Background: It remains challenging to predict outcomes in patients with advanced HCC. Small and non-European studies have associated low muscle mass (sarcopenia) and visceral adiposity with impaired survival and increased treatment toxicity. However, large studies in European patients are lacking. Methods: A retrospective analysis was performed in HCC patients treated with sorafenib at two tertiary referral centers between 2007-2016. Muscle mass and density and adipose tissue areas were measured at baseline by computed tomography (CT) at the third lumbar vertebra (L3) level. Sarcopenia and low muscle density were defined using published cutoff points. Body composition parameters were correlated with overall survival (OS), time-toprogression (TTP), response rate, and toxicity. Results: In total, 278 patients were included (79% male, median age 66) with a median OS of 9.5 (95%CI;8.1-11.0) months. At baseline, 52% had sarcopenia and 41% had low muscle density. Sarcopenia showed an independent association with TTP (HR 1.36;95%CI 1.03-1.77;p=0.04), whereas low total adipose tissue index (TATI) was associated with reduced OS. Combined presence of sarcopenia and low total adipose tissue index (TATI) was associated with reduced treatment duration (16 vs 11 weeks, p=0.029) and independently associated with poorer OS (HR 1.68;95%CI 1.24-2.27;p=0.001). None of the body composition parameters was independently associated with response rate or treatment toxicity. Conclusion: In European patients with HCC treated with sorafenib, low TATI and presence of sarcopenia are independent prognostic factors of poorer OS and TTP respectively. Combined presence impairs survival to a greater extent. CT-assessed body composition provided prognostic information prior to sorafenib treatment.

BackgroundTo decrease burden of disease of rheumatoid arthritis (RA) we need to identify patients at risk for RA as early as possible, preferably as no clinical apparent synovitis could be detected yet. Previous studies suggest that this should be in the arthralgia phase or even before that. Up to now it has been fairly difficult to identify those arthralgia patients who develop inflammatory arthritis (IA), but recent studies in ultrasound (US) suggest that earlier detection is possible [1].ObjectivesWe aim to identify which arthralgia patients will develop clinical apparent IA within a year using US to detect subclinical synovitis at first consultation.MethodsIn a multi-centre prospective cohort study we followed arthralgia patients with ≥2 painful joints of hands, feet or shoulders without clinical apparent synovitis. Patients had a symptom duration of <1 year which could not be explained by other conditions (e.g. fibromyalgia). We collected data at baseline, 6 months and 12 months follow-up, which included physical examination, laboratory variables (ESR, CRP, auto-antibodies), diagnosis and medication used (including DMARDs at 6 and 12 months). At baseline we examined patients by US, which included 26 joints (MCP2–5, PIP2–5, wrists, MTP2–5) graded on greyscale (GS; 0–3) and power Doppler (PD; 0–3) according to a semi-quantitatively scoring system of Naredo et al. US synovitis was defined as GS grade 2 or 3 and/or PD grade 1, 2 or 3. After one year follow-up we determined the incidence of IA (clinical soft tissue swelling or start of DMARD treatment). We performed a complete-case analysis. For univariate logistic regression we tested demographic characteristics, clinical characteristics, and ultrasound findings and their association for development of IA. For multivariate logistic regression we selected the strongest variables (p<0.2).ResultsIn total, 196 patients were included of whom 154 completed the 12 months follow-up. At baseline 72 (38%) arthralgia patients had US synovitis and in 29 (15%) patients a positive PD signal was detected. At 12 months follow-up 36 (23%) patients had developed IA of whom 22 patients initiated DMARD treatment. Table 1 shows baseline characteristics of cases and non-cases and the results of the univariate analysis. Strongest variables were ACPA, RF, morning stiffness >30 minutes and PD signal. In the multivariate logistic regression positive ACPA (OR 4.56: 95% CI 1.26–16.46) and the presence of PD signal (OR 5.79: 95% CI 1.75–19.19) at baseline were associated with the development of IA during one year follow-up.ConclusionsIn this early arthralgia cohort 38% of patients showed US synovitis at baseline. At 12 months 23% of the patients developed IA. In a multivariate analysis positive PD signal and positive ACPA were significantly associated with the development of IA after one year.ReferencesColebatch AN, Edwards CJ, Ostergaard M, van der Heijde D, Balint PV, D'Agostino MA, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid a...

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BackgroundThe feet are often involved in rheumatoid arthritis (RA), but physical examination of the metatarsophalangeal (MTP) joints to detect arthritis is always challenging especially in case of obesity, oedema and malalignment. Ultrasound (US) has proven to be more sensitive than physical examination to detect (subclinical) synovitis in the MTP joints.Objectives(i) To determine the frequency of subclinical synovitis in the MTP joints by US among patients in DAS28 remission or LDA, and (ii) to assess discordance between the evolution of US arthritis in the feet and DAS28 over time in newly diagnosed RA patients who are treated to target.MethodsA multicentre cohort of newly diagnosed RA patients was followed prospectively for one year. Patients were treatment naïve for synthetic DMARDs, biological DMARDs and glucocorticoids, and symptom duration was less than one year. All patients were treated to target with regular visits. Demographics, clinical (SJC28, TJC28) and laboratory (ESR, RF, ACCP) parameters were recorded at each visit. US examination of the dorsal aspect of MTP2-5 joints was performed at baseline, three months and one year. Images were scored on greyscale (GS; 0-3) and power Doppler (PD; 0-3). A US positive MTP joint was defined by GS>1 and/or PD>0. Simple descriptive statistics were used and longitudinal course of both DAS28 and number of US positive MTP joints were plotted for each patient. Discordance of course was defined as crossing of slopes.ResultsAt baseline, 174 patients were included of whom 159 completed one year follow-up. At baseline, 109 (73%) patients had at least one US positive MTP joint. Overall, mean (SD) DAS28 decreased from 4.9 (1.3) at baseline to 2.3 (1.2) at one year, while the number of US positive MTP joints decreased from median (interquartile range) 1 (0-4) at baseline to 0 (0-0) at one year. Discordance in longitudinal course of DAS28 and US positive MTP joints over one year was seen in 9 patients (6%). After one year of follow-up, 98 (62%) patients were in DAS28 remission (DAS28<2.6) of whom 23 (23%) still had at least one US positive MTP joint. Twenty-nine patients had low disease activity (DAS28≤3.2) of whom 7 (24%) had at least one US positive MTP joint.ConclusionsMost patients (94%) improved both in DAS28 score and number of US positive MTP joints during follow-up. However, 23% of the early RA patients in DAS28 remission still had subclinical synovitis on US in at least one MTP joint at one year. Monitoring of MTP joints by US and subsequent steering of treatment might be considered to prevent for example progressive radiological damage.Disclosure of InterestNone declared