Our results did not show LORA as a separate subgroup of RA with a different prognosis with regard to radiographic progression.

In women at increased risk of RA, characteristic systemic autoimmunity was associated with menopause, suggesting that the acute decline in ovarian function might contribute to the development of autoimmunity associated with RA and potentially to the increased risk of RA in women.

BackgroundNailfold capillaroscopy (NC) is an important tool for the diagnosis of systemic sclerosis (SSc). The capillaroscopic skin ulcer risk index (CSURI) was suggested to identify patients at risk of developing digital ulcers (DUs). This study aims to assess the reliability of the CSURI across assessors, the CSURI change during follow-up and the value of the CSURI in predicting new DUs.MethodsThis multicentre, longitudinal study included SSc patients with a history of DUs. NC images of all eight fingers were obtained at baseline and follow-up and were separately analysed by two trained assessors.ResultsSixty-one patients were included (median observation time 1.0 year). In about 40% of patients (assessor 1, n = 24, 39%; assessor 2, n = 26, 43%) no megacapillary was detected in any of the baseline or follow-up images; hence the CSURI could not be calculated.In those 34 patients in whom CSURI scores were available from both assessors (26% male; median age 57 years) the median baseline CSURI was 5.3 according to assessor 1 (IQR 2.6–16.3), increasing to 5.9 (IQR 1.3–12.0) at follow-up. According to assessor 2, the CSURI diminished from 6.4 (IQR 2.4–12.5) to 5.0 (IQR 1.7–10.0).The ability of a CSURI ≥ 2.96 category to predict new DUs was low (for both assessors, positive predictive value 38% and negative predictive value 50%) and the inter-assessor agreements for CSURI categories were fair to moderate.ConclusionsIn this study, around 40% of patients could not be evaluated with the CSURI due to the absence of megacapillaries. Clinical decisions based on the CSURI should be made with caution.Trial registrationCurrent Controlled Trials, ISRCTN04371709. Registered on 18 March 2011.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1733-6) contains supplementary material, which is available to authorized users.

BackgroundNailfold videocapillaroscopy (NVC) is an imaging technique representing a reliable tool for the classification, diagnosis and monitoring of systemic sclerosis (SSc) patients. The capillaroscopic skin ulcer index (CSURI) was suggested to identify patients at risk of developing digital ulcers (DU) [1].ObjectivesThis study aims (1) to describe the practicality of the CSURI in clinical practice, (2) to describe the change of CSURI during follow-up, and (3) to assess associations between the change in CSURI and demographic and disease characteristics.MethodsThis Swiss multicentre, prospective, observational study analysed SSc patients with a history of active DU. Demographic characteristics and routine clinical data were recorded and patients underwent NVC at baseline and at the follow-up visit.The centres' investigators were trained to perform NVC and, the nailfolds of 8 fingers (digit 2–5 on both hands) were examined if possible. All images were stored centrally and separately analysed by two extensively trained and experienced reviewers (OD & UAW) separately.In each NVC image the total number of capillaries in the distal row, the number of megacapillaries and the maximum diameter of the megacapillaries were assessed. Based on these 3 characteristics, the CSURI was calculated according to Sebastiani et al. [1] for patients with at least 1 megacapillary present. Data were analysed descriptively.ResultsBetween 2011 and 2015, 61 patients fulfilled the eligibility criteria and had at least one follow-up visit (median observation time 1.0 years, interquartile range [IQR] 1.0–1.1). Of these patients, more than a third (reviewer 1: n=24 patients, 39%; reviewer 2: n=26 patients, 43%) had no megacapillaries present on NVC on any assessed finger and hence the CSURI could not be calculated for those either at baseline or follow-up. Therefore, this analysis is based on the remaining 34 patients who had at least one megacapillary present on NVC at baseline and at follow-up by both reviewers (26% male; median age 57 years, IQR 48–65 years).The median baseline CSURI scores according to reviewer 1 was 5.3 (IQR 2.6–16.3) increasing to a median of 5.9 (1.3–12.0) at follow-up. The CSURI as evaluated by reviewer 2 reduced from baseline (median 6.4, IQR 2.4–12.5) to follow-up (5.0, IQR 1.7–10.0).None of the assessed demographic or disease characteristics (Box 1) were associated with the changes in the CSURI between baseline and follow-up for the scores obtained by reviewer 1 and reviewer 2 at the same time; although the limited sample size should be kept in mind interpreting this lack of association.ConclusionsIn this study, around 40% of patients could not be evaluated with the CSURI due to the absence of megacapillaries on NVC. Clinical decisions based on the CSURI in routine practice should be made with caution, as it can vary greatly between assessors even if they are extensively trained.References Sebastiani M, et al. Predictive role of capillaroscopic skin ulcer risk index in systemic sclerosis: a multicentre validation s...

Background The detection of joint swelling is a key feature in the diagnosis and assessment of arthritic diseases. Ultrasound and MRI have proven to be more sensitive and reliable than clinical examination, but a comprehensive examination of the small joints with these techniques is either time consuming or expensive. The automated breast volume scanner (ABVS) was developed to acquire series of consecutive B-mode pictures of the female breast and these data can be analysed in all three dimensions. Objectives To analyse the value of ABVS in detecting swelling of the finger joints compared to clinical examination and manual ultrasound. Methods 19 consecutive patients suffering from psoriatic (n=4) or rheumatoid (n=15) arthritis with at least 1 swollen MCP (metacarpophalangeal) or PIP (proximal interphalangeal) joint were included. ABVS and manual ultrasound were conducted using the ACUSON S2000™ (Siemens Medical Solutions, Mountain View, USA). The ABVS transducer was equipped with a linear array (5 – 14 MHz band width); the frequency was set at 11 MHz. Each automatic sweep of the scanner generated 15.4 x 16.8 cm x maximum 3 cm volume data sets. The system was set to perform an automatic scanning time of 65 s per scan with a slice thickness of 0.5 mm. The dorsal and palmar side of each hand were scanned separately. Multiplanar reconstruction enabled examination of the images at multiple levels for the presence of lesions or joint swelling (figure) Results Clinical examination of MCP, PIP, and DIP joints detected in average 4.1 swollen joints, manual ultrasound 13.7 joints, and ABVS 10.6 joints per patient. The interobserver reliability for detection of joint swelling were 73.3%, 72.5% and 85.9% for manual ultrasound, ABVS, and clinical examination, respectively. The sensitivities and specificities were 30.7% and 91.3% for clinical examination and 59.9% and 63.4% for ABVS using manual ultrasound as gold standard. Image/graph Conclusions ABVS is a simple and time sparing option for effective detection of joint swelling in patients suffering from arthritis with good sensitivity and specificity compared to manual ultrasound. Disclosure of Interest None Declared