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Background Giant cell arteritis (GCA), the most common primary vasculitis, can cause irreversible blindness in 20–30% of untreated cases, but glucocorticoid therapy leads to significant toxicity in >80% of patients. Ultrasound has proven to be effective in diagnosing giant cell arteritis (GCA) and has the potential to monitor disease activity. Objectives We reviewed data on all patients referred to a single university hospital between August 2014 and December 2015 who were seen in a “fast-track” service established to diagnose and evaluate suspected GCA or a suspected flare. Methods All patients underwent rapid evaluation by a combination of standard clinical assessment and ultrasound of the temporal and axillary arteries. The ultrasound scan was considered positive when we identified the presence of a dark halo around the temporal artery wall or a homogeneous hypoechoic wall thickness >1.5 mm in the axillary arteries. We performed a retrospective analysis and comparison of the ultrasound findings with the clinical features, temporal artery biopsy (TAB) results and decision to treat patients with suspected or established GCA. Results We performed 206 scans in 169 patients (71% females, mean [SD] age 72 ± 11 years). In 123 cases, patients were referred for suspected GCA: 63% were already receiving high-doses of steroids (mean of 12 ± 10 days); 78% had headache; 60% high inflammatory markers; 33% abnormal vascular examination (e.g. diminished/absent pulse or bruits); 31% scalp tenderness; 28% jaw claudication; 26% polymyalgia rheumatica and 26% visual symptoms. In 39 cases the scan was positive: 9 also had a TAB (4 positive) and all were treated as GCA. In 77 cases the scan was negative: 27 also had a TAB (1 positive) and 9 were treated as GCA. In 7 cases the scan was inconclusive requiring further investigations (e.g. TAB). Patients with a positive scan had a mean CRP of 17.6 ± 30.1 g/dl and a mean ESR of 41.3 ± 43.3 mm/hour; patients with a negative scan had a mean CRP of 13.8 ± 17.9 g/dl and a mean ESR of 16.3 ± 17.6 mm/hour (p=0.979 and p=0.048, respectively). We scanned 83 patients with an established diagnosis of GCA to assess for flare or monitor disease activity: 29 had a positive scan (21 increased medication; 8 were follow-ups with improvement from baseline) and 54 had a negative scan (4 increased medication; 50 allowed a safer taper or withdrawal of glucocorticoids). Patients with a positive scan had a mean CRP of 8.0 ± 10.1 g/dl and a mean ESR of 15.6 ± 17.3 mm/hour; patients with a negative scan had a mean CRP of 9.6 ± 16.9 g/dl and a mean ESR of 20.5 ± 19.3 mm/hour (p=0.970 and p=0.190, respectively). Conclusions The combination of rapid clinical evaluation and ultrasound were key elements in diagnosis and monitoring of GCA, allowing more flexible use of glucocorticoid dose regimens and reducing the number of TABs required. The only patient with a negative scan but a positive TAB had already received 20 days of glucocorticoids, suggesting that delay in investigation after starting therapy could affect the results of the scan. References Luqmani RA, et al. The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis. Arthritis Rheumatol 2015; 67 (suppl 10) Disclosure of Interest C. Ponte: None declared, A. Floris Grant/research support from: Italian Society of Rheumatology, S. Vaggers: None declared, N. Goodfellow: None declared, J. Sznajd: None declared, L. O9Neill: None declared, J. Piper: None declared, J. Gunn: None declared, K. Mankia: None declared, R. Luqmani Grant/research support from: GSK, Nordic, Medimmune, Chemocentryx, Roche, UCB, Consultant for: GSK, Nordic, Medimmune, Chemocentryx

The use of PET/CT for determining systemic Kaposi sarcoma (KS) involvement and treatment response remains to be formally assessed. Pretreatment human herpes virus-8 (HHV-8) viral load may predict clinical response of KS to therapy; however, its role in treatment monitoring and correlation with PET/CT findings is unknown. We report PET/CT findings and HHV-8 viral loads of a 46-year-old man with HIV-associated lymphadenopathic KS. After treatment with highly active antiretroviral therapy, an interval PET/CT showed partial response, despite an undetectable HHV-8 viral load. Chemotherapy was initiated, and the patient achieved a complete clinical, PET/CT, and virological response. PET/CT enabled monitoring of treatment response and led to changes in management.

Background Rheumatic conditions can impact significantly on patients’ working lives as highlighted by previous national and international surveys.1,2 Since these studies the economic climate has worsened, with growing pressures on maintaining employment. It is important to understand how patients perceive their condition to affect work in the current climate, and what they feel rheumatologists can do to help. Objectives We sought to assess the impact of rheumatic diseases on working life in our patient population four years since the last national survey. We aimed to characterise patients’ perspectives on the current key obstacles and perceived solutions. Methods Anonymous questionnaires were sent to all patients on our departmental DMARD monitoring database. Data was compared using the chi-square test. Results Of 1455 patients invited, 504 responded (35%). Median age was 65 years. 319 (63%) had RA, 58 (12%) PsA, 14 (3%) ankylosing spondylitis and 34 (7%) other rheumatic diseases. 79 (16%) did not give their diagnosis. 165 patients (33%) were in paid employment. Of the 339 patients not working, 237 were retired (70%); 66 (19%) were not working due to their rheumatic condition. Of those working 53% thought they would still be in their current job in 3 years. 25% of working patients reported their condition had both caused them to change work and hindered career progression. 71% had told their employer about their diagnosis and 37% felt their employer did not understand their condition. More working patients felt their employer had assisted them sufficiently in making changes to their working conditions than those not working (43% vs 22%, p

Background Delivering information effectively to patients is essential for medications such as prednisolone, where dosing is complex and other drugs need to be taken to mitigate against potential side effects. Patients with Giant Cell Arteritis (GCA) are treated with a decreasing prednisolone regimen. Patients are usually elderly, unwell and vulnerable and in need of clear and straightforward information. Only a proportion of verbal information is retained. Written information leaflets can be overwhelming, especially for those with poor literacy skills. Pictorial leaflets have proven useful in our department for drugs such as methotrexate, sulphasalazine and leflunomide. Objectives We hypothesised that a pictorial leaflet would be useful for early GCA patients where a complex prednisolone regimen and the need for additional drugs must be understood. Methods A colour pictorial leaflet was designed to supplement the Arthritis Research UK written information for prednisolone. The A5 leaflet contains photographs of the prednisolone tablets to be taken for each dose. The design allows the clinician to enter the start date for each dose and indicate the desired dosing regimen. Photographs of the additional tablets to be taken, along with clear dosing information and indications, are shown on the reverse of the leaflet. These are alendronic acid, calcium and vitamin D, omeprazole and aspirin as per British Society for Rheumatology (BSR) guidelines for GCA 1 . Pictorial leaflets were shown to patients who were taking or had taken prednisolone treatment. Leaflets were also sent to local General Practitioners (GPs). Patient and GP feedback was obtained using separate questionnaires. Results 37 patients completed feedback. 24 (65%) could not recall being given written information when prednisolone was started. 37 (100%) thought the pictorial information leaflet was clear and easy to read. 33 (89%) rated the pictorial leaflet as more useful than standard written leaflets. Many patients commented that the simplicity and clarity of the leaflet made it a useful memory aid. Feedback was received from 34 GPs. 33 (97%) thought the leaflet was clear and easy for patients to follow. 34 (100%) thought the leaflet would be useful for patients to receive alongside standard written information. Conclusions Patients find pictorial information leaflets clear and easy to follow. For medications with complex dosing and when multiple drugs are prescribed, pictorial leaflets are a useful adjunct to standard written information. Our leaflet allows the desired prednisolone regimen to be clearly recorded and serves as a patient’s personal memory aid. It also highlights important information about osteoprotective, gastroprotective and cardioprotective medications prescribed for GCA. References http://www.rheumatology.org.uk/resources/guidelines/bsr_guidelines.aspx Disclosure of Interest None Declared