Y. Kisten

Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

Objectives To study fully automated digital joint space width (JSW) and bone mineral density (BMD) in relation to a conventional radiographic scoring method in early rheumatoid arthritis (eRA). Methods Radiographs scored by the modified Sharp van der Heijde score (SHS) in patients with eRA were acquired from the SWEdish FarmacOTherapy study. Fully automated JSW measurements of bilateral metacarpals 2, 3 and 4 were compared with the joint space narrowing (JSN) score in SHS. Multilevel mixed model statistics were applied to calculate the significance of the association between ΔJSW and ΔBMD over 1 year, and the JSW differences between damaged and undamaged joints as evaluated by the JSN. Results Based on 576 joints of 96 patients with eRA, a significant reduction from baseline to 1 year was observed in the JSW from 1.69 (±0.19) mm to 1.66 (±0.19) mm (p<0.01), and BMD from 0.583 (±0.068) g/cm2 to 0.566 (±0.074) g/cm2 (p<0.01). A significant positive association was observed between ΔJSW and ΔBMD over 1 year (p<0.0001). On an individual joint level, JSWs of undamaged (JSN=0) joints were wider than damaged (JSN>0) joints: 1.68 mm (95% CI 1.70 to 1.67) vs 1.54 mm (95% CI 1.63 to 1.46). Similarly the unadjusted multilevel model showed significant differences in JSW between undamaged (1.68 mm (95% CI 1.72 to 1.64)) and damaged joints (1.63 mm (95% CI 1.68 to 1.58)) (p=0.0048). This difference remained significant in the adjusted model: 1.66 mm (95% CI 1.70 to 1.61) vs 1.62 mm (95% CI 1.68 to 1.56) (p=0.042). Conclusions To measure the JSW with this fully automated digital tool may be useful as a quick and observer-independent application for evaluating cartilage damage in eRA. Trial registration number NCT00764725.

A5.02 Fluorescence optical imaging coupled with ultrasound radiography for detecting subtle hand inflammation in early rheumatoid arthritis

Objectives Fluorescence Optical Imaging (FOI) is an emerging modality that uses an intravenous fluorophore to display altered microcirculation (abnormal perfusion/capillary leakage) in synovial tissues in the hands. FOI can be analyzed visually (FOI-v) or by using automated Disease ACTivity (DACT). Using musculoskeletal ultrasound (MSUS) as a validated reference measure, we previously showed FOI to be highly sensitive and specific in detecting clinically manifest and silent synovitis in patients with various rheumatic diseases. Here, we analyze whether the same is true for early rheumatoid arthritis (eRA). Methods Hands and wrists ineRA patients were assessed by clinical examination, MSUS and FOI-DACT. Active inflammation was defined as having synovial-hypertrophy/effusions and intra-articular Doppler signaling on MSUS, and as increased optical-intensities on FOI-v. Scores on DACT ≥ 1 was considered indicative of disease activity. Results 39 eRA patients were studied [72% females, 56% previous/current smokers, 54% RF(+) and 69% ACCP(+)]. Of the 1326 joints in these patients, 303 were inflamed by clinical assessment, 380 by MSUS, and 400 by FOI-v. The percentages of patients and (mean ± SD) joints by clinical, MSUS and FOI-v were 69%(7.8 ± 8.1), 95%(9.7 ± 7.7), and 95%(10.3 ± 7.2), respectively. Using MSUS as reference, FOI-DACT was 95%(35/37) accurate in identifying patients with active disease, 24%(9/37) of whom had erosive RA. Good correlations noted between MSUS and FOI-v (rho = 0.803; p < 0.001), clinical assessment and FOI-v (rho = 0.732; p < 0.001), and MSUS and clinical (rho = 0.793; p < 0.001). The sensitivity, specificity, NPV and PPV of inflammation by FOI-v was 81%(308/380), 90%(854/946), 61%, and 96% respectively. Of the clinically negative but MSUS positive (145/1023) joints, 68%(98/145) were also FOI-v positive. Remarkably, one patient had 15 joints that were FOI-DACT positive and MSUS negative, but a month later, the same joints became MSUS positive. Although the wrists and MCPs were frequently inflamed, DIP joint inflammation was also seen in 34 and 14 joints in 12 patients by FOI-DACT and MSUS, respectively. Nine of these patients had osteoarthritis by conventional radiography. Conclusions As reported for established rheumatic diseases, here we show high correlations and agreements between clinical examination, MSUS and FOI-v in detecting subtle inflammation in early RA as well. Moreover, DACT-FOI emerges as a useful automated quantitative scoring method for synovial inflammation in eRA. Reference Kisten Y, Györi N, af Klint E, et al. 2015 Detection of clinically manifest and silent synovitis in the hands and wrists by fluorescence optical imaging. RMD Open. 1: e000106. doi:10.1136/ rmdopen-2015-000106(http://rmdopen.bmj.com/content/1/1/e000106.full.pdf+html)

SAT0093 Hand Joint Inflammation on Fluorescence Optical Imaging Reveal Distinct Patterns in Seropositive and Seronegative Early Rheumatoid Arthritis

Background Detection of abnormal Rheumatoid Arthritis (RA) related autoantibodies, Rheumatoid Factor (RF) and Anti-Citrullinated Peptide Antibody (ACPA), along with Musculoskeletal ultrasound (MSUS) play a critical role in the diagnosis of early RA (eRA). Fluorescence optical imaging (FOI) is an emerging modality designed for the hands and wrists that detects subclinical hand joint inflammation1 and may therefore prove valuable in the assessment of eRA. Objectives Here, we analyzed the FOI results of eRA patients and investigate whether patterns of hand joint inflammation may distinguish seropositive from seronegative RA. Methods In FOI, Inflammation is considered positive, when altered microcirculation (capillary leakage/perfusion) is seen as abnormally increased focal optical signal intensities by visual inspection of the entire image series in real-time (360 seconds all 34 joints: 3 wrists, 5 MCPs, 5 PIPs and 4 DIPs, bilaterally are evaluated using post-processing imaging techniques). Unsupervised ascending hierarchical clustering was used to identify clusters of patients with different patterns of joint involvement in FOI. The robustness of the clustering was verified using another clustering method (k-means), and agreement between the 2 methods was assessed using Cohens kappa. Baseline clinical and biological characteristics of patients were compared between the clusters using non-parametric tests. Results Out of 1326 joints of 39 eRA patients (26 females; 9 with erosive RA; 54% RF+; and 69% ACPA+), 400 (30%) were considered positively inflamed by FOI. The mean (±SD) number of active joints detected by FOI was 10.3 ± 7.2. Clustering of joint involvement according to the FOI distinguished 2 separate clusters of patients: Cluster1 (n=29) and Cluster2 (n=10). The proportion of seropositive patients was significantly higher in cluster 1 versus cluster 2 (26/29 versus 3/10, p<0.01) (figure). The distribution of inflammation throughout the joints, except for right MCP2, PIPs 5, left MCP1 & DIPs in cluster 2 displayed distinguishable patterns (p<0.05) compared to cluster 1, which showed joint inflammation to be largely concentrated around wrists, right MCP2, bilateral MCP3, and to a lesser degree around PIPs 2–4, and left MCP2. The DIPs showed no significant differences between clusters. Conclusions Two separate patterns of inflammatory joint involvement may be distinguished in early RA, using fluorescence optical imaging. The proportion of seropositive patients was significantly different between these patterns, suggesting that FOI identifies patterns of joint involvement that are different for seropositive and seronegative RA. References Kisten Y, Györi N, af Klint E, et al. 2015 Detection of clinically manifest and silent synovitis in the hands and wrists by fluorescence optical imaging. RMD Open 2015;1: e000106. doi:10.1136/ rmdopen-2015-000106 (http://rmdopen.bmj.com/content/1/1/e000106.full.pdf+html) Disclosure of Interest None declared

FRI0537 Automated Joint Space Width Measurement and Digital X-Ray Radiogrammetry in Early RA

Background Despite technological advancements and the availability of ultrasound and magnetic resonance imaging modalities, conventional radiography still remains the main imaging tool in Rheumatoid Arthritis (RA) patient management (1). One of the validated methods of radiographic scoring in RA, the modified Sharp van der Heijde (SHS) method, has much strength but is time-consuming, observer-dependent, and requires training, and is therefore seldom used in clinical practice (1, 2). Automated digital methods have been developed for analysing radiographs and may provide useful information on Joint Space Width (JSW) and/or Bone Mineral Density (BMD). Objectives To assess the feasibility and correspondence of fully automated digital measurements of JSW with conventional methods in early RA. Methods Patient characteristics and radiographic reports scored by the SHS method of 119 early RA patients were acquired from the SWEFOT database. From this cohort, 96 patients had both baseline and follow-up JSW and BMD measurements. Fully automated bilateral BMD of metacarpal diaphyses 2–4 and JSW of MCP joints 2, 3 & 4 (Sectra, Linköping, Sweden) were assessed. Additionally, JSW was compared to the joint space narrowing (JSN) score. Multilevel mixed models taking into account correlations between joints of the same hand, contralateral hand and repeated visits were used. Furthermore, these models were adjusted for height, age, gender and BMI. Results We studied 119 early RA patients (78% female), with an average age of 54 ±14.4 years. In 576 joints, patients with both baseline and follow-up JSW and BMD measurements, a significant reduction from baseline to 1 year was shown in the mean JSW (0.169 ±0.019cm to 0.166 ±0.019cm, p<0.01) and mean BMD (0.583 ±0.068g/cm2 to 0.566 ±0.074g/cm2, p<0.01). Significant correlations between JSW and BMD were observed at baseline (r=0.32, p<0.01) and 12-months (r=0.35, p<0.01). Inverse correlations emerged between automated JSW and SHS Joint Space Narrowing (JSN) assessments at baseline (r=-0.29, p<0.01) and 12-months (r=-0.24, p=0.014). JSWs of undamaged (JSN=0) joints were wider than damaged joints (0.168cm [95% CI: 0.170–167] versus 0.154cm [95% CI: 0.163–0.146]). Similarly the unadjusted multilevel model showed significant differences in JSW between undamaged (0.168cm [95% CI: 0.172–0.164]) and damaged joints (0.163cm [95% CI: 0.168–0.158cm]), p<0.01. This difference remained significant in the adjusted model (0.166cm [95% CI: 0.170–0.161] versus 0.162cm [95% CI: 0.168–0.156], p<0.05). Conclusions Digital JSW may have potential as a quick and observer-independent measure of cartilage damage in early RA. References Boini S, Guillemin F. Radiographic scoring methods as outcome measures in rheumatoid arthritis: properties and advantages. Annals of the rheumatic diseases. 2001;60(9):817–27. Peloschek P, Langs G, Weber M, Sailer J, Reisegger M, Imhof H, et al. An automatic model-based system for joint space measurements on hand radiographs: initial experience. Radiology. 2007;245(3):855–62. Disclosure of Interest M. Platten: None declared, Y. Kisten: None declared, J. Kälvesten Employee of: Sectra AB, L. Arnaud: None declared, K. Forslind: None declared, R. van Vollenhoven: None declared

THU0455 Evaluating Psoriatic Skin Lesions in Psoriasis and Psoriatic Arthritis: Ultrasound as A Complementary Measure

Background Currently, the diagnosis and assessment of psoriatic arthritis (PsA) and psoriasis (PsO) skin lesions are mostly done by visual inspections, and when in doubt, supplemented by biopsies. Although PsA is primarily assessed by physical examination, the utility of ultrasound (US) is beneficial. Objectives The aim of this proof of concept study was to determine the performance of ultrasound (using advanced imaging software applications) in assessing skin lesions and inflammation in selected PsA and PsO patients. Methods A rheumatologist and dermatologist assessed the PsA and PsO patients respectively. PsA examination included the standard clinical joint assessments, and we thereafter evaluated the hands & wrists and symptomatic joints with US for synovitis & tenosynovitis (including nail beds & tendons). Blinded by the clinical results and treatment plans, the epidermal, dermal and subcutaneous tissue thicknesses of 2 of the most affected psoriasis lesions were US scanned using high frequency B-Mode, automated Color Doppler quantification (CDQ; measured over 4 seconds) and elastography applications (measuring lesion size, depth, hyperemia and tissue elasticity). The skin tissue adjacent to the psoriasis lesions, as well as the unaffected skin on the contralateral side (self-control) was measured. Results A total of 270 skin depth measurements (2 of the most affected lesions, 3 intervals apart, at 3 different sites described above) of 5 PsA/PsO patients were analyzed. Epidermal thickness differed significantly between the adjacent and control tissue layers [F (2,27) =30.95, MSE =0.76, p<0.001]. Similar findings were evident for dermal thickness differences [F (2,27) =5.05, MSE =1.59, p=0.014]. In contrast and as expected, subcutaneous tissue thicknesses showed no significant differences. US using color Doppler revealed the presence of hyperemia in 80% of the examined lesions by CDQ resulted in flow averages ranging from 0.016–0.655 for minimum ratios to 0.103–0.241 for maximum ratios. Of these Doppler active lesions, 60% were echogenic (some with acoustic shadowing). Contrary, 20% of the psoriasis lesions showed no obvious Doppler activity, displaying reduced tissue stiffening on elastography (suggesting healed lesions). Two of 10 (20%) lesions showed no abnormal findings (soft on elastography) having no acoustic shadows, and low-level CDQ activity (minimum 0.016:0.034 and maximum 0.103:0.135 ratios). Ultrasound displayed the presence of synovitis, tenosynovitis, and nail-bed hyperemia together with altered microcirculation & hand psoriasis skin perfusion in PsA patients. Conclusions Ultrasound metrics of skin tissue (plaque characteristics, tissue depth & elasticity, and Doppler activity quantification) has potential as a complementary measure for the clinical assessment of PsA and PsO. Disclosure of Interest None declared

AB0981 Hand Joint Inflammation in Early Ra: Clinical Ultrasound and Fluorescence Optical Imaging Diagnostics

Background Altered microcirculation (abnormal perfusion/capillary leakage) of synovial tissue can be detected early using Fluorescence Optical Imaging (FOI). FOI utilizes an intravenous fluorophore1,2 that displays high-resolution hand images that can be analyzed visually (FOI-v) in real-time, or by using digital Disease ACTivity (DACT) scoring methods. We previously reported FOIs sensitivity and specificity in detecting silent synovitis in various rheumatic diseases1. Objectives Here, we test the diagnostic performance of FOI-DACT in detecting subtle hand joint inflammation in early rheumatoid arthritis (eRA), as compared to clinical evaluation and MusculoSkeletal UltraSound (MSUS). Methods Fingers and wrists of patients with eRA were assessed by clinical examination, MSUS and FOI-DACT imaging. Inflammation was defined as having synovial hypertrophy/effusions and intra-articular Doppler signaling on MSUS, and as increased optical intensities on FOI-v. Scores of DACT≥1 were considered indicative of disease activity. Results 1326 joints of 39 eRA patients [72% females, 56% previous/current smokers, 54% RF(+) and 69% ACPA(+)] were studied. The incidence and mean number ±SD of joints inflamed by clinical, MSUS and FOI-v were 23% (7.8±8.1), 29% (9.7±7.7) and 30% (10.3±7.2), respectively. Using MSUS as a reference, FOI-DACT was 95% (35/37) accurate in identifying patients with active disease, 24% (9/37) of whom had erosive RA. High correlations and agreements emerged between MSUS and FOI-v (r=0.803, p<0.001; kappa±SE:0.70±0.02 [95% CI 0.67–0.75]), clinical and FOI-v (r=0.732, p<0.001; kappa±SE:0.56±0.03 [95% CI 0.51–0.61]) and MSUS and clinical (r=0.793, p<0.001; kappa±SE:0.59±0.03 [95% CI 0.54–0.64]). The sensitivity, specificity, NPV and PPV of inflammation by FOI-v was 81% (308/380), 90% (854/946), 61%, and 96% respectively. Of the clinically negative but MSUS positive (145/1023) joints, 68% (Subclinical: 98/145) were also FOI positive. Remarkably, one patient had 15 joints that were FOI-DACT positive and MSUS negative, but a month later, the same joints became MSUS positive. Although the wrists and MCPs were frequently inflamed, DIP joint inflammation was noted in 12 patients by FOI-DACT and MSUS. Nine of these patients had osteoarthritis by conventional radiography. Conclusions In early RA, Fluorescence Optical Imaging (FOI) coupled with digital Disease ACTivity (DACT) scoring correlates well with MSUS, and has a high positive predictive value. FOI-DACT emerges as a useful automated quantitative scoring method for synovial inflammation, and may be used in monitoring the effects of therapy. References Kisten Y, Györi N, af Klint E, et al. 2015 Detection of clinically manifest and silent synovitis in the hands and wrists by fluorescence optical imaging. RMD Open 2015;1: e000106. doi: 10.1136/rmdopen-2015-000106 (http://rmdopen.bmj.com/content/1/1/e000106.full.pdf+html) Glimm AM, Werner SG, et al. Analysis of distribution and severity of inflammation in patients with osteoarthitis compared to rheumatoid arthritis by ICG-enhanced fluorescence optical imaging and musculoskeletal ultrasound: a pilot study. Annals of the Rheumatic Diseases. Published online Aug. 26, 2015. (http://dx.doi.org/10.1136/annrheumdis-2015-207345). Disclosure of Interest None declared

SAT0632 Quantification of Hand and Wrist Synovitis Using Digital Activity Fluorescence Optical Imaging

Background The objective detection and quantification of inflammatory disease activity is critical for achieving optimal therapy results. Fluorescence optical imaging (FOI) is a novel modality designed for imaging the hands and wrists, and the automated quantification of the ensuing scans using DACT (Disease ACTivity)-FOI is a novel algorithm for analyzing these images. Objectives To determine the utility of DACT-FOI in the assessment of hand and wrist inflammation. Methods Bilateral finger and wrist joints (n=1360) of 40 patients with inflammatory arthritis were studied. Synovitis was defined as tender and swollen joints on clinical examination, presence of synovial thickening/effusion and intra-articular Doppler signals on ultrasound (MSUS), and abnormal focal optical signal intensities on FOI, respectively. The DACT score used an automatically generated algorithm of the composite images (of 240 frames per second) to achieve a quantified score for each patient. Using dedicated image parameters and size correction, the enhanced pixels were extracted automatically from the image background, and the high signal intensities calculated. The DACT-FOI formula was based on fluorescence intensity curve thresholds that were used to discriminate intensity variations, and then divided by the 95th centile of intensities in normal individuals as the reference value. DACT-FOI ≤1 was referred to as normal digital activity signals. Subclinical synovitis was defined as being clinically non-inflamed but inflamed on MSUS. Results Out of the 1360 joints evaluated, 215 (16%) were inflamed clinically, 329 (24%) by MSUS, and 347 (26%) by FOI. For overall hand and wrist disease activity (n=40), the number (mean ± SD) of active joints detected by clinical, MSUS and semi-quantitative FOI was 5.4±7.0; 8.2±7.8; and 8.7±7.8, respectively. The automated digital activity (±SD) calculation by DACT-FOI was 3.8 (±2.1). Correlations of high statistical significance was denoted as ** when p<0.01. A strong positive correlation (r =0.458**; p=0.003) between clinical synovitis and DACT-FOI was demonstrated. The mean DACT values also correlated significantly with MSUS (r =0.442**; p=0.004) and semi-quantitative FOI (r =0.439**; p=0.005). There was a highly significant correlation of synovitis detection between clinical examination and MSUS (r =0.730**; p=0.000) and between clinical examination and semi-quantitative FOI (r =0.577**; p=0.000). Agreement between MSUS and FOI in synovitis detection was good, and revealed strong correlations (0.816**; p=0.000). Out of the non-inflamed joints by clinical examination, 142/1145 (12%) were inflamed by MSUS, of which 102/142 (72%) were also inflamed by FOI. Thus, for detecting subclinical synovitis, the sensitivity, specificity, and positive and negative predictive values of FOI were 72% (102/142), 93% (934/1003), 77% and 91%, respectively. Conclusions FOI and the automated analysis DACT-FOI were technically feasible with high reproducibility and strong agreement with clinical scoring. Therefore, this objective digitally quantified measurement of inflammatory disease activity in the hands & wrists may be useful both in diagnosis and in monitoring the effects of clinical therapy. Disclosure of Interest None declared

AB0490 Kaltenborn's Manual Mobilization Method for Pain Relief in RA Hand Joints: Clinical and Ultrasound Findings in a Pilot Study

Background Pain is an important manifestation of rheumatoid arthritis (RA) and it is imperative to find complementary options for patients experiencing pain despite antirheumatic treatment. Kaltenborns manual mobilization is a complementary and alternative medicine (CAM) method based on gentle traction and passive motion. It has been tested extensively in osteoarthritic joints and found to provide pain relief, but there are no published studies to date on the use of this method in RA hand joints under ultrasound (Doppler) surveillance. Objectives The aim of this pilot study was to preliminarily assess the effectiveness of the Kaltenborn manual mobilization method in reducing tenderness, pain, and Doppler activity in patients with RA. Methods A total of 110 hand joints (1 wrist, 5 MCPs & PIPs bilaterally) in 5 female patients with RA who did not respond to antirheumatic treatment were clinically examined with patient-reported outcomes (PROs) for joint swelling, tenderness, and pain (VAS). Using Kaltenborns technique, the MCP2-5 joints in 1 randomized hand (4/5 patients, n=20) were manually mobilized. Synovitis, tenosynovitis and disease activity were evaluated using the ultrasound Doppler quantification method. Three treatment sessions, each with two segments, were carried out every 2nd day for 1 week. Results Out of the 20 MCP joints treated in the test-hand, 75% (15/20) were self-reported as tender. Of these, 67% (10/15) were non-tender after the 3rd treatment session (1 week). In the control-hand, 60% (12/20) were self-reported as tender. Of these, 50% (6/12) were non-tender after 1 week. Both hands combined yielded highly significant reductions in self-reported tenderness (27/40 vs. 11/40, OR 5.48 [2.10, 14.28], p<0.001). After combining bilateral baseline tenderness with reduced bilateral tenderness after 1 week, patient and physician assessments of both hands demonstrated clinically relevant agreement (0.419, p=0.007). The VAS score (mean ± SD) for the test-hand at baseline was 60.0 (±22.1) vs. 40.0 (±24.2) after the last treatment session (p=0.003). The mean for the control hand was 50.4 (±25.0) at baseline vs. 31.0 (±23.9) after the last treatment session (p=0.036). There was a 14.2% overall reduction in quantitative Doppler activity from the treated joints at baseline (51.5±35.7) vs. all treatment segments within the 1st and 3rd treatment sessions over 1 week (37.3±31.6) (p<0.002). When comparing solely to the final segment of the 3rd treatment session, the treated joints had the largest mean decrease from baseline (21.0%, 51.5±35.7 vs. 30.5±30.8) (p<0.002) (figure). Conclusions An overall pattern of tenderness and pain reduction from baseline to post treatment and even among the control hand was observed, suggesting symmetry behind pain perception in RA. A strong patient-reported effect is present with pain outcomes and quantitative ultrasound helps with identifying changes in inflammation. A highly significant decrease in Doppler activity was observed. The remarkable ultrasound findings may indicate possible physiological microcirculatory changes as a result of joint mobilization therapy. These results support further studies of Kaltenborns manual mobilization as a relatively safe, complementary treatment option for RA patients with tender hand joints despite antirheumatic therapy. Disclosure of Interest A. Levitsky: None declared, Y. Kisten: None declared, P. Nordström: None declared, S. Lind: None declared, N. Vivar: None declared, R. van Vollenhoven Grant/research support from: AbbVie, BMS, GSK, Pfizer, Roche, UCB, Consultant for: AbbVie, Biotest, BMS, Crescendo, GSK, Janssen, Lilly, Merck, Pfizer, Roche, UCB, Vertex

SAT0622 The Clinical Use of Digital Joint Space Width and X-Ray Radiogrammetry as Markers for Early Radiographic Progression in RA

Background Early prediction of radiographic progression is beneficial in rheumatoid arthritis (RA) patient management. The van der Heijde modified Sharp score (SHS) is currently the gold standard that quantifies radiographic progression. The digital joint space width (JSW) measurement (Kälvesten et. al, submitted 2015) is a quick method which may offer a remedy to observer dependency and measurement error. Likewise, objective quantification of hand osteopenia may also offer added value in the assessment of bone involvement in early RA. Objectives To determine the relationships between metacarpal bone mineral density (BMD) scores and the automated JSW measurements, and how they correlate with radiographic progression in SHS from baseline to 12 months. Methods Bilateral hand BMD and JSW measurements of the metacarpals (2, 3 & 4) and SHS of early RA patient data, acquired from the SWEFOT database were studied. Computer assisted automated measurements of the MCP joint spaces were calculated from the hand x-rays of each patient using dedicated software analysis. Hand BMD was assessed by digital x-ray radiogrammetry (DXR; Sectra, Linköping, Sweden) of the same hand radiographs, scored with SHS at baseline and at 12 months. The Z-score BMD was a calculated measure adjusted for age and gender. Measurement differences of the ΔJSW, ΔBMD scores, and ΔSHS were established and correlated. IBM SPSS version 22.0 software was utilized for statistical analyses. Results We studied 119 early RA patients (78% female), with an average age of 53.6 years. In 714 joints (MCP2, 3 & 4 bilaterally), the automated JSW showed an average narrowing (ΔJSW) of -0.0492mm from baseline to 12 months. The BMD for both hands displayed an average bone loss of -0,0238g/cm2 from baseline to 12 months. A highly significant correlation was evident for JSW and BMD averages (0.459, p<0.01; 0.551, p<0.01) at baseline and at 12-month follow-up respectively. Even the ΔJSW and ΔBMD over the 12 months demonstrated a highly significant correlation (0.417, p<0.01). BMD Z-Scores showed similar patterns with JSW (0.246, p<0.05, n=109; 0.360, p<0.01, n=106) at baseline and 12 months respectively. A positive inverse relationship emerged between automated JSW and the joint space narrowing (JSN) component of SHS (-0.319, p<0.01; -0.254, p<0.01) at baseline and 12 months respectively. The average JSW measurements of both hands (n=117) also revealed significant correlations (-0.224, p<0.05; -0.271, p<0.01) with total SHS at baseline and 12 months respectively. No significant correlation was found between JSW and SHS erosion score. The 12-month BMD displayed near significant correlations with the 12-month SHS erosion score (-0.174, p=0.060) and the 12-month total SHS (-0.157, p=0.090). Conclusions Automated analyses of JSW and BMD were technically feasible with reproducibility and agreement with each other. Moreover, JSW displayed highly significant correlations with joint space narrowing and total SHS scores. Bone mineral density, on the other hand, did not correlate with joint space narrowing but rather approached significance with erosion and total SHS scores. Therefore, these objective digitally quantified measures of joint space narrowing and hand bone loss may be useful as complementary markers for early radiographic progression. Disclosure of Interest M. Platten: None declared, Y. Kisten: None declared, J. Kälvesten Employee of: Sectra Imtec AB, K. Forslind: None declared, R. van Vollenhoven: None declared