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Background Ultrasound has been shown to be a promising tool in the evaluation of salivary glands for parenchyma changes with the potential to improve diagnosis. The changes range from mild inhomogeneity of the glandular tissue to large vesicular changes almost eliminating all normal glandular tissue. American-European Consensus Group (AECG) classification criteria for SS are often used diagnostically (1). Objectives To describe ultrasound findings in salivary glands (SGUS) in a cohort of patients with suspected Sjogren’s syndrome (SS) and assess their positive and negative predictive value for the diagnosis. Methods 191 consecutive patients with suspected SS (ocular and/or oral dryness) referred to the department of Rheumatology between March 2017 and March 2018 were evaluated by SGUS as part of the initial evaluation. All had unstimulated sialometry, Schirmer’s test and laboratory test done (including autoantibodies (ANA screening, Rheumatoid factor and anti-cyclic citrullinated peptide, anti-Ro/SSA and anti-La/SSB), and screenings test for hepatitis B+C). In doubtful cases, a minor salivary gland (MSG) biopsy was performed. SGUS was performed with a GE Logiq E9 equipped with a linear ML6-15 probe and included grey-scale evaluation of the submandibular and parotid gland bilaterally. SGUS was considered abnormal when moderate to severe inhomogeneity with anechoic or hypoechoic areas was present in at least one gland. Results 63 patients were diagnosed with SS according to the AECG classification criteria - 57 patients with primary SS, 6 with secondary SS. 128 patients with sicca symptoms did not fulfill AECG criteria for SS and none were diagnosed with SS based on other parameters. Demographic data for the cohort is shown in table 1. 55 patients had MSG biopsy performed. The SGUS examination and evaluation was performed in less than 15 min per patient. The sensitivity of SGUS is 0.51 and the specificity 0.88; the PPV of SGUS for the SS diagnosis was 0.68 and the NPV was 0.78 The sensitivity of SGUS for positive MSG biopsy was 0.29 and the specificity 0.82 – the PPV was 0.50 and the NPV was 0.65; for abnormal sialometry the sensitivity of SGUS was 0.32 and the specificity 0.82 - the PPV for SGUS was 0.64 and NPV was 0.55. Table 2 shows the association between SGUS and final diagnosis, MSG biopsy and sialometry, respectively. Conclusion SGUS has a high specificity but poor sensitivity for the SS diagnosis with a good NPV and a high specificity for positive MSG biopsy and positive sialometry. SGUS is a feasible method for the evaluation of structural changes in the salivary gland and may aid in the diagnosis and classification of SS. Reference [1] Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. Classification criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61:554–8. Disclosure of Interests Viktoria Fana: None declared, Uffe Moller Dohn Speakers bureau: Speakers fee from Eli Lilly, Novartis and Roche, Lene Terslev Speakers bureau: Speakers fee from : Roche, Novartis, Pfizer, MSD, BMS, Celgene

Background Peripheral enthesitis (PE) is a characteristic feature of spondyloarthritis (SpA) that may be asymptomatic and only detectable by imaging. Ultrasonography (US) has greater sensitivity than clinical examination for the detection of PE.[1] Objectives The aim of the study was to investigate the anatomical distribution, morphological abnormalities and response to anti-tumor necrosis factor (anti-TNF) therapy of US-detected PE in patients with axial SpA (axSpA) initiating adalimumab (ADA). Methods In a randomized, placebo-controlled, double-blinded investigator-initiated trial (NCT01029847), patients with axSpA according to the Assessment of SpA International Society (ASAS) criteria were randomized to subcutaneous ADA 40 mg every other week (eow) or placebo from baseline to week 6. From week 6 to 24, all patients received ADA 40 mg eow. Of 49 patients enrolled, 21 participated in the US sub-study. US assessment applying the OMERACT US definitions for enthesitis[2] of 10 peripheral entheseal regions (Tables 1 & 2) and clinical examination were performed at baseline, weeks 6 and 24. US was performed by an experienced investigator. Hypo-echogenicity, increased thickness and Doppler activity of the enthesis were considered signs of active inflammation, whereas insertional bone erosions, intratendinous calcifications and enthesophytes were regarded as signs of chronic lesions.[2] Results See tables. Conclusions In this axSpA cohort, US assessment primarily identified PE in the lower extremities, and predominantly chronic lesions. No change in chronic PE lesions were found during treatment indicating a low sensitivity to change of these lesions. The number of entheses with inflammatory activity was too low to detect any changes on US during ADA therapy. References D9Agostino MA, et al. Ann Rheum Dis 2011, 70(8):1433–1440. Terslev L, et al. Arthritis Care Res (Hoboken) 2014, 66(5):741–748. Disclosure of Interest None declared