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Background 9The OMERACT Ultrasound (US) in calcium pyrophosphate deposition disease (CPPD) sub-task force has been working on the assessment of the utility of US in CPPD since 2014 first creating definitions for CPPD identification and then demonstrating that US is a reliable tool[1]. Objectives Objective of this study is to assess the diagnostic accuracy of US in CPPD Methods This is a multicentre international diagnostic accuracy study involving 17 centres from 9 countries. We enrolled in this study consecutive patients waiting to undergo knee replacement surgery due to severe osteoarthritis. Each patient underwent US examination of the knee, focusing on the menisci and the hyaline cartilage, the day prior to surgery, scoring each site according to the presence/absence of CPP as defined by OMERACT[1]. After surgery, the menisci and the condyles were collected and examined microscopically. Six samples were collected, both from the surface and from the internal part of menisci and cartilage trying to cover a large part of the structure. All slides were observed under transmitted light microscopy and by compensated polarised microscopy. A dichotomous score was given for the presence/absence of CPP crystals. US and microscopic analysis were performed by blinded operators. Sensitivity and specificity of US were calculated using microscopic findings of the menisci and cartilage as the gold standard. Results These preliminary analyses include 30 patients. The mean age was 71yrs (SD±9.1), 19 (63%) were females. 17 patients were positive at US analysis and 12 at microscopic analysis. Diagnostic accuracy results of US at patient level, are presented in figure 1. Conclusion These preliminary results demonstrate that US is a sensitive exam for identification of CPPD with acceptable specificity. US is the first diagnostic technique with consistent reliability and validity to be applied for non-invasive screening for CPPD in clinical practice. References [1] Filippou G, Scire CA, Adinolfi A, et al. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints—an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. Ann Rheum Dis 2018;:annrheumdis-2017-212542. doi:10.1136/annrheumdis-2017-212542 Disclosure of Interests Georgios Filippou Speakers bureau: Laborest, Abbvie, BMS, Sanofi, Anna Scanu: None declared, Antonella Adinolfi: None declared, Carmela Toscano: None declared, Raquel Largo-Carazo: None declared, Esperanza Naredo Consultant for: Abbvie, Speakers bureau: AbbVie, Roche, Bristol-Myers Squibb, Pfizer, UCB, Lilly, Novartis, Janssen, and Celgene GmbH, Emilio Calvo: None declared, Gabriel Herrero-Beaumont: None declared, Pascal Zufferey: None declared, Christel Madelaine-Bonjour: None declared, Daryl MacCarter: None declared, Stanley Makman: None declared, Zachary Weber: None declared, Ingrid Moller: None declared, Marwin Gutierrez: None declared, Carlos Pineda: None declared, Denise Clavijo Cornejo: None declared, Hector Garcia: None declared, Victor Ilizaliturri: None declared, Jaime Mendoza Torres: None declared, Raul Pichardo: None declared, Luis Carlos Rodriguez Delgado: None declared, Emilio Filippucci: None declared, Edoardo Cipolletta: None declared, Teodora Serban: None declared, Florentin Ananu Vreju Consultant for: abbvie and novartis, Speakers bureau: abbvie, novartis, pfizer, sandoz, eli lilly, ucb pharma, Gael Mouterde: None declared, Maria-Antonietta d’Agostino: None declared, Marcello Govoni: None declared, Leonardo Punzi Consultant for: BMS, Fidia, Grunenthal, Menarini, Speakers bureau: BMS, Fidia, Grunenthal, Menarini, Nemanja Damjanov Grant/research support from: AbbVie, Pfizer and Roche, Consultant for: Abbvie, Gedeon Richter, Merck, Novartis, Pfizer and Roche., Speakers bureau: Abbvie, Gedeon Richter, Merck, Novartis, Pfizer and Roche., Lene Terslev Speakers bureau: Speakers fee from : Roche, Novartis, Pfizer, MSD, BMS, Celgene, Irene Azzolin: None declared, Giulio Guerrini: None declared, Carlo Alberto Scire: None declared, Annamaria Iagnocco: None declared

Background Acquisition and maintenance of competences by Health Professionals in Rheumatology (HPRs) is important to ensure the best care for people with rheumatic and musculoskeletal diseases (RMDs). HPRs’ competencies have never been systematically evaluated, nor international recommendations provided. A EULAR Task Force (TF) was formed for this purpose. Objectives To perform a systematic literature review (SLR) on the core competences of HPRs with a focus on nurses, physiotherapists (PT) and occupational therapists (OT) to inform the “EULAR recommendations for the generic core competences of Health Professionals in Rheumatology” Methods Thirteen main themes identified by the TF and translated into research questions, formed the basis of the SLR. Existing literature was systematically evaluated using the following databases (PubMed/Medline, Embase, Cochrane library, CENTRAL, Emcare, PsycINFO, Academic Search Premier, Web of Science, Google Scholar, ERIC and National Science Digital Library) from 1/1/1990 to 20/02/2018. Relevant search terms for competences, RMDs and HPRs were used. In addition, EULAR HPR national presidents were invited to share any documents describing HPRs’ competences. Inclusion criteria were: studies on competences or roles, knowledge, attitudes, skills or educational needs relevant for the management of people with RMDs, of HPRs in general or specifically of nurses, PTs or OTs, at post-graduate level. Exclusion criteria were: HPRs’ competences for children’s care or for concurring co-morbidities; extended roles of HPRs; a very specific clinical intervention or an intervention clearly attributable to only one profession or studies written in a language other than English or Dutch. All abstracts were screened to identify eligible studies for full text inclusion. The methodological quality of the studies was scored using appropriate tools (Table). Results From 591 unique references reviewed, 79 studies were included. Twenty studies addressed competences of multiple HPRs. The methodological quality of most papers was high to medium (Table). The identified studies underpinned a range of HPRs’ competences, including: communication skills, promotion of physical activity, basic knowledge about RMDs and education of patients and other health providers. Competences more relevant to specific professions (e.g musculoskeletal system examination skills for PTs and assessment of house and work environment for OTs) were also recorded. Heterogeneity in the HPR desired competences and practice across countries highlighted the need for further education of HPRs to acquire certain competences. Conclusion High-quality literature is available on the competences of HPRs for the management of people with RMDs. This literature supports the formulation of evidence-based recommendations for the core competences for HRPs by a EULAR Task Force. Disclosure of Interests None declared

Background Tenosynovitis is very common in patients with rheumatoid arthritis (RA) and is associated with lower physical function. Several studies have confirmed the limitations of clinical examination for detection of tenosynovitis in comparison with ultrasound (US) and a highly validated and reliable US scoring system is therefore needed if implementing US-tenosynovitis as an outcome measure in clinical trials. The Outcome Measures in Rheumatology (OMERACT) US group9s tenosynovitis scoring system has a good single and multicenter intra- and inter-observer agreement, whereas the sensitivity to change in a multicenter design has never been tested. Furthermore, it is unknown whether low grade synovial hypertrophy without Doppler Signal represents true inflammation, i.e. can be eliminated by anti-inflammatory therapy and is sensitive to change. Objectives The aim of this study was to test the sensitivity to change of the OMERACT US scoring system for tenosynovitis, including minimal signs of tenosynovitis, in a multicenter design in order to validate it as an outcome measure in RA multicenter clinical trials. Furthermore, to assess the association between US and health assessment questionnaire (HAQ) and Disease Activity Score 28 for joints (DAS28). Methods Forty-nine patients with established RA (duration ≥1 year) and 18 early RA patients ( Results At baseline tenosynovitis was most frequently found at the extensor carpi ulnaris and tibialis posterior tendons (70.7% and 44.4%, respectively). The overall GS score showed a statistically significant decrease from baseline median 5 (25th;75th percentile: 2;7) to 6 months 0 (0;3) and the overall Doppler score decreased statistically significant from baseline 3 (2;6) to 6 months 0 (0;1), both with a p 0.9), as did HAQ and DAS28 (table 1). Among tendons with grey scale (GS)=1/Doppler=0, 36 of 39 (92.3%) showed therapy-induced improvements. A change of 2.1 (95% confidence interval: 1.2;14.9) and 2.1 (CI: 1.1;13.2) in DAS28 corresponded to a change in GS and Doppler of 1 (both p=0.02) respectively, using a mixed-model for repeated measurement. However, no association between US and HAQ was found. Conclusions In conclusion, this RA multicenter study documented a high sensitivity to change of both GS and Doppler US tenosynovitis scores, indicating utility of the OMERACT US scoring system for diagnosing and monitoring tenosynovitis in multicenter trials. Secondly, synovial hypertrophy without Doppler signal, do respond to therapy, suggesting it reflects true inflammation. Finally, changes in US tenosynovitis scores are associated with changes in DAS28. Disclosure of Interest None declared

Background Joint destruction in rheumatoid arthritis (RA) is comprised of hyaline cartilage and bone damage, with the former more clearly associated with irreversible physical disability than bony damage. Objectives To test the reliability of a semiquantitative scoring system for the assessment of cartilage by musculoskeletal ultrasound (US) in a web-based exercise as well as a patient-based reliability study of patients with RA. Methods Static images of metacarpophalangeal (MCP) joints 2–5 in RA patients and healthy controls were acquired and a dataset of 123 anonymized images including 25 duplicate images was circulated among an international EULAR-OMERACT taskforce of 25 rheumatologist experts in US who independently scored the images using a semiquantitative scoring system. Subsequently 12 taskforce members participated in a patient-based reliability study. During this meeting MCP joints 2–5 of 6 patients with RA were assessed twice on the same day by all experts using US machines (GE) equipped with high-frequency transducers (18–22MHz) with presets calibrated for the appropriate assessment of cartilage. Participants assessed metacarpal cartilage both in the standardized longitudinal midline scan as well as by freehand technique utilizing multiple planes and scored by the semiquantitative scoring system. Intraobserver reliability was assessed by Cohen9s kappa and interobserver reliability by Fleiss9 kappa. Results The three-grade semiquantitative (Grade 0, normal cartilage; Grade 1, minimal change; Grade 2, severe change) scoring system demonstrated excellent (kappa: 0.87) to good (kappa: 0.73) intraobserver reliability in the web-based exercise and the patient-based reliability study respectively. Interobserver reliability was good in the web-based exercise (kappa: 0.64) and moderate (kappa: 0.49) in the patient-based reliability study. The dynamic technique performed slightly better than the longitudinal midline scan alone. Conclusions A semiquantitative scoring system demonstrated good intra- and moderate to good inter-observer reliability in a web-based exercise and patient-based reliability study. Our study demonstrates that US is a reliable tool for evaluating cartilage and supports the use of a new semiquantitative US scoring system for evaluating cartilage change in RA. Acknowledgements The patient-based reliability study was supported by a research grant from UCB. Disclosure of Interest None declared