M. Olejarova

Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies

ObjectiveTo investigate the effect of glucosamine sulfate on long-term symptoms and structure progression in postmenopausal women with knee osteoarthritis (OA). DesignThis study consisted of a preplanned combination of two three-year, randomized, placebo-controlled, prospective, independent studies evaluating the effect of glucosamine sulfate on symptoms and structure modification in OA and post-hoc analysis of the results obtained in postmenopausal women with knee OA. Minimal joint space width was assessed at baseline and after 3 years from standing anteroposterior knee radiographs. Symptoms were scored by the algo-functional WOMAC index at baseline and after 3 years. All primary statistical analyses were performed in intention-to-treat, comparing joint space width and WOMAC changes between groups by ANOVA. ResultsOf 414 participants randomized in the two studies, 319 were postmenopausal women. At baseline, glucosamine sulfate and placebo groups were comparable for demographic and disease characteristics, both in the general population and in the postmenopausal women subset. After 3 years, postmenopausal participants in the glucosamine sulfate group showed no joint space narrowing [joint space change of +0.003 mm (95% CI, −0.09 to 0.11)], whereas participants in the placebo group experienced a narrowing of −0.33 mm (95% CI, −0.44 to −0.22; P < 0.0001 between the two groups). Percent changes after 3 years in the WOMAC index showed an improvement in the glucosamine sulfate group [−14.1% (95%, −22.2 to −5.9)] and a trend for worsening in the placebo group (5.4% (95% CI, −4.9 to 15.7) (P = 0.003 between the two groups). ConclusionThis analysis, focusing on a large cohort of postmenopausal women, demonstrated for the first time that a pharmacological intervention for OA has a disease-modifying effect in this particular population, the most frequently affected by knee OA.

Serum calprotectin (S100A8/9): an independent predictor of ultrasound synovitis in patients with rheumatoid arthritis.

IntroductionCalprotectin, a heterodimeric complex of S100A8/9 (MRP8/14), has been proposed as an important serum biomarker that reflects disease activity and structural joint damage in rheumatoid arthritis (RA). The objective of this cross-sectional study was to test the hypothesis that calprotectin is associated with clinical and ultrasound-determined disease activity in patients with RA.MethodsA total of 37 patients with RA (including 24 females, a mean disease duration of 20 months) underwent a clinical examination and 7-joint ultrasound score (German US-7) of the clinically dominant hand and foot to assess synovitis by grey-scale (GS) and synovial vascularity by power Doppler (PD) ultrasound using semiquantitative 0–3 grading. The levels of serum calprotectin and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were determined at the time of the ultrasound assessment. We analysed the relationship between serum calprotectin level, traditional inflammatory markers, and ultrasound-determined synovitis.ResultsThe levels of serum calprotectin were significantly correlated with swollen joint count (r = 0.465, p < 0.005), DAS28-ESR (r = 0.430, p < 0.01), ESR (r = 0.370, p < 0.05) and, in particular, CRP (r = 0.629, p < 0.001). Calprotectin was significantly associated with GS (r = 0.359, p < 0.05) and PD synovitis scores (r = 0.497, p < 0.005). Using multivariate regression analysis, calprotectin, adjusted for age and sex, was a better predictor of PD synovitis score (R2 = 0.765, p < 0.001) than CRP (R2 = 0.496, p < 0.001).ConclusionsThe serum levels of calprotectin are significantly associated with clinical, laboratory and ultrasound assessments of RA disease activity. These results suggest that calprotectin might be superior to CRP for monitoring ultrasound-determined synovial inflammation in RA patients.

Serum Calprotectin Discriminates Subclinical Disease Activity from Ultrasound-Defined Remission in Patients with Rheumatoid Arthritis in Clinical Remission

Objective Clinical remission in some patients with rheumatoid arthritis (RA) may be associated with ongoing synovial inflammation that is not always detectable on clinical examination or reflected by laboratory tests but can be visualized by musculoskeletal ultrasound. The goal of our study was to determine the levels of serum calprotectin, a major leukocyte protein, in patients with RA in clinical remission and to investigate the ability of serum calprotectin levels to distinguish patients in ultrasound-defined remission from those with residual ultrasound subclinical inflammation. Methods Seventy RA patients in clinical remission underwent clinical and ultrasound examination. Ultrasound examination was performed according to the German US7 score. Ultrasound remission was defined as grey scale (GS) range 0–1 and power Doppler (PD) range 0. The levels of serum calprotectin and C-reactive protein (CRP) were determined. The discriminatory capacity of calprotectin and CRP in detecting residual ultrasound inflammation was assessed using ROC curves. Results The total number of patients fulfilling the DAS28-ESR, DAS28-CRP, SDAI and CDAI remission criteria was 58, 67, 32 and 31, respectively. Residual synovial inflammation was found in 58–67% of the patients who fulfilled at least one set of clinical remission criteria. Calprotectin levels were significantly higher in patients with residual synovial inflammation than in those with ultrasound-defined remission (mean 2.5±1.3 vs. 1.7±0.8 μg/mL, p<0.005). Using ultrasound-defined remission criteria, calprotectin had an AUC of 0.692, p<0.05 using DAS28-ESR remission criteria and an AUC of 0.712, p<0.005 using DAS28-CRP remission criteria. Calprotectin correctly distinguished ultrasound remission from subclinical activity in 70% of patients. CRP (AUC DAS28-ESR = 0.494, p = NS; AUC DAS28-CRP = 0.498, p = NS) had lower and insignificant discriminatory capacity. Conclusion The present study demonstrates the potential of calprotectin to distinguish RA patients in both clinical and ultrasound-defined remission from patients in clinical remission but with residual subclinical disease activity.

Relationship between serum calprotectin (S100A8/9) and clinical, laboratory and ultrasound parameters of disease activity in rheumatoid arthritis: A large cohort study

Background Calprotectin may be a sensitive biomarker of rheumatoid arthritis (RA) disease activity. Objectives In the current study, we investigated whether calprotectin is a better biomarker than CRP for predicting clinical activity and ultrasound parameters in patients with RA. Methods A total of 160 patients with RA underwent clinical (swollen joint count—SJC, tender joint count—TJC, Disease Activity Score—DAS28, Clinical Disease Activity Index—CDAI, and simplified Disease Activity Index—SDAI) and ultrasound (German US7) examination. Clinical and laboratory measures were correlated with ultrasound findings using Spearman´s correlation coefficient. Differences in serum calprotectin levels in patients with variable disease activity according to the DAS28-ESR and CDAI scores were assessed using ANOVA. Multivariate regression analysis was used to determine the predictive values of calprotectin, CRP and SJC for CDAI and PD US synovitis scores. Results Serum calprotectin was significantly associated with DAS28-ESR (r = 0.321, p<0.001), DAS28-CRP (r = 0.346, p<0.001), SDAI (r = 0.305, p<0.001), CDAI (r = 0.279, p<0.001) scores and CRP levels (r = 0.556, p<0.001). Moreover, calprotectin was significantly correlated with GS (r = 0.379, p<0.001) and PD synovitis scores (r = 0.419, p<0.001). The multivariate regression analysis showed that calprotectin is a better predictor of the CDAI score and PD US synovitis than CRP. Conclusions The results of this study support an additional role of calprotectin in assessing inflammatory activity in patients with RA.

FRI0532 Association between The 7-Joint Ultrasound Score (US7S) and Physical Function in Rheumatoid Arthritis

Objectives To investigate the longitudinal relationship between physical disability and US7S in a prospective cohort of patients with RA. Methods A cohort of 205 RA pts (49 incident/156 prevalent) (mean±SD age 55±14 years, 47% RF+, 63% ACPA+, DAS28-CRP 3.7±1.5, mHAQ 0.43±0.52, disease duration in incident vs. prevalent pts. 0.9±0.7 vs. 8.1± 8.3 resp.) was followed up longitudinally for 29±9 months. Assessments at baseline and at month 3 and 6, and then every 6 months comprised DAS28-CRP, functional evaluations using the modified Health Assessment Questionnaire (mHAQ) and an ultrasound assessment of the clinically dominant hand and foot by US7S1. US7S consists of 5 subscores for synovitis (syn) and tenosynovitis (ten) assessed by grey-scale (GS) and Power-Doppler (PD), and an erosions score (ES). A linear mixed model was used to assess the longitudinal relationship between US7 subscores and mHAQ. Univariate analyses with an interaction term for incident vs. prevalent disease, and a multivariate analysis (with age, sex, BMI, RF and ACPA status, and DAS28-CRP entered as covariates) were performed. Results In univariate analyses (table) mHAQ was longitudinally associated with GSsyn, PDsyn, PDten and GSten US7 subscores (with resp. β coefficients significantly higher in incident patients), while erosions score was a significant predictor of mHAQ only in prevalent pts. In a multivariate model the US7 subscores were individually no longer significant predictors of mHAQ, although the R2 of the model was improved by addition of US7 items from 43.6 to 46.9 (p<0.001 for improvement of R2).Table 1. Univariate analyses and interaction with incident (i)/prevalent (p) RA (predicted variable – mHAQ) Predictor RA β (95% CI) p-value* p-value** % variability explained – R2 DAS28-CRP all 0.112 (0.100; 0.123) <0.001 0.510 44.5 i 0.120 (0.093; 0.146) <0.001 p 0.110 (0.097; 0.123) <0.001 GSsynUS all 0.008 (0.004; 0.011) <0.001 0.038 3.2 i 0.014 (0.007; 0.021) <0.001 p 0.006 (0.002; 0.010) 0.002 PDsynUS all 0.012 (0.008; 0.016) <0.001 0.018 4.3 i 0.021 (0.012; 0.029) <0.001 p 0.009 (0.004; 0.014) <0.001 GStenUS all 0.018 (0.002; 0.035) 0.032 0.078 1.7 i 0.045 (0.011; 0.080) 0.010 p 0.010 (0.000; 0.020) 0.316 PDtenUS all 0.024 (0.012; 0.037) <0.001 0.032 2.0 i 0.053 (0.024; 0.083) <0.001 p 0.017 (0.010; 0.024) 0.013 ES all 0.009 (−0.003; 0.021) 0.145 0.062 0.3 i −0.021 (−0.055; 0.013) 0.216 p 0.013 (0.001; 0.026) 0.047 *p-value of significance of given β. **p-value of significance of difference between incident and prevalent RA. Conclusions This study provides evidence that RA related activity and damage reflected by US7S contribute to impaired physical function in RA, and their impact differs in early and established disease. When combined with conventional clinical parameters, the additional explanatory value of US7 for mHAQ was only minor. References Backhaus M. et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 2009 Sep 15;61(9):1194–201 Acknowledgement This work was supported by the project (Ministry of Health, Czech Republic) for consensual development of research organization 023728, and IGA grant NT12437 Disclosure of Interest None declared

THU0353 Serum Tweak Levels in Patients with Neuropsychiatric Systemic Lupus Erythematosus

Background Systemic lupus erythematosus (SLE) is autoimmune disease involving various organs including the nervous system. Neuropsychiatric SLE (NPSLE) occurs in 30 - 40% of SLE patients. One of the most common manifestations of NPSLE is cognitive dysfunction (CD) which occurs in 21 - 81% of SLE patients. TWEAK is a TNF family ligand that mediates pleotropic effects through its receptor Fn14, including the stimulation of inflammatory cytokine production and induction of neuronal death. Recent studies in animal models and human SLE patients suggest TWEAK as a potential mediator of NPSLE. Objectives To examine potential association between serum TWEAK levels and NPSLE, mainly cognitive dysfunction in patients with SLE, to determine a possible association with other types of organ involvement and specific autoantibodies (antineuronal, antiphospholipid, anti-dsDNA, antinuclear, anti-P protein, etc), and a correlation with disease activity. Methods The SLE patients (fulfilling ACR classification criteria for SLE) have undergone a complete neuropsychiatric examination for the presence NPSLE including brain MRI. CD has been assessed according to the ACR classification of NPSLE. The activity of the disease was evaluated using the diseases activity index (SLEDAI). Serum TWEAK levels were measured by ELISA. Results We analyzed 90 SLE patients. The neuropsychiatric involvement and cognitive dysfunction with moderate to severe disability was diagnosed in 58 (64.4%), 53 (58.8%) patients, resp. The headache, cranial neuropathy and epilepsy were the most frequent neurological manifestations. Active disease was present in 44 patients (48.8%). In contrast to recent studies no significant differences were found in the serum TWEAK levels between patients with and without NPSLE. There were also no differences in serum TWEK levels between patients with and without CD. We did not observe any association of serum TWEAK levels with different organ SLE manifestations, presence of antibodies or disease activity. Conclusions NPSLE and CD were found to be frequent SLE manifestations in our cohort. However, serum TWEAK levels do not seem to be a reliable biomarker for NPSLE or other manifestations in patients with SLE. Further studies in patients with new NPSLE manifestation prior to initiating therapy may be needed. References Wen J, Xia Y, Stock A et al. Neuropsychiatric disease in murine lupus is dependent on the TWEAK/Fn14 pathway. J Autoimmun 2013; 43: 44–54. Stock AD, Wen J, Putterman Ch. Neuropsychiatric lupus, the blood brain barrier, and the TWEAK/Fn14 pathway. Front Immunol 2013; 4: 484. Fragoso-Loyo H, Atisha-Fregoso Y, Nuñez-Alvarez CA et al. Utility of TWEAK to assess neuropsychiatric disease activity in systemic lupus erythematosus. Lupus 2015 Oct 13.[Epub ahead of print] Xu WD, Zhao Y, Liu Y. Role of the TWEAK/Fn14 pathway in autoimmune diseases. Immunol Res. 2015 Dec 12 [Epub ahead of print] Acknowledgement Supported by the project (Ministry of Health, Czech Republic) for conceptual development of research organization 00023728 (Institute of Rheumatology). Disclosure of Interest None declared

AB0952 Serum Visfatin and Resistin, but Not Adiponectin or Leptin, Are Associated with Ultrasound Synovitis in Patients with Rheumatoid Arthritis

Background Adipocytokines are soluble mediators secreted by adipose tissue and immune cells with potent immune regulatory functions. Some adipocytokines have been previously associated with disease activity and radiographic progression in patients with rheumatoid arthritis (RA)1. Objectives To investigate associations between adipocytokines, clinical and traditional laboratory markers as well as with ultrasound synovitis in patients with RA. Methods A total of 82 patients with RA (62 females, median disease duration 4.2 years) were enrolled into this study. All patients underwent clinical examination (swollen joint count - SJC, tender joint count – TJC, Disease activity score - DAS28-ESR and DAS28-CRP, Clinical disease activity index - CDAI, Simplified disease activity index - SDAI). Moreover, ultrasound examination of 7 selected joints mostly affected in RA (wrist, second and third metacarpophalangeal and proximal interphalangeal, and second and fifth metatarsophalangeal joints) was performed to measure synovial hypertrophy in Grey Scale (GS) and pathological neovascularization in Power Doppler (PD) using semi-quantitative grading 0–33. Blood samples were taken at the same day as clinical and ultrasound assessments. Serum concentrations of adiponectin, resistin, visfatin, leptin and CRP were measured. Clinical and laboratory measures were correlated with ultrasound findings using Spearmans correlation coefficient. Results Serum visfatin and resistin levels were associated with the disease activity (Figure 1) and correlated significantly with DAS28-ESR (r=0.473, p<0.001; r=0.363, p<0.001, resp.), DAS28-CRP (r=0.443, p<0.001; r=0.348, p<0.005, resp.), SDAI (r=0.431, p<0.001; r=0.344, p<0.005, resp.), CDAI (r=0.419, p<0.001, r=0.344, p<0.005, resp.) and with CRP levels (r=0.456, p<0.001; r=0.364, p<0.001, resp.). Moreover, visfatin and resistin levels significantly correlated with GS (r=0.430, p<0.001, r=0.273, p<0.05, resp.) and PD synovitis scores (r=0.309, p<0.01, r=0.283, p=0.01, resp.). Neither leptin nor adiponectin correlated with parameters of disease activity in patients with RA. Conclusions Our study supports circulating visfatin and resistin as promising serum pro-inflammatory biomarkers reflecting clinical, laboratory as well as ultrasound parameters of synovial inflammation in RA. References Senolt L, Krystufkova O, Hulejova H, Kuklova M, Filkova M, Cerezo LA, Belacek J, Haluzik M, Forejtova S, Gay S, Pavelka K, Vencovsky J: The level of serum visfatin (PBEF) is associated with total number of B cells in patients with rheumatoid arthritis and decreases following B cell depletion therapy. Cytokine 2011, 55: 116–121 Acknowledgement This work was supported by the project (Ministry of Health, Czech Republic) for consensual development of research organization 023728, IGA grant No. NT12437 and GAUK grant No. 1010213. Disclosure of Interest None declared

FRI0592 Serum Calprotectin is Associated with Ultrasound-Determined Active Synovitis in Patients with Rheumatoid Arthritis

Background Calprotectin (S100A8/9, MRP8/14) is a promising circulating biomarker reflecting disease activity in patients with rheumatoid arthritis (RA). In two small previous studies in RA patients1,2, serum calprotectin correlated with ultrasound synovial inflammation. Objectives To investigate associations between serum calprotectin, clinical and ultrasound-determined disease activity in a larger cohort of RA patients in a cross-sectional study. Methods A total of 167 patients with RA (134 females) were enrolled in this study. All patients underwent clinical assessment (SJC, TJC, DAS28-ESR) and ultrasound examination according to the US-7 score3 to assess synovitis by gray-scale (GS) and power Doppler (PD) using semiquantitative grading (0-3). Serum calprotecin was measured by ELISA. Associations between serum calprotectin, C-reactive protein (CRP) and clinical as well as ultrasound findings were explored using Spearmans correlation coefficient. A multiple regression analysis was used to determine the predictive value of calprotectin (mg/l), CRP (mg/l) and DAS28 for GS and PD synovitis score. Results Serum calprotectin significantly correlated with DAS28 (r=0.357, p<0.001), SJC (r=0.258, p=0.001), TJC (r=0.181, p<0.05), ESR (r=0.386, p<0.001) and particularly with CRP levels (r=0.540, p<0.001). In addition, calprotectin was also associated with GS (r=0.341, p<0.001) and PD synovitis (r=0.313, p<0.001). Using a multivariate linear regression model with calprotectin, CRP and DAS28-FW as explanatory variables, calprotectin and DAS28, but not CRP, were significant predictors for GS (β=0.371, p<0.001; β=0.598, p<0.001, resp.) and PD synovitis (β=0.346, p<0.001; β=0.379, p<0.001, resp.). Conclusions This study confirms in a large cohort of RA patients that serum levels of calprotectin are significantly associated with clinical, laboratory and ultrasound assessments of disease activity. Calprotectin is more closely associated with local joint inflammation than CRP and thus may represent a more specific circulating biomarker for monitoring synovial inflammation in RA patients. References Hammer HB, Fagerhol MK, Wien TN, Kvien TK. The soluble biomarker calprotectin (an S100 protein) is associated to ultrasonographic synovitis scores and is sensitive to change in patients with rheumatoid arthritis treated with adalimumab. Arthritis Res Ther. 2011;13(5):R178. Hurnakova J, Hanova P, Hulejova H, et al. Serum calprotectin (S100A8/9) correlates with clinical and ultrasound outcomes in patients with early rheumatoid arthritis. In Ann Rheum Dis. 2014; Suppl (2):658–658. Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, Hartung W, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 2009 Sep 15; 61(9):1194-1201. Acknowledgements This work was supported by the project (Ministry of Health, Czech Republic) for consensual development of research organization 023728, IGA grant No. NT12437 and GAUK grant No. 1010213. Disclosure of Interest None declared

SAT0205 Potential of US 7 Score in Evaluating of Disease Activity of Patients with Rheumatoid Arthritis in the State of Remission

Background It has been shown that patients in remission of rheumatoid arthritis (RA) continue to have subclinical synovitis1. Objectives To evaluate the usefulness of the US7 scoring system in detecting synovitis in patients with RA who are in remission of disease. Methods 73 patients with remission of rheumatoid arthritis (RA) according to DAS 28 <2.6 criteria with duration of at least 3 months were identified. ACR/EULAR remission criteria were assessed separately. HAQ, SJC, and TJC were evaluated during 1 year at 3 months intervals. The 7-joint ultrasound score (US7) was used for all US assessments2. Sonographers used the same US machine; settings were not allowed to be changed. Inter- and intraobserver reliability in using US7 scoring system were computed for all measurements. Spearmann coefficient was used to calculate statistical correlations. Results 212 patient visits were recorded and 1484 joints were investigated. Only 13 patients (17.3%) in clinical remission had no synovitis in US7 (GS0, PD0), regardless whether tenosynovitis was present or not. 50 patients (68%) continued to have subclinical synovitis in US7 at the baseline (GSUS/PDUS>1). Relapse rate during one-year observation (DAS28>2.6) was 17% at 3rd and 6th months, respectively, 11% in 9th month and 18% at 12th month, respectively. Total score of GSUS and PDUS synovitis at month 3 (p<0,01, p<0,05) and 6 (p<0,001, p<0,01) correlated well with DAS 28 score. This statistical significance was not reached in month 1 and 9, where the relapse rate was 0 (baseline) and low (month 9), thus only subclinical synovitis was more frequently seen while DAS28<2.6. GSUS synovitis on US7 significantly correlated with ACR/EULAR remission criteria at months 1,3,6 and 12 (all p<0,01). There was a strong correlation between present synovitis and tenosynovitis on US7 but no correlation of TS itself and other disease activity or disability parameters were observed (HAQ, DAS28, ACR remission crit.). Number of erosions increased during one-year observation. Conclusions With the US7 score, it was possible to find a high percentage of subclinical synovitis in patients in remission of RA according to previous studies published using other scoring systems. Therefore, US7 might be a simple and effective tool to monitor disease activity of RA even in the state of remission. There was a better correlation between US7 GSUS findings and ACR/EULAR remission criteria than remission assessed according to DAS28 criteria. Further studies are needed to confirm these findings with US7 scoring system. References Gärtner M, et al. Sonographic joint assessment in rheumatoid arthritis: associations with clinical joint assessment during a state of remission. Arthritis Rheum. 2013 Aug;65(8):2005-14. Backhaus TM, et al. The US7 score is sensitive to change in a large cohort of patients with rheumatoid arthritis over 12 months of therapy. Ann Rheum Dis. 2013 Jul;72(7):1163-9. Acknowledgements Supported by project of MHCR for conceptual development of research organization 023728 and IGA grant No. NT12437. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3859

SAT0188 Serum Calprotectin (S100A8/9) Correlates with Clinical and Ultrasound Outcomes in Patients with Early Rheumatoid Arthritis

Background Calprotectin, a heterodimeric complex of S100A8/9 (MRP8/14), has been demonstrated as an important biomarker of clinical and laboratory disease activity and structural joint damage in rheumatoid arthritis (RA).1,2 Ultrasound is a sensitive and reliable tool for assessing synovial inflammation in RA.3 Objectives To test the hypothesis that calprotectin is associated with clinical and ultrasound disease activity in patients with RA in a cross-sectional study and to investigate the contribution of various parameters to predict ultrasound findings. Methods A total of 37 patients with RA (24 females, median disease duration 18 months) underwent clinical examination (DAS28) and 7-joint ultrasound score (US-7) of clinically dominant wrist, second and third metacarpophalangeal and proximal interphalangeal, and second and fifth metatarsophalangeal joints to assess synovitis and tenosynovitis by gray-scale (GS) and power Doppler (PD) ultrasound using semiquantitative grading 0-3. The levels of serum calprotectin and C-reactive protein were measured at the time of ultrasound assessment. Clinical and laboratory measures were correlated with ultrasound findings. Multiple regression analysis was used to determine the predictive value of calprotectin, CRP and DAS28 to determine PD synovitis. Results We found that DAS28 (r=0.605, p<0.001; r=0.605, p<0.001, resp.) and CRP levels (r=0.451, p=0.006; r=0.463, p=0.004, resp.) correlate significantly with GS and PD synovitis. In addition, calprotectin correlated significantly with PD synovitis (r=0.497, p<0.005). Furthermore, serum calprotectin significantly correlated with CRP (r=0.629, p<0.001) and DAS28 (r=0.385, p<0.019). In addition to DAS28 (p=0.001), calprotectin (p<0.001) was a strong predictor of active PD synovitis (adjusted R2=0.811). Conclusions This study confirms tight association between clinical, laboratory and ultrasound assessment and support circulating calprotectin as an important biomarker for monitoring synovial inflammation in RA. References Andrés Cerezo L, Mann H, Pecha O, et al. Decreases in serum levels of S100A8/9 (calprotectin) correlate with improvements in total swollen joint count in patients with recent-onset rheumatoid arthritis. Arthritis Res Ther. 2011;13(4):R122. Hammer HB, Fagerhol MK, Wien TN, Kvien TK. The soluble biomarker calprotectin (an S100 protein) is associated to ultrasonographic synovitis scores and is sensitive to change in patients with rheumatoid arthritis treated with adalimumab. Arthritis Res Ther. 2011;13(5):R178. Backhaus TM, et al. The US7 score is sensitive to change in a large cohort of patients with rheumatoid arthritis over 12 months of therapy. Ann Rheum Dis. 2013 Jul;72(7):1163-9. Acknowledgements This work was supported by project of MHCR for conceptual development of research organization 023728, IGA grant No. NT12437 and GAUK grant No. 1010213. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5005