BackgroundMusculoskeletal Ultrasonography (MSUS) is now a widely used tool for the monitoring of rheumatoid arthritis (RA). Although there are many proposed sets of composite scores, a fixed set of joints may not be an ideal tool to assess a disease like RA which affects many joints and tendons in different presentations.ObjectivesTo assess the correlation of 3 proposed ultrasonographic composite scores with disease activity indices.MethodsThree different composite scores were proposed by the first author, the first score (modified U8 score) which included bilateral wrists, 2nd MCP,3RD MCP and knees which of the same set of joints proposed by Yoshimi et al 2015 with a modification of scoring of each joint according to EULAR/OMERACT combined score so the range of scores (0-24). The second score (U9) was the same of the modified U8 score plus scoring the most clinically affected joint or tendon (one joint or one tendon) so the range of score (0-27). The third proposed score (8+2) was the same of the modified U8 score plus scoring the 2 most clinically affected joint or tendon (one joint and one tendon or 2 joints or 2 tendons) so the range of score (0-30). All targeted joints were evaluated by grey-scale (GS) and power Doppler (PD) ultrasound using EULAR/OMERACT combined score (0-3). Targeted tendons were scored (0-3) by either -scale (GS) and power Doppler (PD) ultrasound and the highest score was used.One hundred and fifty four RA patients diagnosed according to ACR/EULAR criteria were recruited for the present study. A total of 154 patients with RA were included. Disease activity was assessed by clinical disease activity indices (CDAI and DAS28 ESR). Functional status was assessed by health assessment questionnaire (HAQ).ResultsIn the cross-sectional cohort with 154 patients, correlation between the modified (U8) score and clinical disease activity parameters (CDAI and DAS28) was significant but modest (r=0.3, P=0.03 and r=0.4, P=0.01) respectively. The same was true for the (U 8+2 score) (r = 0.41, P= 0.0001, r=0.4, P=0.005). The 8+1 (U9 score) gave the best positive correlation with CDAI and DAS28 (r=0.7, P<0.001, r=0.6, P<0.001) respectively.HAQ was highly correlated with U9 score (r=0.7, P<0.001) and moderately correlated with U8+2 score (r=0.3, P=0.05) and not correlated with the modified 8 score.ConclusionThe U9 score gave the best correlation with disease activity parameters. It is simple and applicable and gives a high degree of flexibility to the sonographer according to the clinical picture.References[1] A novel 8-joint ultrasound score is useful in daily practice for rheumatoid arthritis. Modern Rheumatology25(3). DOI: 10.3109/14397595.2014.974305Disclosure of InterestsNone declared

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Calcific tendinopathy is most commonly seen around the shoulder joint. Only a few cases of quadriceps calcific tendinopathy (QCT) were reported. This study compares pain, function, clinical examination results, and ultrasonographic findings among primary knee osteoarthritis (KOA) patients with or without ultrasonography-detected QCT. A cross-sectional study was conducted on 214 patients with knee OA. Ultrasonography (US) of knee joints was performed according to the EULAR guidelines. Kellgren-Lawrence radiographic grading was used to score OA. Pain and functional status were assessed using the visual analog scale (VAS), the Health Assessment Questionnaire-II (HAQ-II), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). QCT was detected in 50 out of 428 knees (11.6%), i.e. in 46 out of 214 patients (21.49%). Most cases of QCT were detected in the following sites: 36 in the vastus lateralis (72%), 10 in the vastus intermedius (20%), and only 4 in the vastus medialis (8%). QCT was found mainly in advanced KOA stages: 44 cases of QCT were found in patients with grade 4 KOA and 6 cases in grade 3 KOA. The presence of QCT showed a statistically significant association (p<0.05) with VAS, HAQ-II, WOMAC subscales, synovitis, and effusion detected by US. In knees with ultrasound-detected QCT, ultrasonographic features of CPPD were found in 31 knees (62%). QCT was found in cases with advanced KOA and mainly with ultrasonographic findings of CPPD disease. QCT could be considered an independent poor prognostic finding regarding pain, functional activity, and response to NSAIDs.

BackgroundThe era of musculoskeletal ultrasound (MSUS) is becoming enormous, but the extent to which MSUS has influenced management plans for patients with different musculoskeletal symptomsremains questionable.ObjectivesTo assess the changes in the provisional diagnosis and treatment decisions made by rheumatologistsafter receiving MSUS reportsfor their patients.MethodsThis study has been carried out at Rheumatology & Rehabilitation outpatient clinicsin Zagazig University Hospitals in Egypt. This is anobservational study on 101 patients with musculoskeletal complaints who have been referredby rheumatologists for a MSUS scan atZagazig University MSUS Unit in the same department.The patients’ mean age was 41.5 ± 15.67, including 70 females (69.3%) and 31 males (30.7%). Patients included 29 patients with hand/wrist complaints (28.7%), 2 patients with elbow pain (2%), 36 patients with shoulder pain (35.6%), 7 patients with ankle/foot pain (6.9%), 10 patients with knee pain (9.9%), and 17 patients with polyarticular pain (16.8%). The rheumatologists were asked to set a provisional diagnosis and treatment planbefore the MSUS scan and toreconsider their own plan for any adjustments afterwards.ResultsRegarding all 101 patients, the diagnosis & treatment decisions were changed in 37%and 65% respectively after the MSUS scan as shown in figure (1). Fifty percent of the changes in treatment were classified as minor in the form of adding/changing the type of NSAIDs, adding/changing the dose of steroids, changing the dose of DMARDS and adding/modifying physiotherapy while the other 50%were major in the form of initiating/adding DMARDs, interventional treatmentor referral to surgery.Ten patients out of 29 with hand/wristcomplaints encountered change in diagnosis (34.5%), 1 patient out of 2 with elbow pain (50%) and 11 patients out of 36 with shoulder pain (30.6%). In patients with knee pain and ankle/foot pain, changes occurred with 4 patients for each representing 40% and 42.9% respectively. Regarding patients with polyarticular complaints 8 patients representing 47.1% were categorized to different disease entities.Treatment decisions were much more frequently changedas more pathological details were clarified by MSUS. Treatment decision changes occurred in 83.3% of patients with shoulder pain 70% of which were minor mainly due to better evaluation of rotator cuff syndromes grading tears and detecting bursitis. While for knee pain 50% of treatment decisions were changed of which 60% were major as in knee osteoarthritis detection of significant synovitis&Baker’s cysts lead to interventionaltreatment.Regarding patients with hand/wrist &polyarticularcomplaints, 44.8% and 68.8% of treatment decisions were changed respectively of which 75% and 90.8% were major owing mainly to changes in diagnosis &detectingsubclinical activity. Finally regarding ankle/foot pain, treatment changes happened in 71.4%of which 80% were minor.Figure 1ConclusionMSUS scanshave a great impact on rheumatologists’ decisions in clinical practice. Remarkable ch...

BackgroundKnee osteoarthritisObjectivesTo assess the reliability of a novel ultrasonographic scale of activity in knee osteoarthritis (OA)MethodsA cross-sectional observational study included 110 patients with knee pain who fulfilled the American College of Rheumatology (ACR) criteria for knee osteoarthritis (OA). All patients were subjected to clinical assessment WOMAC scale (Western Ontario and McMaster Universities Index of Osteoarthritis and global visual analog scale) and functional assessment using health assessment questionnaire (HAQ). Ultrasonographic assessment of activity was done By 3 rheumatologists with different levels of experience in musculoskeletal Ultrasonography (1-12 years). Ultrasonographic assessments were done according to (MOAKA scale) that was proposed by the first author (table 1).Abstract AB0801 Table 1 Mortada OsteoaArthritis Knee Activity score (MOAKA score)DomainDescriptionScoreSeverity of knee OA6 grades according to severity scale published by Mortada et al 2016 (1)Grade 0: 0Grade 1: 1Grade2a: 2Grade 2b: 3Grade 3: 4Grade 4: 5Effusion4 gradesGrade 0:no effusionGrade 1: Mild effusionGrade 2: moderate effusionGrade 3: severe effusionGrade 0: 0Grade 1: 1Grade 2: 2Grade 3: 3Synovitis4 grades using the combined EULAR/OMERACT score of grey scale synovitis and Doppler activityGrade 0: 0Grade 1: 1Grade 2: 2Grade 3: 3Pes Anserine tendonitis/bursitis3 gradesGrade 0:normal,Grade 1: mild inflammationGrade 2: severe inflammationGrade 0: 0Grade 1: 1Grade 2: 2Backer cyst3 grades;Grade 0: normal no cyst,Grade 1: small and simple cystGrade 2: large and/or complicated cystGrade 0: 0Grade 1: 1Grade 2: 2Total scoresSum of scores of all domains0 - 15ResultsThere were high kappa values both in intraobserver and interobserver evaluation of activity of knee OA using the proposed (MOAKA) ultrasonographic scale (0.85 and 0.75 respectively).There were positive correlations between MOAKA score and all WOMAC subscales (pain, stiffness and function) (r=0.4, P=0.02, r=0.35, P=0.001 and r=0.4, P=0.01) respectively.Also there were a strong positive correlation between MOAKA scale and both (VAS and HAQ) (r=0.86, P=0.001 and r=0.71, P=0.001)ConclusionUS can reliably detect the activity of Knee OA. Good agreement was found between the proposed US grading scale and WOMAC & HAQ scores. MOAKA US scale is simple and reliable.Disclosure of InterestsNone declared