Aim: The purpose of this study is to compare and correlate US evaluation with clinical scores of the disease activity in patients with rheumatoid arthritis (RA) and concomitant fibromyalgia (FM). Material and methods: Ten patients diagnosed with RA according to the 2010 ACR/EULAR classification criteria and associated FM based on the ACR 1990 classification criteria and two control groups, one with RA (10 patients) and one with FM (10 patients), were included. Clinical assessment was performed and the disease activity scores were calculated. Synovial/tenosynovial hypertrophy, fluid collections in grey scale (GS), and Power Doppler (PD) US assessed by US in the 28 joints included in the disease activity score 28 (DAS28). Results: GS US score and PD US scores were correlated with DAS28 only in patients with RA (Pearson r coefficients 0.3 and 0.5). Mean DAS28 score was significantly higher in the RA/FM group, compared to RA and FM (5.6 versus 4.6 versus 4.5, respectively). Patients with RA/FM had similar median US scores to RA patients, while in FM group significantly lower median US scores were detected (16 versus 9.5 versus 0 for GS US and 3.5 versus 1.5 versus 0 for PD US, respectively). Conclusions: Disease activity scores should be interpreted with caution in patients with RA and FM. When available, US should be used to guide treatment decisions in patients with RA and FM.

Gastrointestinal tract involvement is the most common visceral affectation in systemic sclerosis (SSc), but the manifestations may vary in extension and severity. Endoscopic and histopathological gastroesophageal findings were investigated in patients with SSc. A total of 79 consecutive patients with definite SSc were enrolled in a cross sectional study. Clinical data were collected, upper gastrointestinal endoscopy and biopsies from gastric mucosa were performed in all cases. Fifty-seven (72.1%) out of 79 SSc patients had gastroesophageal symptoms. The most frequent were dysphagia, present in 33 (41.7%) and gastroesophageal reflux symptoms in 23 (29.1%) patients. Out of the 79 patients, 22 were asymptomatic, but in 16 esophageal and gastric mucosa changes were endoscopically detected. Reflux esophagitis was found in 39 (49.3%) patients. The presence of esophageal manifestations was not related to the disease duration or with its other variables. Signs of gastritis were endoscopically described in 47 (59.4%) and confirmed on histopathologic examinations in 45 patients. In 31 patients without any endoscopic changes, 18 (22.7%) showed signs of gastritis on histopathologic examination. No significant statistical differences were found between symptomatic and asymptomatic patients or between those with limited cutaneous SSc and those with diffuse cutaneous SSc in terms of clinical, endoscopic or histopathological findings, except the higher proportion of hiatal hernia in symptomatic patients. The results of this study might suggest that upper gastrointestinal endoscopy should be performed during the early stage of the disease and then periodically in patients diagnosed with SSc, even in the absence of typical symptoms.

Aims: The aim of the study was to assess the evolution of time-intensity curves parameters of contrast-enhanced ultrasonography (CEUS) after 6 months of conventional treatment in early arthritis patients with wrist involvement. Material and methods: Patients diagnosed with early rheumatoid arthritis or undifferentiated arthritis on the basis of 2010 ACR/EU-LAR classification criteria, with bilateral wrist arthritis and both radiocarpal (RC) and intercarpal (IC) synovial hypertrophy identified by grey-scale ultrasonography, were enrolled. Synovial hypertrophy was semi-quantitatively scored (grade 0-3) by grey-scale and by Power Doppler at wrist level. CEUS was performed using Sonovue. The region of interest was selected as the area corresponding to the synovial hypertrophy of the RC and IC joints. Time-intensity curves parameters were calculated with Contrast Dynamic Software. The minimum and the maximum values of Peak, area under the curve (AUC), and slope were selected for each patient at baseline and after 6 months of conventional treatment. The difference between the visits was noted as "Δ". Results: Eleven patients fulfilled the inclusion criteria. Maximum time-intensity curves parameters' difference significantly decreased at 6 months: Peak (30.00±5.90% vs 23.22±5.22%, p=0.008), AUC (1206.08±216.91%s vs 949.13±280.12%s, p=0.04) and slope (1.6 (1.4;2.3) %/s vs 1(0.7;1.2) %/s, p=0.03). Moderate correlations were found between maximum ΔPeak, maximum ΔAUC and maximum ΔPower Doppler grade (r=0.44, p=0.17; r=0.46, p=0.16, respectively). Conclusions: Peak and AUC for joints that had high baseline values significantly decreased following treatment with conventional synthetic drugs in EA patients with wrist arthritis. This decrease in Peak and AUC was moderately correlated with a decrease in US parameters. The joint with the highest values of these parameters may be used for evaluation of EA patients at follow-up.

BackgroundConcomitant fibromyalgia (FM) may increase subjective components of the disease activity scores (DAS) in rheumatoid arthritis (RA), thus leading to an improper assessment of treatment response. Ultrasonography (US) is currently used in clinical practice as an objective measure of the disease activity. The US7 German score was demonstrated to be sensitive to change, reflecting the therapeutic response in RA patients [1].ObjectivesTo evaluate clinical and US parameters in RA patients with or without concomitant FM, undergoing biological therapy.MethodsRA patients treated with various biological agents who presented in our Department of Rheumatology were consecutively enrolled. Patients underwent clinical and laboratory examinations. US was performed by an experienced sonographer, blinded to clinical evaluation. Synovitis and synovial/tenosynovial vascularity were scored semiquantitatively (grade 0–3) by gray-scale (GS) and power Doppler (PD) US. Tenosynovitis (TS) and erosions were scored for presence [1].Patients were divided in two groups according to the difference between tender joint count (TJC) and swollen joint count (SJC): ≥7 RA-FM group, <7 RA-nonFM group, representing the “joint count” criteria for FM, after the study of Pollard et al. [2].ResultsThirty-nine patients were included, 77% women, mean age 55.2±11.3 years, mean disease duration 15.25±9.4 years. Nine out of 39 (23%) patients were classified as having associated FM. Disease duration and treatment were comparable between groups.Significantly higher values for TJC, patient global assessment (PGA), DAS 28 were found in the RA-FM group, with no differences for SJC or inflammatory markers (ESR, CRP). GS and PD-US7 scores were similar between groups (Table 1).Table 1.Clinical and US findings in RA-nonFM and RA-FM groupsRA-nonFM (n=30)RA-FM (n=9) P value PGA (mm)41.33 (18.28)58.88 (17.63)<0.001TJC3 (0–10)12 (9–17)<0.001SJC2 (0–7)1 (0–6)0.54ESR (mm/h)22.26 (18.42)27.33 (16.87)0.21CRP (mg/l)8.46 (17.84)8.67 (9.11)0.66DAS28 CRP3.33 (0.98)5.13 (1.18)0.015GS Synovitis US7 score3.80 (4.37)2.67 (1.66)0.96PD Synovitis US7 score1.67 (2.90)1.22 (1.20)0.59Erosions US7 score3.77 (2.75)4.89 (2.85)0.29GS TS US7 score0.30 (0.84)0.44 (0.73)0.31PD TS US7 score0.20 (1.10)0.33 (0.71)0.08In the RA non-FM, but not in the RA-FM group, GS and PD-US7 correlated with SJC (r=0.44, p=0.015 – GS synovitis, r=0.47, p=0.008 – PD synovitis; r=0.57, p=0.001 – GS TS; r=0.46, p=0.011 – PD TS) and PD synovitis negatively correlated with the “joint count” criteria (r=-0.44, p=0.015).ConclusionsConcomitant FM in RA patients undergoing biological therapy lead to higher DAS28 scores, but not to synovial inflammation on US. US-PD correlates with clinically detected synovitis in the non-FM group. US is expected to modify treatment decision and to prevent RA mistreatment especially in RA-FM patients.References Backhaus M, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 2009;61(9):1194–201.Pollard LC, et al. Fibr...

BackgroundFibromyalgia (FM) is present in a significant proportion of patients with rheumatoid arthritis (RA)1. Diagnosis and management of patients with rheumatoid arthritis and associated fibromyalgia (FRA) is challenging1. MicroRNAs (miRNA) are small nonconding RNAs that target mRNA and repress protein production. Recent studies have identified specific patterns of microRNA (miRNA) expression in FM patients3.ObjectivesOur objectives were to determine if there are differences in expression levels of miR let-7a, miR-21–5 p, miR −143 and miR-103a-3p in the blood of FRA, RA and FM patients and to determine if any of the aforementioned miR could differentiate between FRA and RA.MethodsWe performed a case control study on 10 FRA patients compared to 10 FM, 10 RA patients with pain of at least 50 mm on VAS, and 10 healthy controls. All patients underwent clinical and laboratory examinations. Cell lysate from peripheral blood was used for the extraction of total RNA with TriReagent; miRNA reverse transcription was performed with the miScriptII Reverse Transcription kit (Qiagen) according to manufacturer’s instructions. cDNAs obtained were further amplified by quantitative PCR (qPCR) with the miScript SYBR Green PCR kit. miRNA relative expression was quantified using the 2-ΔΔCt method. Relative miRNA levels are expressed as fold change (Fc). Data are expressed as median (interquartile range).ResultsThere were no significant differences in terms of baseline characteristics between the groups. Clinical characteristics of included patients are listed in table 1. Patients with RA had higher SJC values and higher ESR and CRP levels as compared to FRA and FM patients. However, the mean DAS28 scores of RA and FRA patients were not significantly different, due to higher TJC values and higher pain levels in the FRA group.Expression levels for miR let-7a, miR-21–5 p3 and miR-103a-3p were similar between the groups. miR- 143 was downregulated in FRA, with a median Fc of 0.6 (IQR 0.3) and FM patients with a median Fc=0.5 (IQR 1.6) and upregulated in RA patients with a median Fc of 1.4 (IQR 0.5). miR-143 expression levels correlated negatively with TJC (r=−0.7; p<0.05) and with the Fibromyalgia Impact Questionnaire score (−0.8, p<0.01) in patients with FRA. ROC analysis showed that the AUC to identify FRA from RA patients was 0.89 (95%CI 0.7–1), p=0.03 (Fig 1). A cut-off value for miR-143 Fc of >1.04 had a sensitivity of 90% and specificity of 70% in differentiating FRA from RA.Abstract THU0518 – Table 1Demographic and clinical data of patientsVariableFRA n=10RA n=10FM n=10Controls n=10p Age (years)54(1455.5 (11)55(1446.5 (9)0.1TJC17(129 (7)7 (11)00.006SJC4 (10)7 (3;9)00<0.001Pain on VAS(mm)75(3270(3070(2500.01ESR(mm/h)25(3354(469 (7)5 (9)0.002CRP(g/dl)6 (21.4)24.6 (41.1)1.3 (1.2)1.3 (4.3)0.001DAS28ESR5.9 (1.9)5.5 (2)3.8 (1.4)-0.001DAS28CRP5.5 (2)5.5 (2)3.8 (0.8)-<0.001HAQ1.8 (0.9)1.8 (0.7)1.1 (1.4)00.001Tender point count16(66 (7)15(50 (1)<0.001ConclusionsmiR-143 is downregulated in patients with FRA and may discriminate between pa...