BackgroundPelvic girdle pain is a common clinical symptom of patients with polymyalgia rheumatica (PMR). It also occurs in patients with rheumatoid arthritis (RA). The origin of this characteristic pain is not really clear, even though some imaging findings have been reported. However, this has neither changed pathophysiologic thinking nor clinical practice related to diagnosis.ObjectivesTo describe pelvic structures in PMR patients in detail which show signs of inflammation by magnetic resonance imaging (MRI) in order to find a disease specific pattern.MethodsIn a retrospective study we used MRIs of patients who had presented with clinical symptoms suggestive of PMR in our centre between 2015 and 2017. Only patients with complete MRI examinations, including contrast enhanced scans in coronal and transversal planes were included to be carefully examined by an experienced musculoskeletal radiologist (MF). After having first described all findings in much detail we developed a preliminary semiquantitative scoring system that assesses a total of 12 sites which appeared to be frequently involved.A total of 40 patients with pelvic girdle pain and complete data were identified from the hospital records. The median (25th/75th percentiles) age of the patients was 67 (55/73) years, the median symptom duration was 13 (6/22) weeks, 55% were female, the median C-reactive protein measured close to the day of the MRI examination was 1.9 (0.7/4) mg/dl, and the median erythrocyte sedimentation rate was 30 (17/43) after the 1st hour. Only 3 patients were rheumatoid factor positive, and 2 patients had anti-CCP antibodies. Ten patients had a diagnosis of RA (25%) in addition to the leading PMR like symptom.ResultsThe MRI signal of interest for PMR is a post-gadolinium signal in T1 weighted pelvic images. The most frequently involved anatomic sites were: the hamstring tendon and the M.gluteus medius and minimus tendon near the greater trochanter in all cases, which were found to be bilaterally involved as was the proximal M.rectus femoris in all cases, and the insertion of the adductor muscles, especially the M.adductor longus at the inferomedial pubic symphysis in 90% of cases. Other sites were also, but less frequently, involved. We think that the involvement of 4 sites including either the M.rectus femoris or the M.adductor longus is rather specific for PMR, see examplary images below. There was no major difference between patients with and without RA.Abstract AB1203 – Figure 1ConclusionsThis study suggests that there may be a MRI pattern specific for PMR. The target structure of the characteristically inflamed anatomic site seems to be the paratenon which implies that the pattern observed in PMR differs from the enthesitis seen in patients with spondyloarthritis. Prospective randomised trials are needed to further test and prove the clinical usefulness of this approach.Disclosure of InterestNone declared

Pigmented lesion classification poses a challenging task for dermatologists and pathologists alike given the variable clinical and histologic presentations. Melanoma has increased potential for morbidity and mortality compared to non-melanoma skin cancers, and it is now the third most commonly diagnosed cancer in the United States (Marghoob et al., 2009;Welch et al., 2021;Whiteman et al., 2016). While dermatologists require the fewest number of biopsies per diagnosis of cutaneous malignancy, both providers and patients must nevertheless accept that any skin biopsy exchanges diagnostic information for scar tissue (Nelson et al., 2019). Finding a diagnostic balance can be difficult, especially on the cosmetically sensitive regions of the face. Dermatologists have a 65-80% accuracy rate in melanoma diagnosis without the use of epiluminescence microscopy (dermoscopy). Artificial intelligence (AI) has potential to be a useful adjunct tool to assist dermatologists with this challenging diagnosis (Argenziano & Soyer, 2001). Thus, it is imperative that dermatologists understand the basics of AI.

BackgroundFacial aging is a concern for many patients. Wrinkles, loss of volume, and discoloration are common physical manifestations of aging skin. Genetic heritage, prior ultraviolet light exposure, and Fitzpatrick skin type may be associated with the rate and type of facial aging. Although many clinical trials assess the correlates of skin aging, there is heterogeneity in the outcomes assessed, which limits the quality of evaluation and comparison of treatment modalities. To address the inconsistency in outcomes, in this project we will develop a core set of outcomes that are to be evaluated in all clinical trials relevant to facial aging.Methods/designA long list of measureable outcomes will be created from four sources: (1) systematic medical literature review, (2) patient interviews, (3) other published sources, and (4) stakeholder involvement. Two rounds of Delphi processes with homogeneous groups of physicians and patients will be performed to prioritize and condense the list. At a consensus meeting attended by physicians, patients, and stakeholders, outcomes will be further condensed on the basis of participant scores. By the end of the meeting, members will vote and decide on a final recommended set of core outcomes. Subsequent to this, specific measures will be selected or created to assess these outcomes.DiscussionThe aim of this study is to develop a core outcome set and relevant measures for clinical trials relevant to facial aging. We hope to improve the reliability and consistency of outcome reporting of skin aging, thereby enabling improved evaluation of treatment efficacy and patient satisfaction.Trial registrationCore Outcome Measures in Effectiveness Trials (COMET) Initiative, accessible at http://www.comet-initiative.org/studies/details/737. Core Outcomes Set Initiative, (CSG-COUSIN) accessible at https://www.uniklinikum-dresden.de/de/das-klinikum/universitaetscentren/zegv/cousin/meet-the-teams/project-groups/core-outcome-set-for-the-appearance-of-facial-aging. Protocol version date is 28 July 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2104-3) contains supplementary material, which is available to authorized users.

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