BackgroundThere is an increasing need for alternative, non-invasive and reliable diagnostic tools with the potential to improve and simplify the diagnostic process for primary Sjogren’s syndrome (pSS). The main advantage of salivary gland ultrasonography (SGUS) is the direct visualisation of structural abnormalities of the salivary glands. Despite these advantages of SGUS, a number of obstacles remain. Different SGUS scoring systems in B-mode were used in previous studies. The diagnostic usefulness of Doppler analysis and glandular size measurement has not been established. Indeed there is no proven prognostic factor for glandular damage in pSS, although a number of studies have revealed the risk factors for lymphoma.ObjectivesWe aimed to assess the diagnostic value of SGUS as a single test for the detection of pSS in an integrated manner. We assessed the diagnostic accuracy of three SGUS parameters: the ultrasound (US) grey-scale scoring system, glandular volume measurement, and intraglandular power Doppler US. The secondary aim was to examine the prognostic factors for severe structural changes in major salivary glands based on the SGUS scoring system.MethodsPatients with pSS (n=94) and idiopathic sicca syndrome (n=44) were evaluated using the SGUS 0–48 scoring system, which comprises five parameters: parenchymal echogenicity, homogeneity, hypoechoic areas, hyperechogenic reflections, and clearness of posterior borders (figure 1). The salivary gland volume and intraglandular power Doppler signal (PDS) were also assessed. A multivariate linear regression analysis was performed to determine the factors associated with SGUS score.ResultsPatients with pSS showed a significantly higher SGUS score than controls [median (IQR): 24.5 (13.0) vs 6 (3.75), p<0.001]. An SGUS cut-off of ≥14 had a sensitivity of 80.9% and a specificity of 95.5% for the diagnosis of pSS. There were no significant differences in the measured volumes and PDS between pSS patients and controls. The SGUS score correlated with unstimulated salivary flow rate (USFR), serum rheumatoid factor and IgG. Double seropositivity with anti-Ro/SS-A and anti-La/SS-B (β=6.060, p=0.001) and USFR (β=−1.913, p<0.001) were independently associated with the SGUS score.ConclusionsThe SGUS scoring system is a valuable diagnostic method for pSS. Double seropositivity of anti-Ro/SS-A and La/SS-B is an independent predictive factor for structural damage of the salivary glands.References[1] Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, et al. 2016American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjogren’s syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis2017;76:9–16.[2] Jousse-Joulin S, Milic V, Jonsson MV, Plagou A, Theander E, Luciano N, et al. Is salivary gland ultrasonography a useful tool in Sjogren’s syndrome? A systematic review. Rheumatology (Oxford)2016;55:789–800.AcknowledgementsThis paper was supported by Konkuk University...

Objective: To assess the diagnostic performance of ultrasound (US) for calcium pyrophosphate deposition (CPPD) at the level of menisci, hyaline cartilage (HC), tendons, and synovial fluid (SF) of the knee, and to examine inter-and intra-observer reliability. Design: We consecutively included patients with knee effusion over a 2-year period (43 patients with CPPD and 131 controls). All patients underwent SF analysis, conventional radiography (CR), and US examination using the Outcome Measures in Rheumatology (OMERACT) definition of the US characteristics of CPPD. Two independent operators performed the US, and inter-observer agreement was calculated. Intra-observer agreement was examined with static images obtained for all enrolled patients. Results: US revealed calcium pyrophosphate (CPP) deposits in menisci, HC, and tendon more frequently in patients with CPPD than in control patients. The presence of US CPP deposits in SF was not significantly different between the two groups. Combined US evaluation of the three components (menisci, HC, and tendon) showed the best diagnostic performance. The sensitivity and specificity for US evaluation of the three components were 74.4% and 77.1%, respectively, while for CR evaluation, the sensitivity and specificity were 44.2% and 96.9%, respectively. Inter-and intra-observer agreement were excellent for medial (k ¼ 0.930, 0.972) and lateral menisci (k ¼ 0.905, 0.942), HC (k ¼ 0.844, 0.957), and SF (k ¼ 0.817, 0.925). Tendon showed fair inter-observer (k ¼ 0.532) and good intra-observer reliability (k ¼ 0.788). Conclusions: Based on the OMERACT definition, US demonstrated better diagnostic capacity than CR to diagnose CPPD, with excellent reliability. Combined evaluation of menisci, HC, and tendon showed the best diagnostic accuracy.

BackgroundAnkylosing spondylitis (AS) is a chronic progressive inflammatory disorder that mainly involves the axial skeleton and causes chronic back pain. It is not unusual for patients with AS to have symptoms similar to neuropathic pain. There were several studies showing that various rheumatic diseases, including rheumatoid arthritis, primary Sjogren syndrome, and fibromyalgia, had neuropathic pain components. However, the existence of neuropathic pain in patients with AS has not been well investigated. The painDETECT questionnaire (PD-Q) is a relatively simple and self-administered screening tool for determining neuropathic pain and has high sensitivity, specificity, and positive predictive accuracy values.ObjectivesThe aim of this study was to investigate the neuropathic pain component in patients with AS using PD-Q, and to assess the relation between neuropathic pain and disease characteristics of AS.MethodsA single-centre prospective study was performed on 105 patients. The patients with AS completed three questionnaires: PD-Q, Beck depression inventory (BDI), and Euro Quality of life (EQ-5D) questionnaires. Patients were classified into three groups according to the PD-Q scores: nociceptive pain (NoP) (score <13), mixed pain (MP) (score 13–18), and neuropathic (NeP) (score >18) pain. Fifteen patients (14.3%) were classified in the NeP group, 22 patients (21.0%) in the MP group, and 68 patients (64.7%) in the NoP group. The questionnaires and clinical and radiographic findings were analysed.ResultsPatients with NeP and MP scored worse on Bath ankylosing spondylitis disease activity index (BASDAI), BDI, modified Stoke Ankylosing Spondylitis Spine Score, pain-visual analogue scale (VAS), EQ-5L index, and showed an increased prevalence of enthesitis and peripheral arthritis (table 1). There were no differences in objective inflammatory markers. PD-Q scores positively correlated with pain-VAS, BASDAI, BDI, and inversely correlated with EQ-5D index (figure 1). Presence of enthesitis, BDI, age, and pain VAS score independently associated with PD-Q scores.ConclusionsThe findings showed a neuropathic pain component in AS. Neuropathic pain in AS was associated with age, high disease activity, radiographic progression, enthesitis, peripheral arthritis, depression, and low quality of life.References[1] Sung JK, Choi JH, Jeong J, et al. Korean Version of the pain DETECT Questionnaire: A Study for Cultural Adaptation and Validation. Pain Pract2017;17:494–504.[2] Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain. Health Qual Life Outcomes2013;11:110.[3] Campochiaro C, Caruso PF. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med2016;375:1302.[4] Neuropathic pain in ankylosing spondylitis: A psychophysics and brain imaging study. Arthritis Rheum2013;65:1494–503.AcknowledgementsThe authors received no financial support for the research, authorship, and/or publication of this article.Disclosure of InterestNone declared

BackgroundMacrophage migration inhibitory factor (MIF) is proinflammatory, angiogenic and tissue degrading cytokine.ObjectivesThis study aimed to determine monosodium urate (MSU)-induced MIF production and the role of MIF in gouty arthritis.MethodsPeripheral blood and clinical data were obtained from 98 patients (31 patients with acute gouty arthritis and 67 patients with intercritical gout). Synovial fluid (SF) was obtained from patients with acute gouty arthritis and SF white blood cells and neutrophils were counted. SF and serum levels of MIF, interleukin (IL)-1, IL-8 and leukotriene B4, were measure using enzyme-linked immunosorbent assay (ELISA) and their relationship was analyzed. Peripheral blood mononuclear cells (PBMC) were isolated and cultured with MSU crystal, the production of MIF was determined.ResultsSF MIF level was higher in acute gouty arthritis than osteoarthritis. Serum MIF was higher in patients with intercritical gout than patients with acute gouty arthritis or healthy volunteers. SF MIF level was positively correlated with SF WBC and neutrophil counts, IL-1b and IL-8 levels in acute gouty arthritis. Serum MIF level was correlated with IL-1b and IL-8 levels in patients with intercritical gout. MSU crystal induced MIF production in PBMC with maximal effect at 100mg/ml.ConclusionsMIF was highly produced in gouty arthritis and MSU induced MIF production. MIF could be involved in early inflammatory process in acute gouty arthritis.AcknowledgementThis research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science, and Technology (NRF-2013R1A1A1008171).Disclosure of InterestNone declared

BackgroundTh17 cells, which are defined by a selective interleukin (IL)-17 secretion, are considered as a distinct lineage of CD4+ helper T cells which are regulated by the other Th1 and Th2 cytokines. IL-17A is a dominant proinflammatory cytokine produced by the Th17 cells. IL-21, IL-22 and IL-26 are also produced by the Th17 cells. In RA, IL-17A induces the production of proinflammatory mediators, such as IL-1 and tumor necrosis factor (TNF)-a from synovial fibroblasts, macrophages, and chondrocytes.ObjectivesThis study aimed to determine the regulatory effect of Th17 cytokines on the osteoclastogenesis in rheumatoid arthritis (RA).MethodsThe expression of IL-17 and RANKL was determined in synovial tissue, fibroblast-like synoviocytes (FLS) and synovial fluids of RA patients using immonohistochemical staining, ELISA and real-time PCR. The Th17 cytokines-induced RANKL expression was studied in RA FLS using real-time PCR, luciferase activity, and western blot. Human peripheral blood monocytes were cultured with M-CSF and Th17 cytokines, and then osteoclastogenesis was determined by counting the number TRAP-positive multinucleated cells. The osteoclastogenesis was also determined after human monocytes were co-cultured with IL-17-prestimulated FLS.ResultsThere was significant correlation between RANKL and IL-17 levels in RA synovial fluid. After RA FLS were stimulated with IL-17, IL-21 and IL-22, the expression of RANKL mRNA increased and the IL-17-induced RANKL expression was decreased by the inhibition of Act1, TRAF6, NF-κB and the AP-1. Th17 cytokines and IL-17-prestimulated FLS induced osteoclastogenesis from monocytes in the absence of osteoblasts or RANKL.ConclusionsTh17 cytokines have a dual effect on osteooclastogenesis in RA; direct induction of osteoclastogenesis from monocytes and upregulation of RANKL production in RA FLS. Th17 cytokines/RANKL axis could be a potential therapeutic target for bone destruction in RA.Disclosure of InterestNone declared