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Background/Aims Magnetic resonance imaging (MRI) plays an increasingly important role in diagnosing and monitoring patients with inflammatory arthropathies due to its ability to detect early, sometimes subclinical, inflammatory changes, including synovitis. It is a sensitive, accurate and relatively non-operator dependent modality. However, it is typically perceived as expensive and time-consuming, and is used infrequently for evaluation of synovitis in clinical care. MRI is thought to be generally well-tolerated by patients, however, there is a paucity of research on patient experience of MRI, particularly in rheumatology where patients may have complex and/or chronic pain. To improve the acceptability, cost-effectiveness and overall utility of MRI for clinicians and patients, we introduced a short synovitis MRI protocol (MRI-SSP) for rapid assessment of synovitis in the hands and feet. Here, we evaluated the acceptability of MRI-SSP to patients and the perceived utility of the protocol for rheumatologists. Methods Different structured questionnaires were designed for patients and rheumatologists which contained qualitative (free-text) and quantitative (five-point Likert-scale) questions. All patients undergoing MRI-SSP of the hand or wrist at University College London Hospital (UCLH) between 01/02/22 to 01/07/22 were prospectively invited to participate and completed the questionnaire via telephone within four weeks of their scan. All rheumatologists at our centre were invited to respond to an online questionnaire. Likert scores were analysed quantitatively and thematic analysis was performed on free-text comments. Results Patient experience - 30 patients agreed to participate (mean age 48 years, range 21-74; 87% female). Average patient Numerical Pain Rating Scale score was 5.1/10 (range 1-10). We found that: 90% found the scan length acceptable; 90% had no or mild side-effects from intravenous contrast; 40% had no pain during the scan; 57% had no anxiety during the scan; 97% found the scan acceptable overall; 97% would be happy to have the scan again; scan length and comfort were important for patients; good radiographer communication helped to alleviate patient anxiety. Rheumatologist perception - 10 rheumatologists responded. Of these, 40% perform ultrasound to assess for synovitis in clinic. We found that: 90% strongly agreed that the MRI-SSP report was helpful in answering clinical questions; 90% strongly agreed that the MRI-SSP influenced clinical decision making; there was a mixed response regarding which modality rheumatologists preferred for assessing synovitis (40% no preference, 30% MRI, 30% ultrasound) and this was independent of which rheumatologists performed ultrasound in clinic. Conclusion Overall, patients found MRI-SSP to be an acceptable investigation, and rheumatologists felt it helpful in clinical decision-making. Important factors affecting patient acceptability were scan length and comfort. In general, our results suggest that dedicated short MRI scanning protocols have the potential to improve the acceptability and accessibility of MRI for rheumatology patients. Disclosure N. Thorley: None. L. Dwyer-Hemmings: None. S. Singh: None. T.J.P. Bray: None. L. Bida: None. M.A. Hall-Craggs: None.

Background/Aims To assess the potential for whole-body MRI (WBMRI) to modify rheumatologists’ impression of disease activity and treatment management in adolescent patients with JIA. Methods Two rheumatology consultants experienced in managing people with JIA reviewed anonymised clinical data from an opportunistic sample of 30 patients with JIA (aged 15-24), not under their care. The cohort were clinically assessed by a senior rheumatology fellow before undergoing a research WBMRI scan, reported for musculoskeletal inflammation by a radiologist blinded to clinical information. The clinical findings and patient-reported outcomes recorded on that visit, alongside the patients’ present and past treatments, imaging and laboratory results were included in the clinical summaries examined by each rheumatologist. They then independently rated their impression of disease activity (See Table 1) and documented their resulting treatment recommendations per patient, in a two-stage approach. The first stage data analysis did not include the WBMRI reports. In stage two, the rheumatologists re-rated disease activity and treatment suggestions in light of WBMRI findings. The responses without and with the WBMRI findings were compared for each consultant and between them. Results Disease activity ratings were changed after reviewing the WBMRI reports in 16/30 and 17/30 patients by the rheumatologist A and B respectively. The activity category (‘active’ to ‘inactive’ or vice versa) changed in 7/16 and 4/17 cases, respectively. The certainty in the activity status increased for both rating clinicians (from ‘likely’ to ‘definitely’ in the same category or from ‘not sure’ to any other category) in 7/16 and 11/17 cases, respectively, whilst decreased for both in two cases. Disease activity assessments and treatment recommendations with and without WBMRI, are summarised in Table 1. Inter-rater agreement without and with WBMRI regarding disease activity (active/inactive) was 84.00% and 82.1% respectively, and regarding the intention to change treatment (yes/no) was 63.3% and 83.3%, respectively. Conclusion WBMRI scan findings changed the rheumatologists’ impression or level of certainty regarding disease activity in about half the patients and treatment plan in about one-third. Therefore, a larger study involving a greater number of rheumatologists across the country, should be considered to validate these results. Disclosure V. Choida: None. R.S. Tattersall: None. J.J. Manson: None. D. Sen: None. C. Ciurtin: None. M.A. Hall-Craggs: None.

Objectives To develop evidence-based recommendations on the use of MRI in the diagnosis of axial SpA (axSpA). Methods A working group comprising nine rheumatologists and nine musculoskeletal radiologists with an interest in axSpA was established, with support from the British Society of Spondyloarthritis (BRITSpA). Two meetings were held. In the first meeting, research questions were formulated. In the second meeting, the results of a systematic literature review designed to inform the recommendations were reviewed. An anonymized Delphi process was used to formulate the final set of recommendations. For each recommendation, the level of evidence and strength of recommendation was determined. The level of agreement was assessed using a 0–10 numerical rating scale. Results Two overarching principles were formulated, as follows: The diagnosis of axSpA is based on clinical, laboratory and imaging features (overarching principle 1), and patients with axSpA can have isolated inflammation of either the sacroiliac joints or the spine (overarching principle 2). Seven recommendations addressing the use of MRI in the assessment of patients with suspected axSpA were formulated, covering topics including recommended sequences, anatomical coverage, acquisition parameters and interpretation of active and structural MRI lesions. The level of agreement for each recommendation was very high (range 8.8–9.8). Conclusion A joint rheumatology and radiology consensus on the acquisition and interpretation of MRI in axSpA diagnosis was achieved, and a research agenda formulated. This consensus should help standardize practice around MRI and ensure a more informed, consistent approach to the diagnosis of axSpA.

Background/Aims Magnetic resonance imaging can facilitate the diagnosis of JIA, but is also increasingly used for monitoring disease activity in individual joints. This prospective study aims to measure the frequency of subclinical synovitis on whole-body MRI, in adolescent patients with JIA. Methods JIA patients were recruited from a tertiary adolescent and young adult rheumatology clinic, between September 2019 and August 2020. All patients were examined by a senior rheumatology registrar, before undergoing a contrast enhanced whole-body MRI scan. Patients were assigned to a clinically active or inactive group, depending on their active joint count (AJC); active patients had AJC≥ 1, while the clinically inactive patients had an AJC =0. The post-contrast, water-only mDixon images were assessed for synovitis by one radiologist, blinded to clinical information. Only joints that were definitely abnormal were counted as synovitic. Eighty-one joints per patient were examined with both methods. The presence of subclinical synovitis in a patient was defined as synovitis in one or more joints on MRI, which were not active clinically. Results Thirty-two patients aged 15 to 24 were included in the analysis. The patient characteristics and the frequency of subclinical synovitis are summarised in the table. Subclinical synovitis was detected in a similar proportion of JIA patients in both active and inactive groups (46.7% vs. 41.2%, P = 0.76). The most frequent region with subclinical synovitis was the hindfoot, detected in 22% (7/32) of JIA patients and 17.2% (11/64) of hindfoot joints assessed by MRI. The second most common joint with clinically unsuspected inflammation was the knee, found in 19% (6/32) of JIA patients and 14% (9/64) knee joints. Similarly, 16% (5/32) of the adolescent patients had active disease in the hip, ankle or midfoot joints. The frequency of elbow involvement was also considerable, with 12% (7/58) of joints with subclinical synovitis in 14% (4/29) of JIA patients. Conclusion In conclusion, 43.8% of JIA patients had subclinical synovitis on whole-body MRI scan with no significant difference between the clinically active vs. inactive JIA patients. Large joints were predominantly affected. Further research is required to validate our findings in a larger cohort of JIA patients. Disclosure V. Choida: None. C. Ciurtin: None. T.J.P. Bray: None. D. Sen: None. C. Fisher: None. M. Leandro: None. M.A. Hall-Craggs: None.

OBJECTIVE: The aim was to evaluate diffusion-weighted imaging (DWI) as a tool for measuring treatment response in adolescents with enthesitis-related arthropathy (ERA). METHODS: Twenty-two adolescents with ERA underwent routine MRI and DWI before and after TNF inhibitor therapy. Each patient’s images were visually scored by two radiologists using the Spondyloarthritis Research Consortium of Canada system, and sacroiliac joint apparent diffusion coefficient (ADC) and normalized ADC (nADC) were measured for each patient. Therapeutic clinical response was defined as an improvement of 5 30% physician global assessment and radiological response defined as 52.5-point reduction in Spondyloarthritis Research Consortium of Canada score. We compared ADC and nADC changes in responders and non-responders using the MannWhitneyWilcoxon test. RESULTS: For both radiological and clinical definitions of response, reductions in ADC and nADC after treatment were greater in responders than in non-responders (for radiological response: ADC: P < 0.01; nADC: P = 0.055; for clinical response: ADC: P = 0.33; nADC: P = 0.089). ADC and nADC could predict radiological response with a high level of sensitivity and specificity and were moderately sensitive and specific predictors of clinical response (the area under the receiver operating characteristic curves were as follows: ADC: 0.97, nADC: 0.82 for radiological response; and ADC: 0.67, nADC: 0.78 for clinical response). CONCLUSION: DWI measurements reflect the response to TNF inhibitor treatment in ERA patients with sacroiliitis as defined using radiological criteria and may also reflect clinical response. DWI is more objective than visual scoring and has the potential to be automated. ADC/nADC could be used as biomarkers of sacroiliitis in the clinic and in clinical trials.