BackgroundMusculoskeletal Ultrasonography (MSUS) is now a widely used tool for the monitoring of rheumatoid arthritis (RA). Although there are many proposed sets of composite scores, a fixed set of joints may not be an ideal tool to assess a disease like RA which affects many joints and tendons in different presentations.ObjectivesTo assess the correlation of 3 proposed ultrasonographic composite scores with disease activity indices.MethodsThree different composite scores were proposed by the first author, the first score (modified U8 score) which included bilateral wrists, 2nd MCP,3RD MCP and knees which of the same set of joints proposed by Yoshimi et al 2015 with a modification of scoring of each joint according to EULAR/OMERACT combined score so the range of scores (0-24). The second score (U9) was the same of the modified U8 score plus scoring the most clinically affected joint or tendon (one joint or one tendon) so the range of score (0-27). The third proposed score (8+2) was the same of the modified U8 score plus scoring the 2 most clinically affected joint or tendon (one joint and one tendon or 2 joints or 2 tendons) so the range of score (0-30). All targeted joints were evaluated by grey-scale (GS) and power Doppler (PD) ultrasound using EULAR/OMERACT combined score (0-3). Targeted tendons were scored (0-3) by either -scale (GS) and power Doppler (PD) ultrasound and the highest score was used.One hundred and fifty four RA patients diagnosed according to ACR/EULAR criteria were recruited for the present study. A total of 154 patients with RA were included. Disease activity was assessed by clinical disease activity indices (CDAI and DAS28 ESR). Functional status was assessed by health assessment questionnaire (HAQ).ResultsIn the cross-sectional cohort with 154 patients, correlation between the modified (U8) score and clinical disease activity parameters (CDAI and DAS28) was significant but modest (r=0.3, P=0.03 and r=0.4, P=0.01) respectively. The same was true for the (U 8+2 score) (r = 0.41, P= 0.0001, r=0.4, P=0.005). The 8+1 (U9 score) gave the best positive correlation with CDAI and DAS28 (r=0.7, P<0.001, r=0.6, P<0.001) respectively.HAQ was highly correlated with U9 score (r=0.7, P<0.001) and moderately correlated with U8+2 score (r=0.3, P=0.05) and not correlated with the modified 8 score.ConclusionThe U9 score gave the best correlation with disease activity parameters. It is simple and applicable and gives a high degree of flexibility to the sonographer according to the clinical picture.References[1] A novel 8-joint ultrasound score is useful in daily practice for rheumatoid arthritis. Modern Rheumatology25(3). DOI: 10.3109/14397595.2014.974305Disclosure of InterestsNone declared

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BACKGROUND: Rheumatoid arthritis (RA) causes disabilities that affect people in working age and can impair their working activity and quality of life (QoL). OBJECTIVES: To assess work activity limitation and QoL among RA patients and to explore the associated risk factors. METHODS: A cross-sectional study on 344 RA patients was conducted at the outpatient clinic using a number of standardized questionnaires including the Health Assessment Questionnaire Disability Index, Workplace Activity Limitation Scale, and RA QoL. Clinical examinations were also performed including the measurement of pain intensity, assessment of disease activity, and the Rheumatoid Arthritis Severity Scale. RESULTS: Most of the employed participants (87%) experienced high work activity limitations. Increasing work limitations were significantly associated with a decrease in QoL domains scores. The most significant risk factors affecting work limitation by logistic regression were high disease activity, the severity of the disease, married females, and a high health assessment disability index among RA patients. CONCLUSIONS: RA patients experience limitations that affect their productivity at work and their QoL. Paying more attention to early management to prevent the upcoming unfavorable health and economic consequences for RA patients is significantly important.

Ankylosing spondylitis (AS) is a chronic inflammatory disease that results in severe pain and stiffness in the joints. The causes and pathophysiology of AS are still largely unknown. The lncRNA H19 plays key roles in the pathogenesis of AS by mediating inflammatory progression by acting in the axis of IL-17A/IL-23. The aims of this study were determining the role of lncRNA H19 in AS and assessing its clinical correlation. A case–control study was conducted and qRT-PCR was utilized to measure H19 expression. Comparing AS cases to healthy controls, it was found that H19 expression was significantly upregulated. For AS prediction, H19 demonstrated a 81.1% sensitivity, 100% specificity, and 90.6% diagnostic accuracy at a lncRNA H19 expression value of 1.41. lncRNA H19 had a significantly positive correlation with AS activity, MRI results, and inflammatory markers. lncRNA H19 seemed to be an independent predictor of AS (adjusted OR of 211 (95% CI: 4.7–939; p = 0.025)). After 3 months of clinical follow-up, seventeen patients (32.1%) showed minimal clinical improvement and fifteen patients (28.3%) showed major improvement. AS activity scores were significantly decreased in patients with high H19 expression. A significantly elevated lncRNA H19 expression was observed in AS cases compared with that in healthy controls. These results suggest that upregulation of lncRNA H19 expression may be involved in the pathogenesis of AS. The expression of the lncRNA H19 is related to the duration and activity of the disease. LncRNA H19 expression seems to be an independent predictor of AS.

Purpose: To assess the utility of contrast-enhanced uCT (CE-uCT) as an imaging biomarker for preclinical assessment of osteoarthritis in a sheep model using IA injection of iodinated contrast medium and short exposure times that can be obtained in vivo. Methods: An in-vitro pilot study was conducted to assess differences in the apparent density between damaged (fibrillated/incised or shaved/ superficial zone removed) and intact bovine osteochondral blocks after exposure to an anionic contrast medium (Conray 60) for 10 minutes (n¼22). The sidewalls of blocks were wrapped in Parafilm™ to limit contrast contact to the cartilage surface only. Fibrillated (n¼6), shaved (n¼7), and intact (n¼4) blocks were immersed in the Conray 60 and intact control (N¼5) blocks were immersed in lactated ringer's solution (LRS) for 10 minutes prior to uCT imaging at 45 micron resolution. Uptake of contrast was measured by calculation of the average apparent density in Hounsfield Units (HU). Twenty-four sheep were enrolled in a followup, ex-vivo, study. Osteoarthritis was induced by arthroscopic meniscal destabilization in n¼20 sheep and n¼4 remained as naive controls. The xray attenuation of cartilage was measured in animals with early (3 month) and late stage (12 month) OA after a 10-minute exposure to anionic contrast media (Conray 60). Concentration (ug/mg) of sulfatedglycosaminoglycan (sGAG) and histological OARSI scores for proteoglycan (PG) staining were also collected and recorded from the medial tibial plateau (MTP) of the operated leg. ANOVA was used to analyze variance in sGAG and HU between sites on the MTP or between groups. Correlation coefficients between sGAG and HU were analyzed using Pearson's correlation coefficients and simple linear regression analysis. Spearmannrank coefficients were used to examine the association between histological PG score and either HU or sGAG. We hypothesized apparent density (HU) would vary with respect to concentration of local sGAG, and that HU would be higher in regions where sGAG is depleted. Results: In the in-vitro CE-uCT study we observed a significant increase in apparent density of intact cartilage samples exposed to Conray 60 for 10 minutes compared to LRS controls (p¼0.03). HU was also significantly higher in fibrillated (p¼0.030) and shaved (p¼0.0007) blocks compared to non-contrasted samples. In ex-vivo CE-uCT imaging of the MTP location accounted the variance in HU for both 3 month (p¼0.09) and 12 month (p¼0.0074) groups but not controls (p¼0.32). Early 3 month OA sheep had elevated levels of sGAG that were significantly higher than the late phase 12 month group group (Fig 1, p ¼0.0032). A significant, negative correlation between sGAG concentration and HU of the same location was observed (r¼ -0.71, p ¼ 0.047) in the early stage (3 month) sheep. Linear regression analysis revealed that every one unit (ug CSC/mg cartilage) increase in sGAG resulted in a reduction in HU by 8.62 units (R 2 ¼ 0.43, p< 0.05). Conclusions: Ten minutes of exposure to contrast media was sufficient to...