BackgroundSjogren Syndrome (SS) affects mainly exocrine glands. Ultrasonography (US) demonstrates specificity and sensibility in major salivary glands (SG) evaluation. Recent data confirm US might be used as primary evaluation technique for its ability to show structural alterations of parenchyma [1].ObjectivesTo assess the gray scale (GS) parenchymal inhomogeneity of major SG in patients with established primary and secondary SS and correlate with clinical and biological data.MethodsConsecutive patients with SS were recruited and SG US was performed. Inhomogeneity of glandular parenchyma was quantified binary on each gland. ESSDAI and ESSPRI scores were calculated. Statistics was performed with SPSS.ResultsTwenty one (42.85% primary SS, 90.47% female) consecutive patients were included. Mean age was 53.66+/-12.99 years and disease duration 5.33+/-3.74 years. Antibody SSA/SSB presence was found in 85.7% (18/21). ESSDAI mean was 8.67+/-8.9 (0–29), ESSPRI 10.13+/-5.59 (0–20). There were no differences regarding ESSDAI and ESSPRI in the two groups (primary and secondary SS). Right parotid gland showed alterations in 71.4% patients (77% with primary SS, 66% with secondary SS). Frequently inhomogeneity was found in all major SG (33%, 22% left and right submandibular, 77%, 44.4% left and right parotid glands) in primary SS. Both submandibular glands were symmetrically involved (p<0.02). Duration of disease was negatively correlated to inhomogeneity of right parotid gland (p<0.02).ConclusionsInhomogeneity in major SG in GS US was found in the majority of patients with primary and secondary SS. The symmetrical involvement of submandibular glands was significant. The inhomogeneity appears in the early period of diagnosis. No major differences were found between two groups.References Damjanov N, Milic V, Nieto-González JC, Janta I, Naredo E. Multiobserver Reliability of Ultrasound Assessment of Salivary Glands in Patients with Established Primary Sjögren Syndrome. J Rheumatol. 2016 Oct;43(10):1858–1863. Disclosure of InterestNone declared

BackgroundDegenerative lesions in shoulder rises exponentialy with age and diabetes was found to be associated with shoulder pain [1,2].ObjectivesTo evaluate the prevalence and type of lesions of shoulder in diabetic patients with no pain using ultrasound (US).MethodsWe included consecutive patients with diabetes with no pain or clinical tumefaction in shoulder. US was performed in both shoulders using the standard scanning planes and dynamic maneuvers. Clinical data as fasting glycemia, BMI, treatment were recorded.ResultsForty two shoulders were examined in 21 consecutive patients (mean age 67.92+/-7.35 years, weight 81.75 +/- 13.57 kg, BMI 25+/-2 kg/m2, fasting glycemia 151.85+/-33.72mg/dl) with diabetes diagnosis mean 5.33 years +/- 5.99. Majority of patients were under treatment with oral antidiabetics (58.3%). Degenerative lesions were found in subscapular (SSc) 33.3% and supraspinatus (SpS) 8.3%) tendons as well as intratendinous micro ruptures with calcifications (33.3% bilateral calcifications in SSc, SpS). Impingement syndrome was objectified in 16.6% of examinations. Minimal inflammatory signs as: sub-acromion sub deltoidian bursitis in 50% (minimum in 33.3%, 8.3% bilateral) and long head biceps tenosynovitis in 58.33% (8.3% minimal Doppler signal). 83.3% showed humeral irregularities and also erosions were found (8.3%).ConclusionsDegenerative and minimal inflammatory lesions in shoulder of diabetic patients exist with no clinical sign (pain, tumefaction). Ultrasonography might be an usefull technique to confirm these alterations before the appearance of symptoms.References Thomas SJ, McDougall C, Brown ID, et al. Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. J Shoulder Elbow Surg. 2007;16:748–751.Abate M, Schiavone C, Salini V. Sonographic evaluation of the shoulder in asymptomatic elderly subjects with diabetes. BMC Musculoskelet Disord. 2010;11:278. Disclosure of InterestNone declared

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BackgroundSjogren Syndrome (SS) affects mainly exocrine glands. The latest diagnostic criteria designed for clinical studies are also used as guidance in clinical practice [1].Ultrasonography (US) demonstrates specificity and sensibility in parotid and submandibular gland evaluation (SG). Parameters considered are echogenicity, homogeneity and margins regularity [1,2,3]. To standardize the assessment of B mode US of SG, different semi-quantitative scores were proposed.ObjectivesTo apply and compare 9 US semi-quatitative scoring systems in B mode scanning of salivary glands in Sjogren Syndrome.MethodsA research using keywords “salivary glands”, “ultrasonograpy”, “Sjogren Syndrome”, “semi-quantitative score” in Medline/Pubmed was performed. There was a selection of most relevant articles. There were not considered relevant publications with impact factor <1. We performed the examination on SG in B mode US and applied these scores (De Vita, Niemela, Hocevar, Salaffi, Yukinori, Cornec,Theander) to our patients (primary and secondary SS).ResultsEighty four SG in patients diagnosed with primary and secondary (57.15%) SS were assessed. In the group of patients with SSA/SSB presence (85.7%), mean score was De Vita 1.78+/-1.21, Niemela 2.56+/-2.17, Hocevar and Wernicke 2.39+/-2.14, Salaffi 2.83+/-2.52, Yukinori 2.39+/-2.14, Milic 3.39+/-2.14, Cornec 1.78+/-1.215, Theander 1.28+/-0.752. Schirmer test and the need for using the artificial tears was correlated to SG alterations in scoring systems proposed by Niemela (r 0.465, p<0.05) and Salaffi ( r 0.496, p<0.02). All scoring systems were strongly correlated between them (r>0.8, p<0.01).ConclusionsInhomogeneity of parenchyma was considered in all scoring systems. Others considered relevant glandular dimension and margins regularity [2,3.4]. There was no difference between the scoring systems. Xeroftalmia valided through Schirmer test is correlated to SG parenchymal alterations. Our data is an update about semi-quantitative scoring systems in US of SG in SS.References Vitali C, Bombardieri S, Jonsson R et al. Classification criteria for Sjögren's Syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. AnnRheum Dis 2002;61:554–8.Makula E, Pokorny G, Palkό A.The place of magnetic resonance and ultrasonographic examinations of the parotid gland in the diagnosis and follow-up of primary Sjögren's syndrome. Rheumatology (Oxford). 2000;39(1):97–104.Niemelä RK, Takalo R, Hakala M. Ultrasonography of salivary glands in primary Sjogren's syndrome. A comparison with magnetic resonance imaging and magnetic resonance sialography of parotid glands. Rheumatology (Oxford). 2004 Jul;43(7):875–9.El Miedany YM, Ahmed I, El Gafaary M. Quantitative ultrasonography and magnetic resonance imaging of the parotid gland: can they replace the histopathologic studies in patients with Sjogren's syndrome? Joint Bone Spine.2004;71(1):29–38. Disclosure of InterestNone declared

BackgroundPatients describe RA remission as the absence of any symptoms or return to normality. Ultrasound (US) in RA remission patients did not exactly overlap clinical evaluation of remission in previous studies (residual synovitis frequently described). US tenosynovitis evaluation and scoring seemed to better follow clinical remission scores than synovitis in RA [1].ObjectivesTo verify with US/clinical evaluations if patients' reported remission is “true” remission, and if and which clinical and US scores are lowest possible in that cohort.MethodsForty-eight RA patients were enrolled in this pilot study between 2015–2017 according to their positive answer to the question “Are you feeling free of symptoms, like before RA started for you?”; the enrollment was regardless of the treatment they were on. Written informed consent was obtained. Clinical evaluation of tender and swollen joints was performed the same day with US evaluation of 24 joints and 26 tendon sites and with lab CRP evaluation, blinded from one another. DAS28 and SDAI were calculated after, counting VAS=1, for both physician and patients.ResultsMean patients age was 58, 35/48 (72.9%) patients were also in remission per DAS28 criteria. Except for CRP value, no other variables (tender, swollen joints, RF, CCP, remission duration) were significantly different in the group with overlapping DAS28 remission. Considering 1.00 as the “ideal” situation (absolute overlapping of US remission and remission felt by patients), the closest was PD scoring in tenosynovitis of the ankle and feet (100%) and the furthest was GS scoring of synovitis in superior and inferior limbs (mean 17.1%)-table 1. Although residual synovitis and tenosynovitis in remission RA patients did not exhibit a statistically significant difference, PD tenosynovitis in both upper and lower limbs was found in less than 10% of patients. This confirms the results from our previous cohort [1], that tenosynovitis better overlaps RA remission than synovitis.Table 1.Prevalence of US remission in patients with clinical remission – bootstraping for CIMSUS RemissionDAS28 remissionSDAI Remission PD Tenosynovitis94.3 (5.7–100)90.9 (77.3–100)GS Tenosynovitis57.1 (40.0–74.3)54.5 (36.4–72.7)PD Synovitis62.9 (45.7–80.0)59.1 (36.4–77.3)GS Synovitis17.1 (5.7–31.7)13.6 (0–31.8)PD Lower limb tenosynovitis100 (100)100 (100)GS Lower limb tenosynovitis91.4 (82.9–100)86.4 (72.7–100)ConclusionsThe way patients perceive their disease activity is not related to either DAS28, SDAI scores or to objective US assessment of joints and tendons (GS or PD). However, PD signal especially in tendons sheaths seems to be absent in patients having a normal life, according to their own opinion. Consequently, patients in remission could benefit from US evaluation on any machine, regardless of its costs and Doppler settings. GSUS synovitis/tenosynovitis can be residual finding and does not imply any dissatisfaction in patients' health. An ongoing cohort of active RA patients is currently conducted to explore the validity of this conc...