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Background Rheumatoid arthritis (RA) is one of the causes of secondary osteoporosis, and steroids are often used in combination, therefore osteoporosis is highly associated with RA. Furthermore, joint disorders due to RA cause various degrees of dysfunction and ADL declines. The Steinbrocker classification is often used as the degree of dysfunction. Immobilization progresses with the progress of dysfunction, possibly causing severe osteoporosis. Objectives Of the 2238 cases in Akita Orthopedic Group omn Rheumatoid Arthrotis (AORA) registry 2017, 101 cases simultaneously measuring bone metabolism markers (TARCP-5b, NTX, urinary DPD, BAP, total P1NP) and pentosidine were involved. Methods Patients were divided by Steinbrocker classification into class 1,2 (group A 84 cases) and clss 3, 4 (group B 17 cases). we examined whether there is a difference in bone metabolism markers in each group according to Steinbrocker classification. Results The average age in group B (75.9) was significantly higher than group A (66.9) (p = 0.01). DAS 28 ESR was significantly higher in group B (p Conclusion Immobilization by long-term bed rest is known to enhance bone resorption. In 2002, Wakae reported DPD in urine showed a higher value in the group of not going out in femoral neck fracture cases. Based on the results of this study, urinary DPD showed a high value in RA group with high degree of dysfunction, which possibly reflected immobilization due to progress of functional disorder. Moreover, it is known that pentosidine will be higher in cases with high disease activity, severe osteoporosis will be occurred in the group with progressive functional disorder which is difficult to tight control. Disclosure of Interests None declared

Background While the number of rheumatoid arthritis (RA) surgeries has been declining due to advances in pharmacotherapies for RA, forefoot surgeries are on the rise. In recent years, the common use of joint ultrasonography in RA consultations has led to the early detection of synovitis. However, little is known about how much forefoot deformities such as hallux valgus and metatarsophalangeal (MTP) joint dislocation are affected by synovitis in the forefoot of RA patients. Objectives The present study examined factors involved in forefoot deformity among patients with foot synovitis identified on joint ultrasound. Methods Subjects (71 patients, 91 feet) were RA patients who had undergone foot joint ultrasonography more than 2 years earlier and underwent standing X-rays of the feet before and after ultrasonography. Surgery cases were excluded. Mean age was 64.9 years (range, 15-90 years). Disease stage was Stage 1 in 14 patients, Stage 2 in 14 patients, Stage 3 in 16 patients, and Stage 4 in 27 patients. According to the Steinbrocker functional classification, RA was Class 1 in 45 patients, Class 2 in 19 patients, Class 3 in 6 patients and Class 4 in 1 patient. Twenty-five patients had been administered biological drugs. At the time of joint ultrasonography, patients were questioned regarding whether they had any complaints involving the forefoot, midfoot or hindfoot (noted separately). The following scans were performed: forefoot (MTP joints 1-5); midfoot (calcaneocuboid, calcaneocuboid and cuneonavicular joints) and hindfoot (peroneal muscle tendon, talocrural joint, talocalcaneal joint and posterior tibial muscle tendon). Foot deformity score (FDS) (hallux valgus angle + first-second intermetatarsal angle [M1M2 angle] + first-fifth intermetatarsal angle [M1M5 angle]) was used as the benchmark for forefoot deformity, and an increase >5° was considered to indicate worsening deformity. Results Forefoot deformity had progressed in 25 patients. Mid- and hindfoot synovitis and the presence of complaints were not associated with deformity. However, significant worsening of FDS was observed in patients with forefoot synovitis or forefoot complaints. While no difference in age, disease activity, biologic disease-modifying antirheumatic drug usage or health assessment questionnaire results were seen in the advanced deformity group, duration of disease was significantly shorter in this group. Conclusion Mid- and hindfoot synovitis was unrelated to forefoot deformity. MTP joint synovitis in the forefoot was related to forefoot deformity. Continuous synovitis in the forefoot must damage the articular capsule and ligament structure, leading to progression of deformity. As shown by the short duration of the disease in the advanced deformity group, deformity may progress in the early stages among patients with forefoot deformity. Disclosure of Interests None declared

Background Treatment outcomes for rheumatoid arthritis (RA) have been improved by advances in drugs. In daily clinical practice, treatment outcomes are assessed with both inflammatory findings and based on swollen joints (SJ), tender joints (TJ), a patient’s global assessment on visual analogue scale (GVAS) score, a physician’s GVAS score, etc. Although composite measures indicate suppressed inflammatory or articular symptoms, many patients show no improvement in GVAS scores. The reported residual symptoms include morning stiffness (MS), pain (P), and dullness (D). Objectives We investigated the residual symptoms of patients achieving low disease activity (LDA) or complete remission (CR). Methods His study included 111 RA patients who received outpatient treatment at our department (31 men and 80 women). The mean age was 65.1 (range, 27–89) years. The disease stages were distributed as follows: 36 patients with Stage 1, 23 patients with Stage 2, 20 patients with Stage 3, and 32 patients with Stage 4. The severity of dysfunction was distributed as follows: Class 1 in 73 patients, Class 2 in 25 patients, Class 3 in 11 patients, and Class 4 in 2 patients (Steinbrocker classification). Based on the disease activity score in 28 joints using the erythrocyte sedimentation rate, disease activity was graded as CR in 54 patients, LDA in 19, moderate disease activity in 37, and high disease activity in 1. Questionnaire forms were used to assess the presence or absence and duration of MS and the presence or absence and severity of P (Pain VAS) and of D (Dullness VAS). These variables were assessed to determine how they were associated with clinical outcome measures, drugs, and surgery. Results The following residual symptoms were observed in 73 patients who achieved the treatment target of LDA or CR: MS in 34 patients (46.6%), P in 48 (65.6%), and D in 38 (52.8%). In the LDA+CR group, the Pain VAS (P Conclusion Residual symptoms were frequently observed even in patients achieving LDA or CR, which is regarded as the treatment target. Because P and D were significantly correlated with the GVAS, relief of these residual symptoms is expected to improve treatment effects. Although D was relieved by bDMARDs, further studies on the treatment of residual P in patients achieving LDA or CR are necessary. Disclosure of Interests None declared

Background While nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently used therapeutic agents, they are known to cause side effects, such as gastrointestinal disorders and kidney dysfunction. As the proportion of patients with chronic kidney disease (CKD) increases with age, dealing with NSAIDs requires particular care in areas with aging populations. However, in many cases, prescriptions are continued without any particular plan. Hence, the effects of acetaminophen (AAP), which does not cause kidney dysfunction, are being revisited. Opportunities are increasing for using formulations containing tramadol hydrochloride in patients with chronic pain or intravenous agents for perioperative pain management. Objectives In this study, we investigated the kidney functions of patients with musculoskeletal disease who had been using NSAIDs for a long time and examined the possibility of switching to AAP. Methods The subjects were 105 patients with musculoskeletal disease (42 men and 63 women) who were being treated as outpatients in the orthopedics department of our hospital and had been using NSAIDs for at least 3 months. They primarily had 5 musculoskeletal diseases, including degenerative osteoarthritis (OA), rheumatoid arthritis (RA), osteoporosis (OP), polymyalgia rheumatica (PMR), and gout (G). After checking their background characteristics, we measured their kidney functions and visual analogue scale (VAS) scores, and then switched them from NSAIDs to AAP. Kidney functions were evaluated by classifying CKD using glomerular filtration rate (eGFR) and urinary protein, and by using the Cockcroft-Gault equation to calculate creatinine clearance (Ccr). The patients were given the NSAIDs that they had been taking for single use. Six months after the switch, we remeasured their kidney functions and VAS scores, and investigated whether they could continue using AAP and whether they had used NSAIDs. Results The patients’ mean age at the time of switching from NSAIDs to AAP was 76 years, and their mean duration of NSAID use was 43 months. For the diseases, 63 patients had OA, 20 had RA, 14 had OP, 6 had PMR, and 2 had G. Before the switch, the mean VAS score was 41.6 mm and mean eGFR was 67.0 mL/min/1.73 m2. On the basis of the eGFR, the CKD classification was G3 or higher in 38.1% of patients. The CKD classifications with the amounts of urinary protein added to the eGFR were as follows: green, 44.7%; yellow, 33.0%; orange, 14.6%; and red, 7.8%, with 55.4% classified as having CKD. By age, the proportions of patients with CKD based on eGFR and CKD classification were as follows, respectively: 0.0% and 12.5% for those in their 50s, 16.7% and 25.0% for those in their 60s, 29.3% and 48.8% for those in their 70s, and 59.5% and 69.0% for those in their 80s and older. The mean AAP dose was 455 mg. Six months after the switch, 69 patients had continuously used AAP without regular NSAID use. Of these patients, 13 had used NSAIDs for rescue purposes. Thirty-six patients had stopped using AAP, the most common reason being ineffectiveness (15 patients), although 9 patients did so because they no longer needed any analgesic. Three patients stopped using the drug owing to palpitations or other side effects, although none stopped because of liver dysfunction. Overall, the mean VAS score declined significantly as compared with before the switch, as did the mean eGFR. Of those who continued to use AAP, 56 patients who did not use any NSAIDs exhibited significantly lower mean VAS scores, but not a significant decline in mean eGFR. Conclusion The proportion of patients with CKD who were receiving long-term NSAID therapy was higher than that of the general population for all age groups. Halting NSAIDs and switching to AAP could help maintain kidney functions, which could continue to decline with NSAID use. References [1] CKD guidebook;2012 Disclosure of Interests None declared

Background Treatment of rheumatoid arthritis (RA) has improved dramatically with the widespread use of biological disease-modifying antirheumatic drugs. In this context, the number of RA patients who undergo orthopaedic surgery is reportedly decreasing. However, the number of RA patients who undergo foot surgery is increasing. Joint ultrasonography has been used for early diagnosis and disease activity assessment in RA, allowing visualisation of synovitis. However, few detailed studies or evaluations of clinical parameters related to synovitis in the foot have been performed. Objectives This study investigated the association between synovitis in the foot as observed on joint ultrasonography and the degree of disability on the health assessment questionnaire (HAQ) in RA patients. Methods The study included 79 outpatients (101 feet) with RA. Patients who had undergone surgery were excluded. The mean age was 66.0 years (24–92 years), and the mean disease duration was 13 years and 5 months (ranging from 1 month to 49 years). Joint ultrasonography was performed by the same examiner using the same diagnostic instrument in the same room. Synovitis was defined as a power Doppler score of ≥Grade 1. The scanning sites were forefoot (metatarsophalangeal joints of toes 1–5), metatarsus (calcaneocuboid and talonavicular joints), and hindfoot (talocrural and subtalar joints, peroneal tendon, posterior tibial tendon). The presence or absence of synovitis was evaluated at each site, and the association with the HAQ score was examined. Results Synovitis was detected in the forefoot of 40 feet (39.6%), in the metatarsus of 34 feet (33.7%), and in the hindfoot of 63 feet (62.4%). Patients with synovitis in the forefoot (PD+: 0.41±0.1, PD-: 0.80±0.1, p=0.018) and hindfoot (PD+: 0.52±0.1, PD-: 0.86±0.1, p=0.043) had significantly lower HAQ scores. Conclusions Given that assessment of foot impairment is not included in the disease activity index for RA, there may be a delay in diagnosis of foot lesions. Our results showed that patients with synovitis in the forefoot and rearfoot had lower HAQ scores (disability measure), suggesting that increased physical activity may be associated with increasing incidence of synovitis in the foot. The ability of RA patients to perform activities of daily living may have improved with advances in pharmacotherapy, leading to increased physical stimulation, resulting in an increased incidence of synovitis of the foot. References [1] Brown AK. Arthtitis Rheum58(10); 2958–67: 2008 [2] Wakefield RJ. Ann Rheum Dis63; 382–5: 2004 Disclosure of Interest None declared