M. Di Carlo

Entheseal involvement in systemic lupus erythematosus: are we missing something?

Background Musculoskeletal involvement is extremely common in patients with systemic lupus erythematosus (SLE). Continuing the research initiated in patients with inflammatory arthritis, recent studies have shown the potential role of musculoskeletal ultrasound (MSUS) in the evaluation of clinical and subclinical lupus synovitis. The inflammatory process in SLE is traditionally considered to be localized at synovial tissue areas while enthesis is not included among the possible targets of the disease. Patients and methods Entheses included in the Glasgow Ultrasound Enthesitis Scoring System were scanned in a cohort of 20 SLE patients serving as disease controls in an MSUS study aimed at assessing enthesitis in patients with psoriatic arthritis. We describe in detail four cases with unexpected and unequivocal expressions of MSUS enthesitis according to the OMERACT definition. Three out of four patients had no predisposing factors for enthesopathy. Case no. 2 was treated with a variable-dose prednisone regimen. Results In the four cases MSUS examination revealed relevant grey-scale and power Doppler abnormalities at the entheseal level, most commonly at the distal insertion of the patellar tendon. Signs of clinical enthesitis were detected in only one patient. Conclusions This case series shows for the first time the presence of clearly evident MSUS findings indicative of enthesitis in four out of 20 SLE patients (20%), raising the hypothesis that enthesis could be a missing target in the clinical evaluation of SLE patients. Our case series justifies further investigations for a better evaluation of the prevalence, characteristics and clinical relevance of entheseal involvement in SLE.

SAT0080 Patient Acceptable Symptom State (PASS) in Self-Report Questionnaires and Composite Clinical Disease Index for Assessing Rheumatoid Arthritis. Identification of Cut-Off Points for Routine Care: Table 1

Background In order to interpret better the patient-reported outcomes (PROs) score changes in clinical routine, some cut-points have been determined. One of these cut-points is the Patient-Acceptable Symptom State (PASS) that is defined as the highest level of symptom beyond which patients consider themselves well [1]. It is strictly a PRO, and consists of a global dichotomized simple question about patients satisfaction of their state of symptoms [2]. Objectives To provide information on the value of PASS in rheumatoid arthritis (RA) by the identification of PASS thresholds for PROs composite scores. Methods The characteristics of RA patients with affirmative and negative assignment to PASS were compared. Contributors to physician response were estimated by logistic regression models and PASS thresholds by the 75th percentile and receiver-operating characteristic (ROC) curve methods. Results 303 RA patients completed the study. All PROs were different between the PASS (+) and PASS (-) groups (p<0.0001). The thresholds with the 75th percentile approach were 2.0 for the RA Impact of Disease (RAID) score, 2.5 for the PRO-CLinical ARthritis Activity (PRO-CLARA) index, 1.0 for the Recent-Onset Arthritis Disability (ROAD) questionnaire and 3.3 for patients assessment of general health (Table). The cut-off values for Clinical Disease Activity Index (CDAI) were in the moderate range of disease activity. Assessing the size of the logistic regression coefficients, the strongest predictors of PASS were the disease activity (p=0.0007) and functional state level (0.006). Table 1 Variable PASS + 75th percentile threshold 80% Specificity cutoff ROC Cutoff Sensitivity/Specificity AUC-ROC curve ROAD (0–10) 1.00 1.10 1.50 92.7/60.1 0.788 PRO-CLARA (0–10) 2.50 2.60 2.90 89.1/82.7 0.933 RAID (0–10) 2.00 2.10 2.60 96.4/73.4 0.862 CDAI (0–76) 13.83 15.85 14.21 81.8/91.6 0.925 PASS thresholds for each specific patient-reported outcomes and other measures defined by the 75th percentile of the cumulative distribution, for patient who rated their condition as PASS-positive, by plotting ROC curves and identifying cutoffs that yielded 80% specificity and by plotting ROC curves and identifying cutoffs that yielded the smallest number of false-positives and false-negatives. Conclusions PASS thresholds were relatively high and many patients in PASS had moderate disease activity states according to CDAI. Factors such as disease activity and physical function may influence a negative PASS. References Kvien TK, Heiberg T, Hagen KB. Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis 2007; 66(Suppl III): iii40-iii41. Tubach F, Ravaud P, Beaton D, et al. Minimal clinically important improvement and patient acceptable symptom state for subjective outcome measures in rheumatic disorders. J Rheumatol 2007; 34(5): 1188-93. Disclosure of Interest None declared

SAT0593 Ultrasonographic Evaluation of Joint Damage in Knee Osteoarthritis: A Comparison with Conventional Radiography

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, Möller I, Canillas F, de Agustín 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

AB1065 Preliminary findings of a 2-months acupuncture intervention on symptomatology and quality of life in patients with fibromyalgia

Background Acupuncture is frequently used in the treatment of different chronic pain conditions. In Fibromyalgia (FM) the evidences available are someway conflicting, and the correct positioning of such kind of therapy has not yet precisely defined. Objectives To assess the response to a single course of acupuncture in patients with FM non-responsive to the usual pharmacological treatment. Methods Consecutive FM patients with unsatisfactory response or intolerance to the pharmacologic treatment (duloxetine and/or pregabalin) were involved in this study. Unsatisfactory response was defined by the presence of a revised Fibromyalgia Impact Questionnaire (FIQ-R) total score ≥40 and of a Patient Health Questionnaire 15 (PHQ15) ≥5 after 3 months of stable pharmacological treatment. Acupuncture treatment consisted in 8 weekly sessions. The acupuncture formula, according to the Traditional Chinese Medicine indications, included the following points: LV3 +LI4 (to move Qi), ST36 +CV6+CV12 (to tonify Qi and Blood), GV20 (to raise Qi), and Ex-HN-3 (Yintang) (to calm the Shen), with acupuncture needle 0.25 × 25 mm with guide tube (Huanqiu). For each session needles were retained for 30 min. At baseline (before the first session) and at the end of the treatment course (after the eighth session) were collected the number of tender points (TP) and patient-reported outcomes (PROs). Differences between baseline and end of the acupuncture treatment were evaluated through the Wilcoxon test, results expressed in median values with 95% confidence interval (CI). Results Thirty-four subjects were enrolled in the study. Thirty-two patients (29 women, 3 men, mean age 49 years, range 18–72 years) completed the acupuncture treatment. In two patients (one woman and one man) the acupuncture therapy was stopped at the second session for poor tolerance to the needles. Eleven patients were in pharmacological therapy with pregabalin, nine with duloxetine, while 12 resulted intolerant both to pregabalin and duloxetine. From baseline, after the 2 months of acupuncture treatment, different parameters showed a significant improvement. Particularly, it has been observed a significant reduction in the TP number (17 [95% CI 16–18] à 10 [95% CI 8–12]; p<0.0001), in the somatic symptoms assessed with the PHQ15 (13.5 [10.0–17.0] à 7.0 [6.0–10.0]; p<0.0001), but also in the FIQ-R total score (61.5 [39.8–70.3] à [30.2–66.5]; p=0.0029), in the Fibromyalgia Activity Score (FAS) (6.7 [4.8–7.7] à 4.6 [CI 3.2–6.1]; p=0.0017), and in the Self-Assessment Pain Scale (SAPS) (4.5 [3.8–5.6] à 3.2 [2.9–4.2]; p=0.0192). Interestingly, acupuncture revealed a good effect even in the neuropatic-like features of pain, measured by the painDETECT questionnaire (19.0 [15.0–25.0] à 14.5 [10.9–17.0]). Conclusions A 2 months acupuncture treatment provides an important global improvement in the health status in FM patients refractory/intolerant to the pharmacologic therapy. The strongest ameliorations are represented by the reduction in the TP number and in the somatic symptoms. References [1] Häuser W, Clauw DJ, Fitzcharles MA. Treat-to-Target Strategy for Fibromyalgia: Opening the Dialogue. Arthritis Care Res2017; doi: 10.1002/acr.22970. [2] Langhorst J, Heldmann P, Henningsen P, et al. Complementary and alternative procedures for fibromyalgia syndrome: Updated guidelines 2017 and overview of systematic review articles. Schmerz2017; doi: 10.1007/s00482–017–0206–1. Disclosure of Interest None declared

FRI0109 Short-term monitoring of sonographic changes induced by a corticosteroid injection in metacarpophalangeal joint of rheumatoid arthritis patients: a pilot study

Background Intra-articular corticosteroid injection is a well-established procedure in the daily practice since many decades [1]. High-resolution ultrasound (US), considered as in vivo microscopy, has the potential to help to understand how drugs develop their anti-inflammatory properties inside the articular space [2]. Objectives To provide a very tight sonographic monitoring of the changes in a single metacarpophalangeal (MCP) joint in rheumatoid arthritis (RA) patients after the administration of intra-articular corticosteroid. Methods In this study we consecutively enrolled RA patients with active disease (Composite Disease Activity Index - CDAI >10), at least one tender and swollen MCP joint, and without contraindication to intra-articular corticosteroid injection (e.g. poor controlled diabetes). After the clinical evaluation that established the most clinically involved MCP joint to inject, patients underwent an US examination of the joint by an experienced sonographer. Synovitis was scored in grey scale (GS) in terms of joint space enlargement (measured at the level where the distance between the bone diaphysis and the joint capsule was greater), and power Doppler (PD) signal (scored by a semiquantitative method: 0 = no intra-articular flow, 1 = single vessel signal, 2 = confluent vessels, and 3 = vessel signal in more than 50% of the intra-articular area). After the baseline US assessment (T0), the MCP joints were injected with 20 mg triamcinolone acetonide under sonographic guidance. Sonographic follow-up was performed in five timepoints: two hours (T1) after the injection, four hours (T2), eight hours (T3), 24 hours (T4), and 48 hours after the injection (T5). Results Fifteen patients (13 women), with a mean age of 62.5 years, completed the follow-up. The mean CDAI was 28.9, anti-citrullinated protein antibodies were present in 9 patients. At T5, in all the patients was detectable a global reduction of joint space enlargement, of intra-articular PD signal, and of the numerical rating scale (NRS) of pain at the joint injected (Table). However, in majority of the patients (n: 13), the joint space enlargement showed an increase in the T1 and T2 US examinations, and in four patients PD signal, compared to T0, increased within the eight hours after the injection. No major adverse events were registered. Power Doppler grade (0–3) Joint space enlargement (mm) NRS pain (0–10) Case ID First Last Maximum First Last Maximum First Last Maximum 1 2 1 3 3,4 2,4 4,2 3 1 5 2 2 0 2 4,4 3,7 5,7 8 1 8 3 2 0 2 2,1 1,3 3 7 2 7 4 3 1 3 2,1 1,8 2,9 9 0 9 5 3 2 3 4 4 4,9 10 0 10 6 3 1 3 6,5 2,7 6,5 2 1 2 7 2 0 2 3,5 1,2 3,6 6 0 6 8 1 1 3 4,6 3,3 4,6 3 0 3 9 3 0 3 2,5 2,1 3,6 2 0 2 10 2 1 3 4,3 3,9 5,6 7 3 7 11 3 1 3 5,3 3,3 5,7 8 3 8 12 3 1 3 3,3 2,6 3,3 7 3 7 13 2 1 2 2,6 2,3 3 7 2 7 14 3 1 3 3,1 2,2 4 7 2 7 15 2 1 3 4,5 3,7 4,5 7 0 7 Conclusions A single intra-articular corticosteroid injection, performed under US guidance, is a very fast treatment to reduce synovitis of the injected joint. In the hours next to the injection is common to reveal a rise of joint space enlargement together with that of PD signal score. References Courtney P, Doherty M. Joint aspiration and injection and synovial fluid analysis. Best Pract Res Clin Rheumatol 2013;27:137–69. Filippucci E, Iagnocco A, Salaffi F, et al. Power Doppler sonography monitoring of synovial perfusion at the wrist joints in patients with rheumatoid arthritis starting adalimumab treatment. Ann Rheum Dis 2006; 65:1433–7. Disclosure of Interest None declared

THU0121 Ultrasound in the assessment of carpal tunnel syndrome in patients with rheumatoid arthritis

Background Carpal tunnel syndrome (CTS) is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA). Ultrasound (US) has proven to represent a reliable tool for the diagnosis of CTS [1]. However, its role in the diagnosis of CTS in patients with RA has been poorly investigated. Objectives The aim of this study is to evaluate the US findings at carpal tunnel level in a cohort of patients with RA, focusing on those with a clinical diagnosis of CTS. Methods Patients with RA fulfilling the ACR/EULAR 2010 classification criteria were consecutively enrolled. The diagnosis of CTS was made according to the American Academy of Neurology practice parameter for CTS [2]. The MSUS assessment was carried out using a MyLab Twice (Esaote SPA) US system working with a 18–22 MHz linear probe. The power Doppler (PD) frequency was set between 7.5 and 11.3 MHz. The following grey scale (GS) US parameters 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 flexor tenosynovitis and palmar radio-carpal synovitis (both in GS and PD), presence of crystal macro-aggregates 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). PD was considered “positive” if grade 1 or more was found. Results We included 40 RA patients. CTS was diagnosed in 19 out of 80 wrists (23.8%) and in 13 out of 40 RA patients (32.5%). Enlarged median nerve was found in 3 out of 19 wrists with CTS (15.8%) and in 6 out of 61 wrists without CTS (9.8%). Flexor tenosynovitis was found in 7 out of 19 wrists with CTS (36.8%) and in 5 out of 61 wrists without CTS (8.2%). Palmar radio-carpal synovitis was found in 2 out of 19 wrists with CTS (10.5%) and in 3 out of 61 wrists without CTS (4.9%). Crystal macro-aggregates were not detected in any of the scanned wrists. Marked bone profile irregularities were found in 2 out of 19 wrists with CTS (10.5%) and in 14 out of 61 wrists without CTS (23%). Positive intra-neural PD was found in 9 out of 19 wrists with CTS (47.4%) and in 9 out of 61 wrists without CTS (14.7%). Conclusions These preliminary results suggest that MSUS could be a useful tool in the diagnosis of CTS also in patients with RA. Intra-neural PD and flexor tenosynovitis were the most frequently MSUS abnormalities detected in RA patients with CTS. The inflammatory involvement of the tendinous and joint structures which are part of the carpal tunnel could lead to median nerve compression and CTS symptoms and should be considered in the MSUS assessment of CTS. References McDonagh C, Alexander M, Kane D. The role of ultrasound in the diagnosis and managment of carpal tunnel sindrome: a new paradigme. Rheumatology (Oxford). 2015 Jan;54(1):9–19.doi: 10.1093/rheumatology/keu275. Practice parameters for carpal tunnel syndrome (summary statement). Report of the quality standards subcommittee of the American Academy of Neurology. Neurology 1993;43:2406–9. Disclosure of Interest None declared

SAT0547 Ultrasound Assessment of Cartilage Damage at Metacarpal Head Level in Rheumatoid Arthritis and Osteoarthritis

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 damage1. In a subgroup of 27 patients with RA and 7 with OA the radiographic scores were calculated. Pearsons 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<0.001; r=0.510, p<0.001, respectively) in RA and between US total score and Kallman score (r=0.687, p<0.001) in OA. Agreement between two imaging methods was high, 78% in RA (κ=0.570, p<0.001) and in 91% in OA (κ=0.750, p<0.001). 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

SAT0552 Musculoskeletal Ultrasound (MSUS) Showing Entheseal Involvement in Patients with Systemic Lupus Erythematosus (SLE): Something Unexpected

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

AB1024 Health-Related Quality of Life in Different Musculoskeletal Disorders: A Comparison among The Conditions and with A Selected Sample of Healthy Individuals Using SF-36 Questionnaire, EQ-5D and SQ-6D Utility Values

Background Given the high prevalence of musculoskeletal (MSK) disorders, there is a need to determine which conditions have the greatest impact on health-related quality of life (HRQoL). Objectives To compare the HRQoL scores of the Medical Outcomes Study Short-Form 36 Health Survey (SF-36) and of the two widely used indirect utility instruments, the EuroQol Five Dimensions questionnaire (EQ-5D) and the Short-Form Six Dimensions questionnaire (SF-6D) among 14 different MSK disorders and to compare them with the results of a selecting sample of healthy controls. Methods 2,633 patients participated to this study. MSK disorders were classified into five diagnostic groups: inflammatory rheumatic diseases (IRD), connective tissue disorders (CTD), symptomatic peripheral osteoarthritis (SPOA), soft tissue disorders (STD) and osteoporosis (OP). IRD were further classified into 3 subgroups: rheumatoid arthritis (RA) (n=572), peripheral psoriatic arthritis (PsA) (n=150) and ankylosing spondylitis (AS) (n=251). CTD were classified into sistemic sclerosis (SSc) (n=75), sistemic lupus erythematosus (SLE) (n=83) and Sjogren sindrome (SS) (n=50). SPOA included symptomatic knee (n=176), hip (n=136 patients), and hand OA (n=87). The STD group included fibromyalgia (FM) (n=226 patients), low back pain (n=141) and shoulder tendinitis/adhesive capsulitis (n=112 patients). The OP group included 172 women who had vertebral fractures due to osteoporosis, and a group of 402 asymptomatic osteoporotic women without vertebral fractures. For comparison were used 649 healthy controls. The HRQoL was evaluated with the SF-36, using physical (PCS) and mental (MCS) component scales and EQ-5D. The SF-6D utility values were calculated from SF-36 by using a definite scoring function. Results The five major rheumatic disease groups, compared to healthy people, significantly impaired all eight health concepts of the SF-36 (p<0.0001). Similar results were found for EQ-5D, EQ-VAS and SF-6D. The patients with IRD have poorer self-reported health status than those without arthritis in all domains of living, but particularly with respect to scales measuring aspects of physical functioning or mobility, role limitation due to physical health problems and usual activities, and bodily pain. RA had the largest negative impact on HRQoL at the individual level, followed by FM, vertebral fractures due to OP, OA of the hip, and SSc. Conclusions Our results indicates that MSK conditions have a clearly detrimental effect on the HRQoL, and physical domain is more impaired than mental and social ones. These findings may help clinical decision making and priority setting for management of individuals with MSK diseases. Disclosure of Interest None declared

SAT0504 Ultrasound Learning Curve in Gout: a Disease-Oriented Training Programme

Background Ultrasound (US) has gained considerable interest among Rheumatologists in the assessment of patients with gout due to its usefulness in both clinical practice and research activity. While a solid and still growing body of evidence supports its use in daily rheumatological practice, operator dependency and the long learning curve represent the main limitations. Objectives To describe the learning curve of Rheumatologists with limited experience in US attending an intensive disease-oriented training programme focusing on the skills required to obtain and interpret US signs of monosodium urate (MSU) crystal deposits at joint and periarticular tissues. Methods Three investigators participated in a seven-days training programme, carried out on 12 male patients with gout. The agreement between the expert and the beginners was calculated in 4 sessions on eight patients with gout The US assessment was performed at the following anatomic sites: second and third metacarpophalangeal (MCP) joints; knee, tibiotalar and first metatarsophalangeal (MTP) joints; second and third finger flexors; quadriceps and patellar posterior tibialis; peroneus longus and brevis, and Achilles tendons. The presence or absence of synovial fluid/synovial hypertrophy, double contour sign, intra- or periarticular and intratendinous tophi, bursitis, bone erosions was recorded. Results A total of 12 patients with gout (all males) were included. Eight patients were scanned directly by all of the investigators during the four sessions of the US evaluation, whereas four patients were scanned during hands-on and practical sessions by the expert sonographer. A total of 416 anatomical sites (for each patient: 10 joints, four finger flexor tendons, two quadriceps tendons, two patellar tendons, two posterior tibialis tendons, four peroneous tendons, and two Achilles tendons) were studied. Both κ values and overall agreement percentages of qualitative assessments of US gout findings showed, at the end of exercise, moderate to excellent agreement, while in the first session, poor/fair agreement was obtained (Beginner 1 (κ values at I and IV session)= synovitis 0.334–0.875 double contour sign 0.184–0.762, intra- or periarticular intratendinous tophi 0.226-709, bursitis 0.429-0.673, bone erosions 0.210-0.810. Beginner 2 (κ values at I and IV session)= synovitis 0.310-0.769 double contour sign 0.133-0.709, intra- or periarticular intratendinous tophi 0.211-0.840, bursitis 0.429-0.818, bone erosions 0.364-0.909). Beginners’ examinations at the end of the training session including sensitivity, specificity, and feasibility of the beginners were also improved. Conclusions After 1 week of the disease-oriented training programme, Rheumatologists with limited experience in US were satisfactorily able to detect and interpretthe mainUS signs indicative of MSU crystal deposits at different tissues in patients with gout. Disclosure of Interest None Declared