Introduction Osteoarthritis (OA) and haemophilic arthropathy (HA) are clinically similar, but pathologically distinct conditions which result in joint pain and loss of function. Distinguishing their disease mechanisms is therefore a key step in the development of curative therapy, as opposed to current symptomatic treatments. A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 4 is a metzincin‐family member proteoglycan with known local involvement in OA pathogenesis. Aim To investigate the potential differences and discriminatory potential of ADAMTS‐4 between OA and HA patients. Methods We determined ADAMTS‐4 plasma concentrations by ELISA in patients with HA and OA. This pilot cross‐sectional study included N = 40 male participants equally divided across four subgroups: haemophilia patients with severe or mild HA and control subjects with severe or mild/no OA. Results Our study showed a striking elevation in plasma ADAMTS‐4 expression levels in HA patients as compared to OA, as well as an increase in patients with severe as compared to mild HA. By performing the binomial logistical analysis and fitting the receiver–operator curve (ROC) (cut‐off probability .5), ADAMTS‐4 had a sensitivity of 95% and specificity of 50% in discriminating between HA and OA among our study participants. Conclusion Uncovering the marked differences in plasma levels of ADAMTS‐4 in patients with HA versus OA potentially sheds new light on the mechanisms of HA pathogenesis and could foster more research into the roles ADAMTS‐4 and other matrix metalloproteinases (MMPs) play in HA versus OA.

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Objectives The primary objective of the study was to establish the status of rotator cuff in the early rheumatoid arthritis (RA) using shoulders ultrasonography (US), Power Doppler (PD) and MRI. The other specific objective was to detect other inflammatory changes of shoulder joint such as erosions, synovitis, effusion, bursitis and humeral head bone oedema. Methods The prospective study was conducted at the Clinical Department of Rheumatology and Rehabilitation, Clinical Hospital Center Zagreb, in the group of 50 patient who fullfiled criteria for diagnosis of RA. The study was conducted by US machine Logiq 700, using 7-11 MHz high-resolution linear probe (General Electric). MRI of shoulder joints was performed using machine: Siemens Magnetom Trio, with 3T magnetic field. Results All three methods were effective in detecting early inflammatory changes. MRI of shoulder was the most accurate method in discovering the humeral head bone oedema. US and MRI of shoulders had very good results in detecting early rotator cuff changes. Rotator cuff tears were found in 7 patients (14%) using US and in 11 patients (24%) using MRI. The highest number of tears were found in the site of supraspinatus tendons (in 5 out of 7 patients using US and in 8 out of 11 patients by MRI). US and MRI showed the highest correlation between findings in the way of detecting rotator cuff tears (correlation index 88%, kappa value=0,598 which is the highest kappa value in the study). US and MRI are efficient in detecting effusions and bursitis. PD of shoulder was the superior method in detecting synovitis with the highest number of positive findings (90%) in comparison to standard US and MRI. Conclusions Those data emphasize the importance of US, PD and MRI of shoulder in detecting early inflammatory changes in the patients with RA, especially of rotator cuff tears using US and MRI and detecting humeral bone oedema using MRI. Disclosure of Interest None Declared

BACKGROUND Calcific shoulder tendinitis (CST) is characterized by hydroxyapatite crystals deposition in the rotator cuff tendons. Therapeutic exercises have been the mainstay of CST treatment, and evidence for therapeutic ultrasound (T-US) utilization and efficacy is lacking. AIM This study aimed to determine whether 4500 J T-US combined with therapeutic exercises is superior to therapeutic exercises alone regarding calcification size reduction and symptom improvement in chronic symptomatic CST. DESIGN This is a double-blind, placebo-controlled study. SETTING This study was conducted at a University Department for Rheumatic Diseases and Rehabilitation of a University Hospital. POPULATION Patients with chronic CST were analyzed. METHODS After eligibility allocation, 46 patients with sonographically confirmed CST were divided into two groups (56 shoulders, 26 per group). Both groups performed the same therapeutic exercises for half an hour under physiotherapist supervision. In the treatment group T-US (4500 J, 10 minutes per session at a frequency of 1 MHz and an intensity of 1.5 W/cm 2 ), and in the placebo group, sham T-US was applied for 4 weeks. Patients were assessed for: calcification size, shoulder pain, global health (GH), shoulder mobility (ROM), handgrip strength, Health Assessment Questionnaire Disability Index (HAQ-DI), Shoulder Pain and Disability Index (SPADI), and overall rehabilitation satisfaction. RESULTS All assessed variables improved in both groups. A significantly greater reduction in calcification size was recorded in the treatment group compared to placebo: -10.92% (IQR 4.61% to 19.38%) versus -5.04% (2.30% to 7.22%), P=0.008. There was a significantly greater decrease in HAQ-DI, reduction of VAS GH, and an increase in hand grip strength in the treatment group, while no significant differences were observed for other parameters between the groups. CONCLUSIONS Our results showed that adding the 4500 J T-US to therapeutic exercises in chronic symptomatic CST therapy resulted in greater calcification size reduction immediately following the treatment, as well as hand grip strength, HAQ-DI, and VAS GH improvement. CLINICAL REHABILITATION IMPACT 4500 J T-US combined with therapeutic exercises is more effective in reducing calcification size than therapeutic exercises alone in the treatment of chronic symptomatic CST.