Musculoskeletal ultrasonography (US) is an established and validated imaging technique in rheumatology. Ultrasonography is able to directly visualize soft tissue pathologies such as synovial tissue changes. Pathological findings in superficial cartilage, bone lesions and synovial tissue changes in the context of rheumatoid arthritis, spondyloarthritis or crystal arthropathies may only be seen by sonography or detected earlier by ultrasonography compared to conventional imaging techniques. The activity of an inflammatory arthropathy can be visualized using Doppler and power Doppler US. US is helpful in the detection of early inflammatory changes, particularly in patients with undifferentiated arthritis and/or unremarkable conventional radiography. In addition to diagnosis in early arthritis and monitoring of therapy in rheumatoid arthritis, sonography is able to detect pivotal pathologies in spondyloarthritis and crystal deposition diseases such as gout, pseudogout and apatite deposition disease. Ultrasound-guided diagnostic and therapeutic interventions are characterized by their excellent accuracy and improvement of clinical effectiveness compared to unguided procedures. In conclusion, ultrasonography plays a pivotal role in the assessment and monitoring of therapy in rheumatic diseases.

Education and training in musculoskeletal ultrasound (MSUS) comprises attendance at theoretical and practical courses and independent study. Web-based learning as a novel teaching method has previously been described. The present study summarizes normal and pathological findings in a web-based approach using widely accepted guidelines. In a prospective study over a period of 3 years normal and pathological images of the musculoskeletal system have been documented and catalogued. Overall 1240 ultrasound images and 183 ultrasound videos were collected. A total of 14.4% were normal and 85.6% were pathological MSUS findings; 61% concerned the upper extremity, while 39% were images and videos of the lower limbs. The most captured conditions included synovitis (33.3%), pathologies of the tendons e.g., tenosynovitis or tendinosis (19.6%) and normal findings (14.4%). The most represented diseases were rheumatoid arthritis (20%), calcium deposition disease (8.2%), gout (7.1%) and osteoarthritis (6.9%). The images and videos were edited and integrated in a web-based tool.

In this practical ultrasound session we discuss exemplary studies demonstrating the feasibility and reproducibility of scoring systems for e.g. Rheumatoid Arthritis. We emphasis the importance of the quality of ultrasound machines, the correct settings and the training of sonographers for the implementation of ultrasound scoring in the routine daily care of RA patients. We promote consensus guidelines and high quality training to improve musculoskeletal ultrasound reliability.LiteratureBrulhart L, Zufferey P, Tamborrini G, Ziswiler HR Clinical and Experimental Rheumatology 2014; 32:Zufferey P, Tamborrini G et al Swiss Med Wkly. 2013;143:w13861Torp-Pedersen ST, Terslev L. Ann Rheum Dis 2008;67:1439Disclosure of InterestNone declared

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BackgroundIn daily practice, surgical biopsy of minor salivary glands is routinely performed for the diagnosis of Sjögren’s syndrome. The classification criteria for Sjögren’s syndrome imply specific positive labial salivary gland biopsy findings. Surgical biopsies of the minor labial glands may result in up to 6% of patients in various complications, e.g. numbness of the lower lip. On the other hand, adverse events following core needle biopsies of the parotid gland in non-rheumatological settings were reported as very rare. Even so parotid gland biopsies require a more demanding surgical expertise mainly to protect the facial nerve.ObjectivesThe objective of this study was to assess the feasibility and to determine the presence of parotid gland tissue in minimally invasive ultrasound-guided parotid gland biopsies in cadavers performed by rheumatologists using histology as a gold standard.MethodsTwo senior rheumatologists obtained under direct ultrasound visualisation in in-plane technique biopsies of 8 parotid glands from 4 different cadavers using a core biopsy needle (core biopsy needle 18G). One biopsy per gland was taken and was subsequently stored. The direction of the bioptic access is shown in Figure 1. The specimen underwent histological examination by an experienced pathologist.ResultsAll histological exams showed typical parotid gland tissue. Notably, no facial nerve tissue or major vessels could be detected in the biopsy material.Abstract AB1215 – Figure 1ConclusionsIn this cadaveric feasibility study, we demonstrated that minimally invasive ultrasound guided parotid core biopsy is a highly precise and easy method to obtain salivary gland tissue.References[1] Shiboski C. H. et al, 2016American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjogren’s Syndrome. Arthritis Rheumatol. 2017 Jan;69(1):35–45.[2] Kim H.Jet al, Ultrasound-Guided Core Needle Biopsy in Salivary Glands: A Meta-analysis, Laryngoscope, 00:000–000, 2017.Disclosure of InterestNone declared