static images, the intra- and inter-reader reliability showed excellent κ values (95% confidence interval) = 0.90 (0.87–0.93) and 0.80 (0.74–0.84), respectively) for all four salivary glands together. In patients, the intra- and inter-reader reliability for all four salivary glands together was κ  = 0.84 (0.73–0.92) and 0.70 (0.64–0.76), respectively. Conclusion The consensus-based CD ultrasound scoring for the evaluation of salivary gland vascularization in pSS showed a good inter-reader reliability and excellent intra-reader reliability in static images and in patients. The clinical application of the developed scoring system should be tested in clinical settings.

ObjectivesThis study aimed to determine the prevalence of ultrasound-detected tendon abnormalities in healthy subjects (HS) across the age range.MethodsAdult HS (age 18–80 years) were recruited in 23 international Outcome Measures in Rheumatology ultrasound centres and were clinically assessed to exclude inflammatory diseases or overt osteoarthritis before undergoing a bilateral ultrasound examination of digit flexors (DFs) 1–5 and extensor carpi ulnaris (ECU) tendons to detect the presence of tenosynovial hypertrophy (TSH), tenosynovial power Doppler (TPD) and tenosynovial effusion (TEF), usually considered ultrasound signs of inflammatory diseases. A comparison cohort of patients with rheumatoid arthritis (RA) was taken from the Birmingham Early Arthritis early arthritis inception cohort.Results939 HS and 144 patients with RA were included. The majority of HS (85%) had grade 0 for TSH, TPD and TEF in all DF and ECU tendons examined. There was a statistically significant difference in the proportion of TSH and TPD involvement between HS and subjects with RA (HS vs RA p<0.001). In HS, there was no difference in the presence of ultrasound abnormalities between age groups.ConclusionsUltrasound-detected TSH and TPD abnormalities are rare in HS and can be regarded as markers of active inflammatory disease, especially in newly presenting RA.