Background:Ultrasonography (US) of the common extensor tendon (CET) of the elbow is often part of the assessment of patients with lateral epicondylitis. This US assessment is currently based on general tendinopathy references and not well-defined US entities.Purpose:To describe CET thickness, color Doppler activity, and bony spurs on US in asymptomatic volunteers and to investigate the influence of sex, age, height, body mass index (BMI), weight, and elbow dominance on the measurements.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Tendon thickness, color Doppler activity, and bony spurs of the CET were measured sonographically in 264 adults (50% women) aged 20 to 96 years. Two different tendon-thickness measuring techniques were applied, labeled the “plateau measure” and the “1-cm measure.” Color Doppler activity was based on a 0 to 4 rating scale (negative, grades 0 and 1; positive, grades 2-4). A bony spur was defined as a bony outgrowth (≥0.3 mm) arising at the insertional site of the CET.Results:With both tendon-thickness measuring techniques, the CET in the dominant elbow was thicker than that in the nondominant elbow, and male tendons were thicker than female tendons (all P ≤ .03). In regression analysis, tendon thickness correlated with weight, color Doppler activity, and arm dominance for both measuring techniques in multiple regression analysis. In addition, the plateau measure correlated with height and the presence of bony spurs. No correlations were observed regarding BMI, sex, or age. Positive color Doppler activity was found in 9% of examined elbows, with no difference between the sexes regarding dominant versus nondominant elbows (all P ≥.20). Bony spurs were found to increase with age, from 23% for people in their 20s to 74% in people older than 70 years. Bony spurs were more common in the dominant elbow (P ≤ .01). Women had a higher prevalence of bony spurs than men, but only in the dominant elbow (P = .03).Conclusion:This study presents the US characteristics and normal values of the CET. In 264 asymptomatic participants, the CET was found to be thicker in men and in the dominant elbow. No difference in tendon thickness could be demonstrated with regard to different age groups. Color Doppler activity was found to be positive in nearly 1 of 10 asymptomatic subjects. Bony spurs were a common finding; they increased in prevalence with every decade in age and were considered part of the aging process. Normal variations in CET morphologic characteristics should therefore be considered when implementing US in trials and clinical practice.

Background:Systemic inflammation in rheumatoid arthritis (RA) is associated with reduced serum lipid levels (LL) and treatment with disease modifying antirheumatic drugs has been associated with increased serum LL [1]. It is unclear whether the changes in serum LL reported in association with adalimumab (ADA) treatment are due to suppressed inflammation or the ADA treatmentper se.Objectives:The primary objective was to compare the effect of ADA + methotrexate (MTX) to placebo (PBO) + MTX on changes in low density lipoprotein cholesterol (LDL-C) from baseline to month 12 in patients with early- and treatment naïve RA. Secondary objectives were to compare the treatment groups on changes in total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglycerides, very low density lipoprotein cholesterol (VLDL-C) and non-HDL-C (=TC – HDL-C).Methods:We present secondary analyses from the OPERA trial, which was an investigator-initiated, multicenter double-blind, placebo-controlled, treat-to-target trial of 180 early and treatment naïve RA patients, who were randomized (1:1) to oral MTX 20 mg once a week in combination with either PBO or ADA 40 mg SC EOW [2]. Any swollen joint was injected with triamcinolone hexacetonide. Lipid profiles of each patient were assessed at baseline and 12 months. All randomized patients with available LDL-C at baseline were included in Intention To Treat (ITT) analysis. Sensitivity analyses were performed on the Per Protocol (PP) and the ITT population with baseline observations carried forward (BOCF). All analyses were based on repeated measurements using mixed linear models.Results:In total, 174 patients (97% of the original OPERA trial population) were included in ITT analysis (ADA n=86; PBO n=88) and 156 patients (ADA n=78; PBO n=78) completed the study with LDL-C measurements at both baseline and 12 months (PP). At baseline mean LDL-C was 2.9 mmol/L (SD 0.9) with 63 (36.2%) patients having an LDL-C above 3.0 mmol/L. There was no significant difference in LDL-C change between ADA+MTX and PBO+MTX groups after 12 months. A nearly statistically significant between-group difference in TC change was found. Other changes in LL were comparable across the two groups. Results in ITT, PP and ITT with BOCF populations were similar.Conclusion:In early RA patients treated to target with methotrexate and intra-articular triamcinolone, 12 months with the addition of adalimumab did not affect lipid levels.References:[1]England BRet al., Bmj2018;361:k1036[2]Hørslev-Petersen Ket al.,Ann Rheum Dis2014;73:654–61Disclosure of Interests:Dzenan Masic: None declared, Kristian Stengaard-Pedersen: None declared, Brian Bridal Løgstrup: None declared, Kim Hørslev-Petersen Grant/research support from: Pfizer (Travel expences), Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Peter Junker: None declared, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Christian Ammitzbøl: None declared, Sören Möller: None declared, Robin Christensen: None declared, Torkell Ellingsen: None declaredTable .Change in primary and secondary outcomes in the ITT analysis