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Objectives: To: (a) determine the extent of ultrasound (US)-detected peripheral enthesitis in a cohort of patients with psoriatic arthritis (PsA); (b) compare this with three clinical examination (CE) enthesitis indices; and (c) determine the effect of concurrent fibromyalgia on the evaluation of enthesitis. Methods: A prospective single-centre cross-sectional study of consecutive outpatients with established PsA undergoing clinical examination for enthesitis and US examination for inflammatory and structural lesions of enthesitis. Multivariable analyses tested for association between US scores, CE enthesitis indices and influence of concurrent fibromyalgia. Results: A total of 106 patients were assessed. Of these, 91/106 (85.8%) had CE enthesitis and 105/106 (99.1%) had ⩾1 US feature of enthesitis. There was a moderate correlation between US entheseal inflammation and both the Leeds Enthesitis Index (LEI) (Spearman rank, r = 0.36) and Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC) ( r = 0.44). US entheseal damage did not correlate with CE enthesitis indices. Twenty-eight (26.4%) patients were classified as having concurrent fibromyalgia, in whom multivariable regression analyses demonstrated no correlation between US scores and CE enthesitis indices. PsA patients without fibromyalgia demonstrated a statistically significant association between both LEI ( r = 0.48, p Conclusion: There is a moderate association between US entheseal inflammation, but not damage, and CE enthesitis indices in patients with PsA. The presence of concurrent fibromyalgia is linked with higher CE enthesitis scores, without an increase in US inflammation, suggesting that CE enthesitis indices should be used/interpreted with caution in these patients. Imaging, including US, should be the preferred modality to detect enthesitis in PsA patients with concurrent fibromyalgia.

Background: Axial spondyloarthritis (axSpA) encompasses psoriatic arthritis with axial disease, ankylosing spondylitis and non-radiological axSpA. Patients with axSpA have a high burden of inflammatory bowel disease (IBD) but few studies have investigated the proportion of IBD cases that have undiagnosed axSpA. Untreated axSpA could have a significant impact on the general health and quality of life of patients; therefore early diagnosis and treatment is crucial[1]. Objectives: This systematic literature review (SLR) aimed to identify the prevalence of undiagnosed axSpA in IBD cases based on cross-sectional imaging (MRI and CT scans) of the axial skeleton from published data. Methods: This SLR was performed in keeping with MOOSE guidelines for observational studies. Original articles in all languages from 1990-2018 were retrieved from PubMed, Embase and Cochrane databases. Article reference lists were checked for further literature. Rheumatology conference (ACR, EULAR, GRAPPA, BSR, Gent Spondyloarthritis) abstract lists from 2012-2018 were reviewed and authors contacted for any additional unpublished data. All abstracts were reviewed by two authors to determine eligibility for inclusion. Results: Twenty observational studies were identified: twelve published papers and eight abstracts. Thirteen studies assessed the prevalence of CT-sacroiliitis in IBD cases, two used magnetic resonance enterography (MRE) imaging and five used MRI imaging. The studies included a variety of patient demographics and IBD types. Sample sizes ranged between 25-1247 patients. Eleven studies included 2 independent radiology readers. The presence of inflammatory back pain was assessed in 7/20 studies, 5/20 included a control group and only 3/20 included a clinical rheumatology assessment. Thirteen studies used IBD imaging to assess for sacroiliitis compared to seven using dedicated MRI or CT imaging of the sacroiliac joints. The prevalence of sacroiliitis ranged from 2.2% to 68%. Eleven studies included patients with Crohns disease (average sacroiliitis prevalence 18.6%) and Ulcerative colitis (average sacroiliitis prevalence 17.4%), with 7/11 studies stating no significant difference in the prevalence of sacroiliitis between the two groups. Four studies identified an association of sacroiliitis with increased disease duration, two with increasing age and only one with IBD location. Conclusion: From these studies, it appears that axSpA may affect a substantial number of patients with IBD and is likely to be significantly underdiagnosed. Cross-sectional imaging intended for the assessment of IBD can be utilised to screen for the presence of axSpA, perhaps even before the onset of musculoskeletal symptoms. Such patients could then be triaged for detailed rheumatological assessment. This review highlights the sparsity of data on the prevalence of axSpA in IBD cases. Few studies have included a clinical rheumatological assessment and just over half assessed for any potential difference in the prevalence of sacroiliitis in the Crohn’s disease (CD) and Ulcerative colitis groups. This review has informed our prospective cross-sectional single-centre observational study, due to start in February 2019. We will assess the sensitivity and specificity of MRE as a screening tool for axSpA in a cohort of 600 CD cases, using clinical assessment and a dedicated axial MRI scan as the gold standard. References [1] Ozgul, a., et al., Effect of ankylosing spondylitis on health-related quality of life and different aspects of social life in young patients. Clin Rheumatol, 2006. 25(2): p.168-74. Disclosure of interests: Jobie Evans Grant/research support from: I am currently working on a MD research project looking at the use of magnetic resonance enterography imaging as a screening tool for axial spondyloarthritis in patients with Crohn’s disease. This study is commercially funded by Merck, Sharp and Dohme corporation (MSD)., Mark Sapsford: None declared, Tim Raine: None declared, Scott McDonald: None declared, Miles Parkes: None declared, Gavin Clunie: None declared, Deepak Jadon: None declared

Objectives Imaging and pathology studies have established a close relationship between tophus and bone erosion in gout. The tophus is an organized structure consisting of urate crystals and chronic inflammatory tissue. The aim of this work was to examine the relationship between bone erosion and each component of the tophus. Methods Plain radiographs and dual energy CT scans of the feet were prospectively obtained from 92 people with tophaceous gout. The 10 MTP joints were scored for erosion score, tophus urate and soft tissue volume. Data were analysed using generalized estimating equations and mediation analysis. Results Tophus was visualized in 80.2% of all joints with radiographic (XR) erosion [odds ratio (OR) = 7.1 (95% CI: 4.8, 10.6)] and urate was visualized in 78.6% of all joints with XR erosion [OR = 6.6 (95% CI: 4.7, 9.3)]. In mediation analysis, tophus urate volume and soft tissue volume were directly associated with XR erosion score. About a third of the association of the tophus urate volume with XR erosion score was indirectly mediated through the strong association between tophus urate volume and tophus soft tissue volume. Conclusion Urate and soft tissue components of the tophus are strongly and independently associated with bone erosion in gout.

To develop a semiquantitative dual-energy computed tomography (DECT) scoring system for measurement of urate deposition in gout.Following a structured review of images, a semiquantitative DECT urate scoring method for foot/ankle scans was developed for testing. This method included 4 regions, each scored 0-3, with a maximum total DECT urate score of 12. DECT scans from 224 patients (182 with gout, 42 without gout) were scored by 2 independent readers. Automated urate volumes were also measured. Paired scans from 8 patients receiving pegloticase were analyzed, and a timing exercise was undertaken. The properties of the DECT urate score were analyzed according to the Outcome Measures in Rheumatology (OMERACT) filter.The interreader intraclass correlation coefficient (95% confidence interval) for the DECT urate score was 0.98 (0.97-0.98). All scored regions contributed to the total DECT urate score. DECT urate scores and volumes were highly correlated (r = 0.91, P0.0001). Both DECT urate scores and volumes discriminated between gout and nongout control participants and between the tophaceous gout, nontophaceous gout, and control groups. Compared with urate volume, the DECT urate score had greater ability to discriminate between responders and nonresponders to pegloticase therapy (P0.001 for DECT urate score and P0.05 for volume). The mean ± SD time required for the DECT urate score was 121 ± 2 seconds and for urate volume was 240 ± 2 seconds (P = 2 × 10(-31) ).We have developed a novel semiquantitative DECT scoring method for measurement of urate deposition in the feet/ankles. This method fulfills many aspects of the OMERACT filter.

Knowledge regarding the possible health benefits of probiotic preparations has been increasing, but clinical trials have largely produced non-significant results. In contrast, the open market for probiotics is expanding worldwide despite little research of consumer characteristics.We aimed to survey the availability of probiotic preparations, the recommendation patterns of general practitioners (GP) and the characteristics of consumers.Pharmacies were visited and the types of probiotic supplements were reviewed. A telephone survey was conducted to identify and characterise users and non-users. A questionnaire was sent to GPs.We found 31 probiotic products containing 16 different strains of bacteria. The majority of GPs were unable to clearly define a probiotic. Of 1512 random phone numbers called, 873 were answered. The prevalence of probiotic use was 25.4% of respondents. More females than males had ever used probiotics (30.6% vs 17.2%; p0.0001). The highest rate of use was found in those with tertiary qualifications (34.2%; p0.001). Of users, 75.2% said they had used probiotics on a recommendation, 80.5% of non-users said they would consider taking a probiotic if it was recommended by the GP. Probiotics were mainly used alongside antibiotic treatment (23%) and gastrointestinal disorders (27.5%). Significantly more users than non-users believed in the benefits of probiotic without concern for possible side effects.The majority of participants would consider taking a probiotic if it was recommended by their GP, but GPs exhibited a lack of knowledge in the use and indications for probiotic therapy. There was a general lack of concern regarding potential side-effects.