Ultrasound is used increasingly for diagnosing large vessel vasculitis (LVV). The application of Doppler in LVV is very different from in arthritic conditions. This paper aims to explain the most important Doppler parameters, including spectral Doppler, and how the settings differ from those used in arthritic conditions and provide recommendations for optimal adjustments. This is addressed through relevant Doppler physics, focusing, for example, on the Doppler shift equation and how angle correction ensures correctly displayed blood velocity. Recommendations for optimal settings are given, focusing especially on pulse repetition frequency (PRF), gain and Doppler frequency and how they impact on detection of flow. Doppler artefacts are inherent and may be affected by the adjustment of settings. The most important artefacts to be aware of, and to be able to eliminate or minimize, are random noise and blooming, aliasing and motion artefacts. Random noise and blooming artefacts can be eliminated by lowering the Doppler gain. Aliasing and motion artefacts occur when the PRF is set too low, and correct adjustment of the PRF is crucial. Some artefacts, like mirror and reverberation artefacts, cannot be eliminated and should therefore be recognised when they occur. The commonly encountered artefacts, their importance for image interpretation and how to adjust Doppler setting in order to eliminate or minimize them are explained thoroughly with imaging examples in this review.

BackgroundIn a systematic literature review (SLR), we identified halo sign, stenosis, occlusion, compression sign and a decreased vessel wall pulsation as elementary ultrasound (US) lesions in giant cell arteritis (GCA).ObjectivesTo establish consensus-based definitions for the key elementary US lesions in GCA.MethodsWe invited 25 rheumatologists from 13 countries experienced in musculoskeletal and vascular US to participate in a Delphi exercise. Based on the results from the SLR and international expert consensus a questionnaire was developed including 12 statements on the definitions of normal temporal and extra-cranial large arteries, arteriosclerosis, halo sign, stenosis, occlusion, compression sign, and vessel wall pulsation. The experts were asked to express their level of agreement or disagreement with the proposed statements. A consensus was defined as agreement of ≥75% of participants.ResultsThe response rate was 24/25 (96%) in round 1 and 24/24 (100%) in round 2. A consensus was achieved for 9/9 Delphi statements [normal temporal and extra-cranial large arteries, arteriosclerosis, halo sign, stenosis of temporal and extra-cranial large arteries, occlusion, compression sign (temporal arteries), US assessment of compression sign (temporal arteries) in round 1. In round 2, 3/3 Delphi statements (arteriosclerosis, halo sign, stenosis of temporal arteries) were redefined. The statements on vessel wall pulsation (definition and assessment) and measurement of vessel wall thickness did not reach the threshold for consensus. The halo and compression signs were deemed to be the most important US signs for GCA with 100% and 83.3% expert agreement, respectively.ConclusionsThis is the first international consensus on definitions for elementary US lesions in GCA. The next steps of the OMERACT project will be web- and patients based exercises testing the reliability of the new definitions.Disclosure of InterestNone declared

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Background The mortality in patients with fragility hip fracture is higher compared to the general population for both men and women (1). The highest incidence of fragility hip fracture has been reported from Norway and other Scandinavian countries (2). Updated mortality data in patients with hip fracture is limited, in particular for long-term survival. Objectives Our aim was to study the overall mortality rates of fragility hip fracture in men and women in Southern Norway after 1 and 5 years compared with the mortality rates of the Norwegian population. Methods Individuals over 50 years (residents of the two southern counties of Norway) with a fragility hip fracture between 1 January 2004 and 31 December 2005 were identified by using the hospital electronic diagnosis registers coded as S72.0-2 (ICD-10). The follow-up time for one person was from the month the fracture occurred to death or the censoring date in January 1, 2009 and 2010. To calculate the standardized mortality ratio (SMR), the mortality risk of the standard Norwegian population was used (3). Statistical significance was defined as p<0.05. Results The final number of fragility hip fractures in the geographic area of Southern Norway was 951 (271 men and 680 women). Mean age for all included patients was 81.2 years (men 80.0 years and women 81.8 years). After one year the overall mortality rate was 22.7% (men 32.1%, women 19.0%, p<0.005) and after 5 years 58.5% (men 69.9%, women 54.3%, p<0.005). The overall mortality rate for hip fracture patients older than 80 years after one year was 29.4% (men 44.6%, women 24.0%, p<0.005) and after five years 69.2% (men 85.4%, women 63.5%, p<0.005). The SMR for the men and women compared to the Norwegian population for the first year was 2.08 (95% CI 1.77-2.38) and 2.78 (95% CI 2.24-3.31) and after five years 1.82 (95% CI 1.41-2.22) and 3.10 (95% CI 2.21-3.98). Conclusions Mortality in fragility hip fracture patients is elevated compared to the background population during the first year and remains elevated also after five years. Mortality rates after a fragility hip fracture was higher in men than women. One explanation may be the lower life expectancy in men than in women. References Vestergaard P, Rejnmark L, Mosekilde L. Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int. 2007 Dec;18(12):1583-93. Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Johnsen V, Hochberg M, et al. Incidence rates of fragility hip fracture in middle-aged and elderly men and women in southern Norway. Age Ageing. 2011 Sep 6. Statistics, Norway. Aldersavhengige dødsfallsrater for menn og kvinner. 1971-2010 (Age-related mortality rates for men and women,1970-2010). Available from: . Disclosure of Interest None Declared

Background Fragility hip fracture is associated with increased mortality both in short and long term. Apart from age and gender, risk factors for hip fracture mortality are not sufficiently understood and only few studies have explored the predictors of hip fracture mortality [1]. Objectives To study risk factors associated with increased mortality in a prospectively recruited cohort of fragility hip fracture patients. Methods Fragility hip fracture patients aged >50 years admitted to a county hospital in Southern Norway between 2004 and 2005 were consecutively identified and invited for assessment at the osteoporosis centre. As part of clinical routine data was collected by using questionnaires (e.g. demographics, risk factors for osteoporosis, medications and co-morbidities). Standardized bone density measurements at lumbar spine and hip were performed by 4 trained nurses by using dual energy x-ray absorptiometry. Bone density was expressed as T-scores (SD). Osteoporosis was defined as T-score ≤ -2.5 at lumbar spine and/or hip [2]. Categorical variables were compared by chi-square test. A logistic regression analysis model was used to identify significant predictors of mortality in the fragility hip fracture patients with death as the dependent variable and statistically significant variables in bivariate analysis as the explanatory variables up to 5 years after fracture. All the analyses were performed using the SPSS version 17.0 (SPSS, Chicago, IL, USA). Statistical significance was defined as p<0.05. Results A total of 432 hip fracture patients (129 men and 303 women) were prospectively identified. Among them 136 (44 men and 92 females) patients [mean age 84 yrs. (SD 7.9)] were not assessed and 296 (85 men and 211 women) patients [mean age 80.7 (SD 9.1)] were assessed at the Osteoporosis center. After 5 years follow up a statistically significant difference in mortality was found between those assessed [58 males (68.2%) and 91 females (43.1%)] and those not assessed at the osteoporosis center [39 males (88.6%) and 75 (78.3%)] for females, p<0.0001. In bivariate analysis, variables significantly associated with increased mortality included indoor activity, osteoporosis, restricted mobility, stroke, dementia, visual impairment, older age > 80 years and male gender. In table 1 the results from the logistic regression model are displayed. Conclusions Male gender, older age and dementia were identified as strong predictors of mortality. Osteoporosis was also found to be independently associated with increased risk of dying. This is of great interest as treatment with bisphosphonates has been shown not only to reduce fractures but also mortality. References Gonzalez-Rozas M, Perez-Castrillon JL, Gonzalez-Sagrado M, Ruiz-Mambrilla M, Garcia-Alonso M (2012) Risk of mortality and predisposing factors after osteoporotic hip fracture: a one-year follow-up study. Aging Clin Exp Res 24: 181-187. (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94: 64...