Search

Objectives To investigate the association between patient–physician discordance in the assessment of disease activity and residual US synovitis/tenosynovitis in a cohort of patients with RA in clinical remission. Methods A post hoc analysis of the STARTER study, promoted by the Musculoskeletal-US (MSUS) Study Group of the Italian Society for Rheumatology, was performed using data from 361 consecutive patients with RA in clinical remission. The global assessment of disease activity by each patient (PGA) and evaluator/physician (EGA) was recorded on a 100-mm visual analogue scale. The PGA-EGA discordance was classified as positive (PGA>EGA) or negative (PGA Results The mean (s.d.) PGA and EGA scores were 6.1 (7.1) and 8.8 (12) mm, respectively, with a median (IQR) absolute difference of 4 (0–10) mm. Positive and negative discordances were recorded in 39 (10.8%) and 65(18.0%) patients, respectively. The GS-S (adjOR 1.099) and PD-S (adjOR 1.167) scores were associated with positive discordance (P Conclusions Patient–physician discordance is associated with the lack of US remission in patients with RA and may represent a further indication for MSUS.

Objectives: To determine the prevalence and distribution of US-detected qualitative cartilage damage at metacarpal heads of patients with RA and hand OA. Methods: Fifty-two RA patients and 34 patients with hand OA were enrolled. US examination of the metacarpal head cartilage from the II to V finger of both hands was performed. A total of 414 MCP joints in RA and 266 MCP joints in OA patients were scanned with a linear probe up to 22 MHz. Qualitative assessments using a previously described scoring system for cartilage damage were performed. The prevalence and distribution of cartilage damage were analysed. Multivariate regression analysis was used to determine the predictive value of age, gender, BMI, disease duration and the presence of RF and anti-CCP antibodies for US-detected cartilage damage. Results: The metacarpal head cartilage was positive for cartilage damage in 35.7% (148/414) of MCP joints in RA and in 43.6% (116/266) of MCP joints in OA patients. In RA, the hyaline cartilage of the II and III metacarpal heads (bilaterally) was the most frequently affected. In OA, cartilage damage was more homogeneously distributed in all MCP joints. Multivariate regression analysis showed that age and disease duration, but not gender, BMI or autoantibody status, were independent predictors of US-detected cartilage damage in RA. Conclusion: Cartilage damage was found in more than one-third of the MCP joints in both RA and OA patients, and in RA patients, the II and III MCP joints were the most damaged.

Background: Retinal involvement in systemic lupus erythematosus (SLE) and Sjögren syndrome (SS) may be subclinical and thus underdiagnosed. Objectives: We aimed at evaluating morphological and functional visual abnormalities in a cohort of SLE and SS patients in the absence of an overt clinical visual impairment. We also investigated potential associations between retinal disorders and disease activity, organ involvement, and treatment with steroid and/or hydroxychloroquine. Methods: The study comprised 42 SLE and 36 primary SS patients and 76 healthy controls (HC). Ophthalmological examination, standard automated perimetry, spectral-domain optical coherence tomography, and fundus perimetry were performed. Results: Retinal thickness of the posterior pole was not different between SLE and HC groups, but it was reduced in the SS group compared with both the HC and the SLE group. In SLE and SS patients, mean defect and pattern standard deviation by standard automated perimetry were higher than in HC. Visual field index values were lower in both SLE and SS patients than in HC. SLE patients with nephritis displayed increased mean defect and pattern standard deviation and reduced visual field index values compared to patients without nephritis. In SLE and SS patients, fundus perimetry differential sensitivity was reduced, and mean defect values were higher than in HC. Disturbances in fundus perimetry in the SLE group were more prevalent in steroid-naïve patients and in SS patients who received a cumulative hydroxychloroquine dose > 1,000 g. Conclusions: Functional eye impairment was demonstrated in SLE patients, possibly associated with kidney involvement. In SLE, corticosteroids might exert a protective role. Morphological alterations and functional impairment were detected in SS patients, which may be linked to hydroxychloroquine toxicity.

ObjectiveTo define the role of ultrasound (US) for the assessment of patients with rheumatoid arthritis (RA) in clinical remission, including joint and tendon evaluation.MethodsA multicentre longitudinal study has been promoted by the US Study Group of the Italian Society for Rheumatology. 25 Italian centres participated, enrolling consecutive patients with RA in clinical remission. All patients underwent complete clinical assessment (demographic data, disease characteristics, laboratory exams, clinical assessment of 28 joints and patient/physician-reported outcomes) and Power Doppler (PD) US evaluation of wrist, metacarpalphalangeal joints, proximal interphalangeal joints and synovial tendons of the hands and wrists at enrolment, 6 and 12 months. The association between clinical and US variables with flare, disability and radiographic progression was evaluated by univariable and adjusted logistic regression models.Results361 patients were enrolled, the mean age was 56.20 (±13.31) years and 261 were women, with a mean disease duration of 9.75 (±8.07) years. In the 12 months follow-up, 98/326 (30.1%) patients presented a disease flare. The concurrent presence of PD positive tenosynovitis and joint synovitis predicted disease flare, with an OR (95% CI) of 2.75 (1.45 to 5.20) in crude analyses and 2.09 (1.06 to 4.13) in adjusted analyses. US variables did not predict the worsening of function or radiographic progression. US was able to predict flare at 12 months but not at 6 months.ConclusionsPD positivity in tendons and joints is an independent risk factor of flare in patients with RA in clinical remission. Musculoskeletal ultrasound evaluation is a valuable tool to monitor and help decision making in patients with RA in clinical remission.

Background High-frequency ultrasound (US) has proven to be a useful imaging tool for the evaluation of carpal tunnel pathology. US impact in the assessment of idiopathic carpal tunnel syndrome (CTS) has been widely investigated, but only few studies have been carried out with the aim of revealing the pathologic conditions responsible for CTS in rheumatoid arthritis (RA) patients1. Objectives The aim of this study is to evaluate US findings at carpal tunnel level in a cohort of patients with RA, focusing on those with a clinical diagnosis of CTS, and to compare these findings with those observed in a cohort of patients with idiopathic CTS (without RA). Methods Fifty-six patients with RA fulfilling the ACR/EULAR 2010 classification criteria were consecutively enrolled. CTS was diagnosed according to the American Academy of Neurology practice parameter for CTS. We also enrolled 19 patients with idiopathic CTS and evaluated 24 symptomatic wrists, excluding those already surgically decompressed. The US assessment was performed using a MyLab ClassC (Esaote SpA) US system, working with a 6-18 MHz linear probe. The power Doppler (PD) frequency was set at 9.1 MHz. The following grey scale (GS) US pathologic findings were assessed at the carpal tunnel level: cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet (at the level of the pisiform and scaphoid bones), presence of finger flexor tenosynovitis and palmar radio-carpal synovitis (both in GS and PD), and marked bone profile irregularities. The median nerve was considered enlarged if its CSA was more than 12 mm2. We evaluated the presence of intra-neural PD signals at the carpal inlet and scored its entity (0=no PD signal, 1=one single vessel within median nerve, 2=two or three single or two confluent vessels and 3=more than three single or more than two confluent vessels). Results CTS was diagnosed in 21 out of 112 wrists (18.75%) and in 14 out of 56 RA patients (25%). Enlarged median nerve was found in 4 out of 21 wrists with RA and CTS (19%), in 6 out of 84 wrists of patients without CTS (7.1%) and in 22 out of 24 wrists of patients with idiopathic CTS (91.7%). Flexor tenosynovitis was found in 6 out of 21 wrists with RA and CTS (28.6%), in 8 out of 84 wrists of patients without CTS (8.2%) and in 4 out of 24 wrists with idiopathic CTS (16.7%). Palmar radio-carpal synovitis was found in 4 out of 21 wrists with CTS (19%), in 10 out of 84 wrists of patients without CTS (11.9%) and in 1 out of 24 wrists with idiopathic CTS (4.2%). Marked bone profile irregularities were detected in 3 out of 21 wrists with CTS (14.3%), in 22 out of 84 wrists without CTS (26.2%) and in none of the patients without RA. In RA patients, positive intra-neural PD signal was found in 9 out of 21 wrists with CTS (42.8%) and in 12 out of 84 wrists without CTS (14.3%). In idiopathic CTS, PD signal was found in 15 out of 24 wrists (62.5%). Conclusion US allowed a detailed identification of the pathological findings at carpal tunnel in both RA and idiopathic CTS patients. When CTS was diagnosed, different US patterns were distinguished being median nerve less frequently enlarged and synovitis more frequently detected in RA patients. Finally, a positive association was found between the presence of intra-neural PD signal and clinical diagnosis of CTS independently of the diagnosis of RA. References [1] Hammer HB, Hovden IA, Haavardsholm EA, Kvien TK. Ultrasonography shows increased cross-sectional area of the median nerve in patients with arthritis and carpal tunnel syndrome. Rheumatology (Oxford) 2006; 45(5):584-8. Disclosure of Interests None declared

Fausto Salaffi,1 Flavio Mozzani,2 Antonella Draghessi,1 Fabiola Atzeni,3 Rosita Catellani,2 Alessandro Ciapetti,4 Marco Di Carlo,1 Piercarlo Sarzi-Puttini5 1Rheumatology Department, Polytechnic University of Marche, Jesi (Ancona), 2Department of Internal Medicine and Rheumatology, University Hospital of Parma, Parma, 3IRCCS Galeazzi Orthopedic Department, Milan, Italy; 4Rheumatology Department, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, Wales; 5Rheumatology Department, L. Sacco University Hospital, Milan, Italy Objective: The aims of this cross-sectional study were to investigate the usefulness of using an Internet survey of patients with fibromyalgia in order to obtain information concerning symptoms and functionality and identify clusters of clinical features that can distinguish patient subsets. Methods: An Internet website has been used to collect data. Fibromyalgia Impact Questionnaire Revised version, self-administered Fibromyalgia Activity Score, and Self-Administered Pain Scale were used as questionnaires. Hierarchical agglomerative clustering was applied to the data obtained in order to identify symptoms and functional-based subgroups. Results: Three hundred and fifty-three patients completed the study (85.3% women). The highest scored items were those related to sleep quality, fatigue/energy, pain, stiffness, degree of tenderness, balance problems, and environmental sensitivity. A high proportion of patients reported pain in the neck (81.4%), upper back (70.1%), and lower back (83.2%). A three-cluster solution best fitted the data. The variables were significantly different (P

Background Psoriatic Arthritis (PsA) is a chronic inflammatory arthritis typically often associated to several comorbidities. The presence of eye involvement in terms of uveitis is well known in PsA patients while retinal abnormalities and dry eye need to be characterised Objectives The aim of the study was to analyse subclinical retinal abnormalities and dry eye in a cohort of PsA patients who were naive to biologic treatments Methods In a prospective cross-sectional study, consecutive PsA patients without clinical eye involvement were enrolled (time frame January 2017-December 2017). Joint disease activity and ESR and CRP were measured. Functional and morphological eye assessment included: complete ophthalmological examination, ocular surface disease index (OSDI), Schirmer test, BUT, spectral-domain optical coherence tomography (SD-OCT), standard automated perimetry (SAP, measured as mean defect – MD – and pattern standard deviation – PSD), and fundus perimetry (FP). Data were compared to findings from the eyes of 24 age/sex matched healthy controls (HC). Results A total of 58 eyes from 29 PsA patients (21 women and 8 men; age 52.7±13.3 years) and 48 eyes from HC (14 women and 10 men; age 47.6±15 years) were evaluated. Overall, most of the PsA patients showed a normal Schirmer test, with the exclusion of three patients (10.3%). PsA patients showed abnormal OSDI in 55.2% and lower BUT in compared to HC (p Conclusions Intriguingly, an impairment in quality of tear film in PsA patients was observed compared to HC. The correlation between ESR and dry eye tests may be explained with a potential relationship between systemic inflammation and sicca syndrome. Interestingly, PsA patients showed a retinal functional impairment by reduced retinal sensitivity measured by MD, FP mean differential sensitivity and FP mean defect values. To our knowledge this is the first study investigating eye function and morphology in PsA patients. Further studies are needed to confirm and explain these results. Disclosure of Interest None declared

Important advances from both therapeutic and clinical assessment have recently been reported in psoriatic arthritis (PsA). Moreover, the constant challenge to provide a more comprehensive assessment of this heterogeneous disease results in a variety of clinical instruments that help the clinician for a global evaluation of both disease activity and responsiveness. The current European League Against Rheumatism (EULAR) recommendations on the use of imaging suggest the use of ultrasound (US) in chronic arthritis to increase the diagnostic accuracy and improvement of its management as compared to clinical examination alone. Although US findings are not firmly established in daily clinical practice, it demonstrated several positive aspects such as good sensitivity and specificity, acceptable reliability, and adequate sensitivity to change, especially in the peripheral PsA. Additionally, recent works introduced the role of US in the assessment of skin and nails opening interesting area of research. The aim of this paper is to describe the potential role of US in the assessment of PsA and to discuss the current evidence supporting its application in daily clinical practice.

A 71-year-old man with osteoarthritis and chondrocalcinosis came to our observation developing a swelling in the groin region after a recent left colectomy for adenocarcinoma. The imaging techniques revealed the presence of an iliopsoas bursitis in connection with the hip. The synovial fluid analysis detected the presence of calcium pyrophosphate (CPP) crystals and allowed the final and unusual diagnosis of iliopsoas bursitis related to acute CPP crystal hip arthritis.

To investigate the influence of fibromyalgia (FM) on achieving remission defined on the basis of the Simplified Disease Activity Index (SDAI) remission criteria in patients with long-standing rheumatoid arthritis (RA). This observational longitudinal cohort consisted of long-standing RA patients being treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological DMARDs (bDMARDs). After 6 months of follow-up, the patients fulfilling or not fulfilling the remission criteria were identified and compared with each other in terms of the presence of FM, neuropathic pain, and other comorbidities. At the end of the 6-month observation period, 24 of the 117 patients (20.4%) met the SDAI remission criteria. Logistic regression analysis showed that the modified Rheumatic Disease Comorbidity Index (mRDCI) (p = 0.0001), the FM presence (p = 0.0001), and the 36-item short-form health survey Mental Component Summary (SF-36 MCS) Score (p = 0.0088) were the strongest predictors of not being in SDAI remission. None of the patients with concomitant FM (17.1%) achieved SDAI remission. In comparison with the non-FM patients, the patients with RA and FM patients had worse scores on the SF-36 MCS (p = 0.011), on the sleep Visual Analogue Scale (VAS) (p = 0.018), on the self-counts of tender joints (p = 0.039), and on the PainDetect Questionnaire (PDQ) (p = 0.001). To avoid over treatment, an assessment of FM should be considered in RA patients who do not fulfil the remission criteria.

Ultrasound (US) is a cost-effective, noninvasive, accessible imaging modality that clinicians use at the point of care to assess disease activity and therapeutic efficacy in different rheumatic conditions. However, its utility has been prevalently demonstrated in the field of chronic arthritides. Only in the last few years there was an interest to explore the potential of US beyond the musculoskeletal area. In this way, preliminary US data about the assessment of the different targets involved in systemic sclerosis such as joints, tendons, skin, vessels, and lung have been provided. The main purpose of this US review is to provide an overview of the potential role of US in the multi-target assessment of SSc and to discuss the current evidence supporting its relevance and applications in daily clinical practice.

OBJECTIVE The main aim of this study was to compare ultrasonography (US) with conventional radiography for the assessment of joint damage in knee OA. METHODS A total of 166 knees of 84 patients (59 women and 25 men) with primary knee OA were included in this study. The femoral hyaline cartilage of the medial para-patellar aspect and the osteophytes of both the medial and lateral femoral condyle were assessed. The cartilage and osteophytes were both quantitatively and qualitatively assessed. The US assessment was feature-specifically compared with conventional radiography. RESULTS There was a strong correlation between the radiographic medial tibiofemoral narrowing grade and the US medial cartilage grade (rs = 0.7144, 95% CI: 0.6218, 0.7873, P

Background Subclinical synovial inflammation detected by ultrasonography (US) in patients with rheumatoid arthritis (RA) in clinical remission relates to disease flare. The impact of tenosynovitis in this context is not known. Objectives To evaluate the association between US-detected tenosynovitis and synovitis in RA patients in clinical remission and flare over 12-months. Methods STARTER is a multicentre cohort study of the US Study Group of the Italian Society for Rheumatology. Participants were selected on the basis of a reliability exercise and the availability of high-end equipment. Patients with RA in clinical remission underwent clinical evaluation and US synovitis (-S) and tenosynovitis (-T) were assessed categorically for Grey Scale (GS) and power Doppler (PD) at 11 joints, extensor and flexor tendons in both hands and wrists. Patients were seen at 6 and 12 months. Flare within 12 months was defined as increase of >1.2 or >0.6 if final DAS28>3.2. The relationship between the presence of GS-T/-S, PD-T/-S was evaluated by logistic models, presented as odds ratios (OR) and 95% confidence interval (CI), adjusted for pre-specified confounders. Results 361 patients (72.3% f, mean age (sd) 56.1 (13.3), median disease duration (IQR) 7.1 years (3.6–13.5)) were included. 98/326 (30.6%) patients had a flare within 12 months. Considering US variables separately, only PD-S significantly predicted flare (OR 1.87 (1.12,3.14)). When the model included both –T and –S, only the concurrent presence of –T and –S predicted flare (PD-T+-S: OR 2.06 (1.04, 4.07); GS-T+-S: OR 2.27, (1.01,5.10)), while isolated –S and –T did not. Conclusions In patients with RA in clinical remission, US-detected synovial and tenosynovial inflammation identifies patients at risk of flare. US might help decisions on management in this population. Disclosure of Interest None declared

The study is addressed to determine if there is a correlation between intra-articular power Doppler (PD) and pain symptoms in patients with rheumatoid arthritis (RA). A cross-sectional study of patients with established RA was rolled out. Seventy-two patients with chronic swelling at metacarpophalangeal (MCP) joints were consecutively enrolled in the study and divided into two groups (painful and painless). In the painful group, the inclusion criteria were pain in the visual analog scale (VAS), from 0 to 10 cm, of at least 4 cm and 0 in the painless group. All two to five MCP joints, bilaterally, were scanned by ultrasound (US) searching for intra-articular PD presence. Any value of p

A 71-year-old man with osteoarthritis and chondrocalcinosis came to our observation developing a swelling in the groin region after a recent left colectomy for adenocarcinoma. The imaging techniques revealed the presence of an iliopsoas bursitis in connection with the hip. The synovial fluid analysis detected the presence of calcium pyrophosphate (CPP) crystals and allowed the final and unusual diagnosis of iliopsoas bursitis related to acute CPP crystal hip arthritis.

Background Musculoskeletal involvement is one of the most common manifestations of SLE and, recently, different studies have demonstrated the role of MSUS in the evaluation of tendons and joints involvement in SLE patients (1). The enthesis is traditionally not included as a potential target of the inflammatory process of the disease, remaining a yet unexplored anatomical area in this cohort of patients. Objectives To investigate the prevalence and distribution of entheseal abnormalities in SLE patients using MSUS. Methods 30 consecutive SLE patients were enrolled in the present study. The scanned entheses were those included in the Glasgow Ultrasound Enthesitis Scoring System: the patellar insertion of the quadriceps tendon (QT), the patellar and distal insertion of the patellar tendon (PT), the calcaneal insertion of the Achilles tendon (AT) and the calcaneal insertion of the plantar fascia (PF). All patients underwent both clinical and ultrasound examination aimed at assessing the entheseal involvement. MSUS entheseal pathology was evaluated by detecting the presence of grey scale changes and power Doppler (PD) signal, as defined by the OMERACT Ultrasound Task Force (2). All the factors that may affect the MSUS findings at entheseal level (lipid profile, body mass index, history of trauma, sport activity and corticosteroid therapy) were carefully evaluated. Results MSUS entheseal abnormalities were found in 20 out of the 30 patients (66.6%) and in 59 of the 300 entheses examined (19.6%). Patients were clinically asymptomatic in 71.4% of the cases. Among the entheses affected, the distal insertion of the PT was the most commonly involved area (37.2%), followed by the calcaneal insertion of the AT (22%) and the proximal insertion of the PT (16.9%). The patellar insertion of the QT and the calcaneal insertion of the PF were involved in the 13.5% and 10.4% of the cases respectively. With regard to the pathological changes PD signal, hypoechoic areas and entheseal thickening were the most frequently detected abnormalities (29.3%, 26.7% and 24.1%, respectively). Calcifications and bone erosions were found in 11.3% and 8.6% of the cases respectively. Conclusions Although the inflammatory process in SLE patients is traditionally considered to be localized at synovial tissue level, this study shows that entheseal changes are not uncommon in SLE, especially at PT insertions, occurring frequently in asymptomatic patients. These preliminary results should lead to further investigations aimed at identifying the factors associated with entheseal involvement in SLE patients. References Gabba A et al. Joint and tendon involvement in systemic lupus erythematosus: an ultrasound study of hands and wrists in 108 patients. Rheumatology (Oxford). 2012 Dec; 51:2278–85. Terslev L et al. Defining enthesitis in spondyloarthritis by ultrasound: result of a Delphi process and of a reliability reading exercise; Outcome Measures in Rheumatology Ultrasound Task Force. Arthritis Care Res 2014; 66:741–8. Disclosure of Interest None declared

Background Ultrasound (US) with very high frequency probe (up to 22 MHz) has a resolution power of 0.1 mm and allows for the direct visualization of the hyaline cartilage of the metacarpal head. Objectives To determine the prevalence and distribution of US-detected cartilage damage at metacarpal heads of patients with rheumatoid arthritis (RA) and osteoarthritis (OA) and to investigate if cartilage damage evaluated by US method is associated with radiographic scores (Sharp van der Heijde score and Simple Erosion Narrowing Score (SENS) in RA and Kallman score in OA). Methods 50 patients with RA and 19 patients with OA were enrolled in this study. The US examination of the metacarpal head cartilage from II to V finger of both hands was performed. 400 metacarpophalangeal (MCP) joints in RA and 152 MCP joints in OA were scanned with a very high-frequency linear probe (i.e. 10–22 MHz), using a previously described scoring system for cartilage damage 1 . In a subgroup of 27 patients with RA and 7 with OA the radiographic scores were calculated. Pearson9s correlation coefficient and Cohen κ were used to investigate associations between US and radiographic scores. Results The US examination of the metacarpal head cartilage from II to V finger of both hands lasted a mean of 6 minutes. The metacarpal head cartilage was found positive for cartilage damage by US in 139 out of 400 (34.8%) MCP joints in RA and in 65 out of 152 (42.8%) MCP joints in OA. In RA, the hyaline cartilage of the II right metacarpal head was the most frequently affected followed by the II left and the III right metacarpal head. The less affected was the V metacarpal head bilaterally. In OA, cartilage damage was homogeneously distributed in all MCP joints. Symmetric damage of cartilage was observed in 97/400 (24.3%) RA joints and in 44/152 (28.9%) OA joints. Conversely, asymmetric damage of the cartilage was observed in 42/400 (10.5%) RA joints (only in patients with disease duration more than 2 years) and in 21/152 (13.8%) joints in OA. A significant positive correlation was found between US total score and either Sharp van der Heijde score or SENS score (r=0.584, p Conclusions The present study provides evidence supporting the feasibility of the US assessment of the metacarpal head cartilage. A positive significant correlation was found between the US findings, obtained with a very high frequency probe by an experienced sonographer and the radiographic scores assigned by an expert radiologist. References Filippucci E et al: Interobserver reliability of ultrasonography in the assessment of cartilage damage in rheumatoid arthritis. Ann Rheum Dis 2010, 69(10), p. 1845–1848. Acknowledgement Supported by EULAR, IGA grant No. NT12437 and GAUK grant No. 1010213. Disclosure of Interest None declared

Background Systemic Lupus Erythematous (SLE) and Sjogren Syndrome (SS) are autoimmune diseases that may exhibit several manifestations including an ocular involvement. Ocular involvement may be underestimated or be subclinical since current treatments as hydroxycloroquine and steroid may exert both beneficial and side effects on eyes. Objectives To assess the eye involvement in patients affected by autoimmune diseases as SLE and SS. Methods 48 patients affected by autoimmune diseases (29 SLE, 19 SS) without an active eye involvement were prospectively and consecutively enrolled. Morphological and functional eye assessment included: complete ophthalmogical examination, Spectral Domain Optical Coherence Tomography examination, fundus perimetry (FP), standard automated perimetry (SAP). 25 age and sex-matched healthy controls (HC) were also evaluated. Results SS patients displayed a reduction of mean retinal thickness in the posterior pole compared with HC and SLE (p=0.0003 and p=0.03, Fig.1A). This reduction was demonstrated in superior and inferior hemifield compared with HC (p=0.001 and p=0.007) and in superior hemifield compared with SLE (p=0.01) (Fig.1B-C). The FP mean differential sensitivity in SLE and SS patients was reduced compared with HC (p Conclusions In a small cohort of patients with autoimmune diseases without an overt active eye involvement a morphological alteration of the retinal posterior pole and functional impairment was demonstrated suggesting a subclinical involvement thatmight be concealed by the treatment. Disclosure of Interest None declared

Background Juvenile idiopathic arthritis (JIA) is one of the most common chronic inflammatory diseases in childhood. In adult patients with rheumatoid arthritis there is large body of evidence supporting the presence of insulin resistance (IR) mainly linked to the underlying inflammation; severity and duration of the disease influence insulin sensitivity and increase the risk of developing cardiovascular disease (CVD) and type 2 diabetes mellitus.

Background Patients with fibromyalgia (FM) often present with varying combinations and degrees of severity of symptoms, which further complicates the ability to understand FM, obscures our understanding of the burden of FM in individual patients and complicates the development of appropriate comprehensive management strategies. Stratifying patients into more homogeneous subgroups may facilitate better understanding of FM. Objectives To identify clusters within a heterogeneous sample of patients with FM using Web/Internet-based diary assessed with validated, self-report questionnaires. Methods Symptom and physical data were available for patients responders to an Internet survey by using a simple clinical tools, such as the Fibromyalgia Impact Questionnaire (FIQ)(1), self-administered Fibromyalgia Activity Score (FAS)(2) and pain evaluated on the basis of the 16 non-articular sites listed on the Self-Assessment Pain Scale (SAPS) in a single measure. The Web portal allows authorized users to access the system via personal computer and Internet browser. Hierarchical agglomerative clustering was conducted to identify subgroups based on symptoms. Results Out of 353 patients who completed the program, 85.3% were women, had a mean age of approximately 51 years old. Mean time since the onset of pain was 4.7 years, with a range of 1 to 18 years. The five highest scoring items (greater disease impact) were related to symptoms: sleep quality, fatigue/energy, pain, stiffness, tenderness level, balance problems and environmental sensitivity. A high proportion of respondents with FM reported experiencing pain in the neck (81.4%), upper back (70.1%), and lower back (83.2%). A three-cluster solution best fit the data and each clustering variable differed significantly (P Conclusions The results of this pilot study suggest that using the Web/Internet-based diary as patient terminal seems to provide a ubiquitous, easy-to-use, and cost efficient solution for patient-centered data acquisition in the management of FM. The data provides a snapshot of FM and help support the clinical impression that there are distinct subsets of patients with FM. Furthermore, the definition of clinically homogeneous subgroups need to be in different countries, contexts and patient samples. References Salaffi F, Franchignoni F, Giordano A, et al. Psychometric characteristics of the Italian version of the revised Fibromyalgia Impact Questionnaire using classical test theory and Rasch analysis. Clinical and Experimental Rheumatology 2013. Salaffi F, Sarzi-Puttini P, Girolimetti R, et al. Development and validation of the self-administered Fibromyalgia Assessment Status: a disease-specific composite measure for evaluating treatment effect. Arthritis Research & Therapy; 11:R125 2009. Disclosure of Interest None declared

Background Conventional radiography is the most commonly used imaging modality for assessing osteoarthritis (OA) in daily practice. However, the sensitivity of conventional radiography for detecting early changes of cartilage damage may be relatively low. Ultrasonography (US) is able to visualize large portions of femoral hyaline cartilage directly and to assess osteophytes [1-3]. Objectives The main aim of this study was to compare US with conventional radiography for the assessment of joint damage in knee OA. Methods One hundred sixty-six knees of 84 patients (59 women and 25 men) with primary knee OA were included in this study. The femoral hyaline cartilage of the medial para-patellar aspect and osteophytes of both medial and lateral femoral condyle were scanned. The cartilage involvement and the osteophytes were both quantitatively (grade 0-3) and qualitatively assessed. An US global grade for knee joint damage was developed merging the US cartilage damage and osteophyte grades (grade 0-3). The US findings were compared with those obtained by conventional radiography using the Kellgren and Lawrence (K/L) grading system (grade 0-3). Results There was a moderate agreement between US cartilage damage grade and K/L grade assessments (weighted κ=0.466: 95% CI 0.361-0.572) and fair agreement between US osteophyte grade and K/L grade assessments (weighted κ =0.306: 95% CI 0.208-0.405). A fair agreement was found also between the US global grade and K/L grade assessments (weighted κ =0.396: 95% CI 0.289-0.504). In 31 knees with K/L grade 1, US grade higher than 1 were found in 6 knees for cartilage damage and 14 knees for osteophytes. Ninety-two percent of knees that had less than 1 mm cartilage thickness were classified as severe OA in radiographs. Conclusions The present study provides evidence supporting the concurrent validity of US in the assessment of knee joint damage due to OA through its agreement with conventional radiography. However, such a correlation was moderate. A possible reason explaining the discrepancy between radiographic and US assessment may be related to the fact that US allows a direct visualization of femoral cartilage while joint space width assessed by conventional radiography is the result of cartilage thinning and/or meniscal degeneration and protrusion. References Grassi W, Lamanna G, Farina A, Cervini C. Sonographic imaging of normal and osteoarthritic cartilage. Semin Arthritis Rheum 1999;28:398-403. Naredo E, Acebes C, Moller I, Canillas F, de Agustin JJ, de Miguel E, et al. Ultrasound validity in the measurement of knee cartilage thickness. Ann Rheum Dis 2009;68:1322-7. Saarakkala S, Waris P, Waris V, Tarkiainen I, Karvanen E, Aarnio J, et al. Diagnostic performance of knee ultrasonography for detecting degenerative changes of articular cartilage. Osteoarthritis Cartilage 2012;20:376-81. Disclosure of Interest None declared