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Objective: to study the functional disorder, joint structural changes with acute phase parameters, and interleukin-1 beta (IL-1β) in patients with hand osteoarthritis (HOA). Materials and methods: the study included 52 women with HOA, the mean age was 63.4 (10.0) years old. The degree of functional impairment was evaluated according to the visual analogue scale (VAS) and the author’s questionnaire. The laboratory study included an assessment of ESR, C-reactive protein (CRP), and IL-1β levels in the blood. The instrumental diagnostic was performed by X-ray, ultrasonography (US), and magnetic resonance imaging (MRI) of the hand joints. Results: no significant data were obtained on the dependence of the severity of structural and functional disorders from ESR, CRP, and IL-1β levels (rConclusions: there was no correlation between HOA activity and CRP and IL-1β levels but some authors propose to use highly sensitive methods to detect CRP. The application of highly sensitive methods for CRP detection could reveal the association between this indicator and the HOA activity. The absence of dependence between IL-1β level and morpho-functional parameters agrees with the data obtained by other researchers. It is possible that the evaluation of the IL-1β level in dynamics can be useful for assessing the treatment response but this requires further studies.

Summary Objective Inflammation worsens joint destruction in osteoarthritis (OA) and aggravates pain. Saturated and n-6 fatty acids (FAs) increase, whereas n-3 FAs reduce inflammation. We examined whether FA levels affected the development of OA. Design We studied participants from the Multicenter Osteoarthritis study (MOST) at risk of developing knee OA. After baseline, repeated knee x-rays and MRIs were obtained and knee symptoms queried through 60 month follow-up. Using baseline fasting samples, serum FAs were analyzed with standard assays. After excluding participants with baseline OA, we defined two sets of cases: those developing radiographic OA and those developing symptomatic OA (knee pain and radiographic OA). Controls did not develop these outcomes. Additionally, we examined worsening of MRI cartilage loss and synovitis and of knee pain using WOMAC and evaluated the number of hand joints affected by nodules. In regression models, we tested the association of each OA outcome with levels of saturated, n-3 and n-6 FAs adjusting for age, sex, BMI, education, race, baseline pain and depressive symptoms. Results We studied 260 cases with incident symptomatic and 259 with incident radiographic OA. Mean age was 61 years (61% women). We found no signficant nor suggestive associations of FA levels with incident OA (e.g., for incident symptomatic OA, OR per s.d. increase in n-3 FA 1.00 (0.85, 1.18) nor with any OA outcome in knee or hand. Conclusion Despite previously described effects on systemic inflammation, blood levels of FAs were not associated with risk of later knee OA or other OA outcomes.

The anatomy of the thumb carpometacarpal (CMC) joint, as well as the force transmitted through it, makes it extremely susceptible to osteoarthritis (OA). The thumb CMC joint has been reported as the most painful joint when compared to other hand joints affected by OA. to provide an updated, systematic review of surgical management and outcomes of the most commonly used surgical procedures to treat CMC joint OA presented in literature. we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till January, 36 studies were included. the overall effect estimates showed that the rate of pain at rest after metacarpal osteotomy was 25.1% (95% CI 9.6 – 40.7%); while the rate of satisfaction after metacarpal osteotomy was 48.1% (95% CI 10.5 – 85.7%). The overall effect estimates showed that the rate of normal handgrip after metacarpal osteotomy was 87.1% (95% CI 79.2 – 95%). the overall effect estimates showed that the rate of pain at rest after Volar ligament reconstruction was18.4% (95% CI 11.5 – 25.4%) and the rate of satisfaction was 81.6% (95% CI 74.6 – 88.5%). no surgical procedure appears to be definitely superior to another for the management of first carpometacarpal arthritis in terms of pain, physical function, patient global assessment, range of motion, or strength. Nevertheless, participants who had trapeziectomy had fewer complications than those who had the other commonly used procedures analyzed in the review.

Background Rheumatoid arthritis is a long-term autoimmune disease and inflammatory disorder. The damaging effect on cartilage, bone, ligaments, and tendons has raised the importance of the accurate diagnosis of structural damage, disease activity and severity assessment to enable therapeutic decisions and to evaluate disease outcome. US is non invasive, relatively cheap and widely accessible imaging tool that facilitates the detection of synovitis joint effusin and erosions more better than clinical, laboratory investigations alone and x-ray. Aim of the Work assess the role of of gray-scale and Doppler ultrasound early detection and characterization of synovitis and structural bone changes in wrist and hand joints in patients with Rheumatoid Arthritis by comparing qualitative and quantitative US parameters with clinical and laboratory indicators of disease activity. Patients and Methods A cross sectional study conducted onthirty five adult patients with RA . All the patients were diagnosed according to the 2010 ACR/European League . The patients were recruited from the Rheumatology and Rehabilitation Outpatient Clinic, Faculty of Medicine, Ain Shams Hospitals .The study was approved by the ethical committee, and consents were taken from all patients enrolled in the study. Patients assessed by history taking, Clinical examination, Laboratory investigations and US gray scale and US power Doppler was done for each patient. Results This study included 35 patients with established RA, 27 females (77.1%) and 8 males (22.9%). Ranged in age between 20-70 years with mean age [45.66±12.76],the mean CDAS28 was [4.62±1.37], ESR [44.93±20.79], CRP [15.92±9.03], 33 patients (94.3%) were found to have synovial thickening, 14 patient (40%) were found to have increased vascularity by PD, joint effusion was detected in 12 patient (34.3%) particularly in MCP joints, 13 (37.1%) had bone erosion and only 9 patients (25.7%) had Tenosynovitis, most of them were detected at the extensor compartment of the wrist joint.positive correlations found between the clinical disease activity indices, laboratory investigations, duration of illness and components of the US findings. Conclusion Ultrasound is non invasive, relatively cheap and widely accessible imaging tool that facilitates the detection of synovitis and erosions,, high resolution gray scale images combined with Doppler technique have made it possible to detect slow low volume blood flow, thus improving the outcome of the standard clinical assessment in Rheumatoid synovial inflammation.

Osteoarthritis (OA) is a widespread disease accompanied by persistent joint damage with obvious functional failure, which leads to early disability in patients. In OA, different groups of joints are involved in the pathological process. Hand joints are one of the classical sites of OA. The paper discusses the role of mechanical load, genetic factors, and sex hormone deficiency in the development of the disease. The treatment policy includes a set of non-pharmacological, pharmacological, and surgical methods.

Background: Evaluation of remission in Rheumatoid Arthritis (RA) largely relies on composite scores based on clinical and laboratory assessments however, patients can fulfill clinical remission criteria as defined by composite scores, yet still have evidence of synovitis detectable on imaging. Aim of the work: To evaluate hand and wrist joints in patients with RA in clinical remission using power Doppler (PD) ultrasonography and to study the association between ultrasonographic findings and composite index scores. Patients and methods: This study was conducted on 50 RA patients in clinical remission. Ten matched healthy subjects were included as control. The modified health assessment questionnaire (MHAQ) was assessed in the patients; disease activity was calculated using a composite index score including disease activity score (DAS28) and clinical disease activity index (CDAI). Ultrasonographic assessment of the hand and wrist joints was performed. Results: The mean age of the patients was 50.9 ± 9.2 years, disease duration was 10.6 ± 5.5 years and were 38 females and 12 males. The mean DAS28 was 2.3 ± 0.3. On ultrasonographic examination, 14 (28%) patients had normal synovium, while 18 (36%) showed synovial hypertrophy without evidence of inflammation and 18 (36%) had PD signals. DAS28 was higher in patients with PD signals (2.36 ± 0.3) compared to those without synovitis (2.3 ± 0.28). There was a significant correlation between PD activity and CDAI (p = 0.005), MHAQ (p = 0.002) and disease duration (p = 0.023). Conclusion: Power Doppler ultrasound can detect residual inflammation in RA patients in clinical remission and its scores were signficantly associated with the clinical disease activity index and functional status. Keywords: Rheumatoid arthritis, Remission, Disease activity score-28 (DAS28), Clinical Disease Activity Index (CDAI), Power Doppler ultrasonography

To evaluate the efficacy and safety of using the drug Voltaren Emulgel 2% (diclofenac diethylaminе 2%) for 14 days in patients with osteoarthritis (OA) of small joints of the hands.62 patients of both sexes with hands OA were included in the study, 31 of whom (main group) used Voltaren Emulgel 2% (diclofenac diethylaminе 2%) topically, and the remaining 31 (comparison group) Voltaren Emulgel 2% (diclofenac diethylamine 2%) + oral nonsteroidal anti-inflammatory drugs. The effectiveness of therapy was assessed by using a visual analogue scale (VAS) in dynamics: joint pain and stiffness at rest, pain on movement and during palpation, by functional indices AUSCAN, FIHOA, by assessment of the effect of therapy by the doctor and the patient on a weekly basis.Joint pain decreased after 2 weeks of therapy in all patients during treatment with Voltaren Emulgel 2% (diclofenac diethylamine 2%) in both groups. Significant reduction in stiffness and improvement in hand joint function was achieved after 7 days and lasted until the end of treatment. By the end of treatment, 100% of patients assessed their condition as improvement.Voltaren Emulgel 2% (diclofenac diethylamine 2%) demonstrates comparable clinical efficacy in patients with OA of the hand joints (reduced pain, stiffness and improved joint function) in monotherapy as complex therapy in combination with oral NSAIDS, while being well tolerated.Цель. Оценить эффективность и безопасность применения препарата Вольтарен Эмульгель 2% (диклофенака диэтиламин 2%) в течение 14 дней у пациентов с остеоартритом (ОА) мелких суставов кистей. Материалы и методы. В исследование включены 62 пациента обоего пола с ОА мелких суставов кистей, из которых 31 человек (основная группа) использовал Вольтарен Эмульгель 2% (диклофенака диэтиламин 2%) местно и 31 (группа сравнения) пероральные нестероидные противовоспалительные препараты (НПВП) + Вольтарен Эмульгель 2% (диклофенака диэтиламин 2%). Эффективность терапии оценивалась с использованием визуальной аналоговой шкалы в динамике по показателям суставной боли и скованности в состоянии покоя и при движении, с применением функциональных индексов AUSCAN, FIHOA, учитывалась оценка эффекта от проводимой терапии врачом и пациентом еженедельно. Результаты и обсуждение. Боль в суставах уменьшилась через 2 нед терапии у всех больных в обеих группах на фоне лечения препаратом Вольтарен Эмульгель 2% (диклофенака диэтиламин 2%). Достоверное уменьшение скованности и улучшение функции суставов кистей достигнуто через 7 дней и сохранялось до конца лечения. Все (100%) больные ОА мелких суставов кистей оценили свое состояние как улучшение к концу лечения. Заключение. Вольтарен Эмульгель (диклофенака диэтиламин 2%) продемонстрировал сопоставимую клиническую эффективность в лечении ОА суставов кистей (уменьшение боли, скованности и улучшение функции суставов) в монотерапии, с таковой для комплексной терапии в комбинации с пероральными формами НПВП, обладая при этом хорошей переносимостью.

Tendon has excellent sliding mechanism and functions as the transmission for the hand joint movement. Tendon injury will cause severe hand movement dysfunction. In order to restore the functions of limbs and fingers, ruptured or deficient tendons must be repaired in time. Commonly used tendon repair methods include modified Kessler stitching, Bunnell stitching, Tsuge loop stitching, etc. After tendon repair, the major issue is to prevent either tendon adhesion or tendon re-rupture. Therefore, tendon surgery should achieve non-invasive suturing repair. The suturing material should cause less damage to the tendon tissue, and have good tensile strength, so that it could meet the requirements of postoperative rehabilitation training for patients, so as to reduce tendon adhesion and re-rupture. In early postoperative rehabilitation, it is advisable for patients to do active-passive combined exercise or active exercise as primary and passive as supplement, so as to maximize the restoration of the function of each hand joint.

The hand and wrist is a complex anatomical area and is frequently affected by rheumatological diseases. Routine radiography is crucial to evaluate and diagnose many diseases affecting the hand and wrist and usually complements ultrasound examinations especially in assessing structural bony changes such as erosions and osteophytes and crystal deposition. Ultrasound has a valuable role in the assessment of the wrist and hand joints including tendons, ligaments and nerves which may be affected by inflammatory rheumatological diseases and is an important tool in the early diagnosis and subsequent management of rheumatological disease. In this chapter, we will focus on the most relevant areas in the wrist and hand that are affected by rheumatological diseases and offer a systematic approach to a comprehensive and thorough examination of this joint in order to accurately assess for any underlying disease pathology. We also discuss the relevant anatomy, an understanding of which is essential to perform accurate ultrasound. The wrist and hand examination is carried out by an examination of the dorsal and volar wrist followed by the dorsal hand and then volar hand. A careful examination of the medial and lateral aspects is carried out to identify bony erosions (especially of the MCPJs) and other structural changes such as tenosynovitis of the 1st extensor (APL/EPB) and 6th extensor tendon (ECU tendons) and disease of triangular fibrocartilage (such as crystal deposition).

No difference between both hands was observed for clinical and radiographical presentations in EHOA patients. A bilateral and symmetrical relationship was found between hand joints. EHOA have symmetrical distribution and specific association in structural lesions. This study aims to analyse the preferential topographical distribution of clinical and structural lesions between the dominant and non-dominant hands in erosive hand osteoarthritis (EHOA) patients. Both hands were assessed via radiography in EHOA patients. A comparative analysis of the clinical features and structural lesions between the dominant and non-dominant hands was performed. The structural lesions were assessed according to the anatomical radiographic score of Verbruggen-Veys (VV). Next, a principal component analysis was performed to describe and highlight the relationships observed between the joints. Sixty patients were included in this study: there were 57 women, and the mean age was 66.1 (± 7.6) years. For the distal interphalangeal (DIP) joints, nodes were observed more frequently on the dominant hand (4 vs 3; p = 0.005). No difference in structural lesions was observed between the two hands except for the 2nd proximal interphalangeal (PIP) (p = 0.045). A principal component analysis with varimax rotation described relationships between the 2nd PIP, 3rd PIP, 4th PIP, 4th DIP and 5th DIP joints in both hands. No significant differences between dominant and non-dominant hands were observed for clinical and structural lesions in our sample of EHOA patients. A bilateral and symmetrical injury was observed in most EHOA joints. Trial registration Clinical trial registration number: NCT01068405.

Background: ImageJ software is used to quantify the joint space width (JSW) of hand and wrist in patients with rheumatoid arthritis (RA) as well as in the healthy control group. Method: Forty-one RA patients and 31 healthy controls were included in this study. All of 72 participants underwent digital radiography of the bilateral hand and wrist; then, all the images were opened by ImageJ software to measure the width of wrist and hand joint space (total 2160 joints). Joint space narrowing (JSN) was defined if the width was less than the mean - 2SD of the control group. Result: The mean JSW of all sites of wrist and hand joints of RA patients were significantly reduced as compared to those in the control group (p Conclusion: ImageJ software is simple and convenient that helps rheumatologists quantify the width of joint space for diagnosis and follow-up in RA patients.

Knuckle pads or Garrod’s nodes are a rare, non-inflammatory condition. They consist of benign, well-circumscribed fibro-adipose tissue over the small joints of hands and feet. Knuckle pads may be under-diagnosed and mistaken for early arthritis. The rheumatologist should perform an accurate differential diagnosis in which he can be helped by ultrasound and by other colleagues, such as the dermatologist. Ultrasound is considered useful in the assessment of the thickening of the subcutaneous tissue, located usually on the extensor site of proximal interphalangeal and metacarpophalangeal hand joints. Dermoscopy may play a role in detecting epidermal and dermal changes. We hereby report the case of a female patient with knuckle pads mimicking psoriatic arthritis.

International audience; The knowledge of local stress distribution in hand joints is crucial to understand injuries and osteoarthritis occurrence. However, determining cartilage contact stresses remains a challenge, requiring numerical models including both accurate anatomical components and realistic tendon force actuation. Contact forces in finger joints have frequently been calculated but little data is available on joint contact pressures. This study aimed to develop and assess a hybrid biomechanical model of the index finger to estimate in-vivo joint contact pressure during a static maximal strength pinch grip task. A finite element model including bones, cartilage, tendons, and ligaments was developed, with tendon force transmission based on a tendon-pulley system. This model was driven by realistic tendon forces estimated from a musculoskeletal model and motion capture data for six subjects. The hybrid model outputs agreed well with the experimental measurement of fingertip forces and literature data on the physiological distribution of tendon forces through the index finger. Mean contact pressures were 6.9 ± 2.7MPa, 6.2 ± 1.0 MPa and 7.2 ± 1.3MPa for distal, proximal interphalangeal and metacarpophalangeal joints, respectively. Two subjects had higher mean contact pressure in the distal joint than in the other two joints, suggesting a mechanical cause for the prevalence of osteoarthritis in the index distal joint. The inter-subject variability in joint contact pressure could be explained by different neuromuscular strategies employed for the task. This first application of an effective hybrid model to the index finger is promising for estimating hand joint stresses under daily grip tasks and simulating surgical procedures.

BACKGROUND: It is important to quantitatively assess tremor for accurate diagnosis and evaluation of the response to interventions in patients with essential tremor (ET). OBJECTIVE: The purpose of this study was to investigate the relationship between quantitative measures of postural tremor and clinical rating scale in patients with ET. METHODS: 18 ET patients performed a postural tremor task that required them to hold their arms outstretched parallel to the floor while wearing a gyro sensor based measurement system. The time domain variables were derived from the sensor signals. Additionally, the frequency domain variables were derived from the power spectrum of the angular velocity signal. Spearman correlation analysis was employed in the relationship between the variables and clinical score. RESULTS: The RMS angular velocity of roll and yaw directions at the hand joint were strongly correlated with the clinical rating scale (r= 0.7, p< 0.01). Similarly, the peak power of roll and yaw directions at the hand joint were moderately correlated with the clinical rating scale (r= 0.61 and r= 0.67, p< 0.01). In contrast, no significant correlation coefficients were observed in the peak frequency (p> 0.05). CONCLUSION: These results indicate that hand tremor of roll and yaw directions are more associated with assessment of severity of ET compared to other joints. This study suggests that quantitative measurements of postural tremor should be considered as tremor directionality as well as attachment location.

Background It has been well documented that patients with symptoms of RA often wait for a long time before consulting their GP. This delay is one of the main reasons why only a minority of RA patients are treated within the 3-month therapeutic window of opportunity. In previous research we have shown that people often do not perceive the initial symptoms of RA to be serious or worthy of urgent medical attention. 40% of respondents to a large-scale survey said they would visit a pharmacy for advice before or instead of visiting a GP following the onset of RA symptoms. Therefore, pharmacy staff appear to be well placed to signpost patients with suspect symptoms towards GP consultation. The current research explores the knowledge and perceptions of RA in a range of pharmacy staff and their views on identifying patients with inflammatory symptoms who would benefit from a GP consultation. This information could identify training needs and opportunities for positive intervention. Methods We conducted semi-structured qualitative interviews (face to face or by telephone) with pharmacy staff. Audio recordings of the interviews were transcribed, and the data were analysed by thematic analysis facilitated by NVIVO. Results A total of 19 pharmacy staff (10 males, 9 females) aged between 22 and 56 were interviewed. Interviewees had a variety of roles within the pharmacy including pharmacist or preregistration pharmacist and pharmacy assistants. Interviewees worked at either a (small) chain pharmacy or an independent pharmacy. Accurate knowledge of RA, the seriousness of the disease and knowledge of the importance of early treatment varied greatly amongst staff impacting on their advice given to patients. Further, although many pharmacy staff said they would suggest a GP visit if someone presented with joint swelling, pain and stiffness, others would advise self-management first and only suggest a GP visit if symptoms did not improve. Pharmacy staff indicated that although they felt that they were ideally placed to signpost people to appropriate care, there was a need for additional training (e.g. on how to identify synovial swelling on inspection of the hand joints) in order for them to distinguish the symptoms of inflammatory arthritis from those of non-inflammatory conditions and suggest appropriate care. Conclusion These interviews suggest that although some pharmacy staff already play a role in accurately signposting people with RA towards a GP visit others need further training. This training should enable them to confidently recognise the symptoms signs of RA and other Musculoskeletal conditions and understand that RA is a serious condition that needs rapid disease modifying treatment initiation and consequently that people need to see their GP promptly. Disclosures G. Simons None. G. Mahoney None. N. Wyatt None. R.J. Stack None. K. Raza Grants/research support; KR has received speaker fees/ honoraria from Abbvie, Sanofi, Lilly, UCB, BMS, Pfizer, Janssen and research grant funding from Pfizer Inc. M. Falahee None.

Background: Lichen planus is a skin disease that may last for years, mainly affecting the skin surface and mucous membranes (such as the oral and genital mucosa), and more rarely, on the nails and hairs. Systemic acitretin is an effective therapeutic agent used in the treatment of lichen planus. The skeletal toxicity of retinoids is controversial. Because skeletal toxicity cannot be demonstrated with acitretin, radiological monitoring is not recommended. Case Report: A 24-year-old male patient was admitted to our dermatology outpatient clinic with hand metacarpophalangeal, proximal interphalangeal joint swelling, and pain, who was in the third month of systemic acitretin treatment for oral lichen planus. In our case, another cause of etiologic could not be detected, and arthritis due to acitretin was considered. Conclusion: As a result, it should not be forgotten that acute arthritis may rarely occur during the use of acitretin and should not be overlooked by the clinician

Objective.We aimed to determine whether hand joints develop an accelerated form of osteoarthritis (OA) and to characterize individuals who develop accelerated hand osteoarthritis (AHOA).Methods.We evaluated 3519 participants in the Osteoarthritis Initiative with complete data for baseline and 48-month radiographic hand osteoarthritis (HOA). One reader scored posteroanterior radiographs of the dominant hand using a modified Kellgren-Lawrence (KL) scale and another reader scored the presence of central or marginal erosions. A third reader read images flagged for signs of diseases other than OA. We defined AHOA as ≥ 1 joints that progressed from a KL grade of 0 or 1 at baseline to KL grade 3 or 4 at 48 months.Results.The definition of AHOA was met by 1% over 4 years: 37 hands had 1 joint affected and 1 hand had 2 joints affected. At baseline, adults who developed AHOA were more likely to have hand pain (37% vs 22%), radiographic HOA (71% vs 36%), as well as central (22% vs 7%) and marginal erosions (11% vs 2%) in other joints compared to those without AHOA. Adults with AHOA were more likely to develop new erosions over 48 months (central 35%, marginal 5%) than those without AHOA (central 5%, marginal 1%). The most common locations of accelerated OA were the second metacarpophalangeal and first carpometacarpal joint.Conclusion.Accelerated OA can occur in the hand, especially among digits commonly used for pinching and fine motor skills.

The utility of superb microvascular imaging (SMI) for evaluating hand joint lesions in patients with rheumatoid arthritis (RA) in clinical remission is unreported. This study aimed to compare SMI and power Doppler imaging (PDI) for the evaluation of hand joint lesions in these patients. Twenty-six patients with RA in clinical remission were enrolled. A total of 572 joints (52 wrist, 260 proximal interphalangeal, and 260 metacarpophalangeal joints) were detected by SMI and PDI. A semi-quantitative scale of 0-3 was used to compare the detection of synovial blood flow signal by SMI and PDI. Inter-observer agreement for the assessment of SMI and PDI scores was measured with kappa values. In the ten healthy volunteers, SMI and PDI signals were both scored 0. In the 26 RA patients, the remission rate via PDI was 65.4% but was only 42.3% via SMI. SMI also detected microvessel flow signal in seven patients diagnosed with clinical remission via PDI. Moreover, a total of 106 blood flow signals (18.5%) were detected by SMI, while 50 blood flow signals (8.7%) were detected by PDI. Compared with PDI, SMI increased 18.0% of power flow signals from Grade 0-1 and increased 13.7% of power flow signals from Grade 1-2. One joint classified as Grade 1 by PDI was classified as Grade 0 by SMI. Inter-observer agreement for PDI and SMI semi-quantitative scoring was moderate (kappa = 0.463). SMI seems more sensitive than PDI for detecting hand joint lesions in RA in clinical remission PDI, and could aid the achievement of true remission in RA patients.

Background: Rheumatoid arthritis (RA) is an inflammatory rheumatic disease with progressive course affecting articular and extra-articular structures resulting in pain, disability and mortality. Persistent inflammation leads to erosive joint damage and functional impairment in the vast majority of patients. The onset of disease is not similar in all patients but varies in regard to type, number, and the pattern of joint involvement. The course of disease may be also different according to the presence or absence of several variables including genetic background, frequency of swollen joints, autoantibody in the serum and the severity of inflammatory process. Objective: The aim of this study was to demonstrate the role of Ultrasonography and Power Doppler in diagnosis of activity of rheumatoid arthritis in the hands and wrist joints among different aged population, compared with the laboratory investigations. Patients and Methods: This study was carried out in Radiology department of Ain Shams university hospitals. Twenty-five patients known patients with rheumatoid arthritis suspecting activity will underwent assessment by ultrasonography and power Doppler of both wrist and hand joints. Result: US & PD are highly sensitive and specific in detection of activity of the Rheumatoid Arthritis in correlation to laboratory investigations. So, they can be used as non-invasive methods in detection of RA activity changes in wrist and hand joints. Conclusion: Both ultrasonography and power doppler are good predicators for activity in rheumatoid arthritis patients

Due to the development of synovitis, early-stage hand osteoarthritis (HOA) mimics hand joint injury in rheumatoid arthritis (RA). However, the topography of synovitis is diverse in these diseases: distal interphalangeal and thumb joints are involved in the process in HOA. In the latter, tests are negative for immunological markers (anti-cyclic citrullinated peptide antibodies), which is typical of RA. The differences between HOA and RA are prominent, as evidenced by hand X-rays and magnetic resonance imaging. Investigations suggest that cytokine profile imbalance is implicated in the pathogenesis of osteoarthritis, which brings it closer to RA. However, therapy for HOA has not been practically developed; there are only a few works on the use of disease-modifying antirheumatic drugs and biological agents in these patients. It is necessary to work out Russian guidelines for the treatment of HOA.

Objective: To investigate the association of high baseline serum levels of metalloproteinases-3 (MMP-3) with structural damage to hand and feet joints, assessed by ultrasonography (US), in patients with early, treatment-naïve rheumatoid arthritis (RA), without initial X-ray-visible erosions, during 24 months follow-up. Methods: Sixty-three early RA (European League Against Rheumatism/American College of Rheumatology 2010), disease-modifying anti-rheumatic drugs/glucocorticoid naïve patients (mean age 53.4 ± 14.1) with symptom duration ≤12 months, had baseline serum levels of MMP-3 tested. OMERACT US group definition was used to detect the presence, as well as longitudinal diameter of erosions by US at study entry and after 24 months, at the level of wrists, metacarpophalangeal (MCP2/MCP5) joints of both hands, and fifth metatarsophalangeal joints. Results: Complete data were collected from 52 out of 63 patients. High baseline serum levels of MMP-3 (MMP-3-positive) were found in 46/63 patients. 122 bone erosions in total (1.9 bone erosions/patients) were detected by US at baseline visit and 213 erosions (4.3/patients) after 24 months. MMP-3 positive patients had significantly higher total number of erosions than MMP-3-negative (p = 0.039) and higher increase in size of bone erosions in the feet but not in the hand joints after follow-up (OR 4.82 [1.23–18.9], p = 0.024; OR 1.17 [0.320–4.26], p = 0.816 respectively). Conclusion: After 2 years of follow-up, US assessment showed a higher number of new bone erosions in MMP-3-positive compared to MMP-3-negative patients with early RA and no visible initial radiographic changes. High baseline levels of MMP-3 predict significantly higher structural damage progression at the level of feet, but not at the level of hand joints.

A 30-year-old woman with esophageal squamous cell carcinoma experienced joint pain and swelling in bilateral knees, wrists, and hand joints during the course of neoadjuvant immunochemotherapy. She underwent 18F-FDG and 68Ga-FAPI PET/CT for response assessment of the tumor and evaluating her arthritis. 68Ga-FAPI PET/CT detected intense uptake in multiple joints, consistent with her polyarthritis. However, these joints showed only mild FDG uptake. The tumor was in complete response, and her polyarthritis was considered as inflammatory arthritis induced by anti-PD1.

To update our earlier systematic reviews which evaluated all published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA). Surgical therapies were not evaluated.RCTs published between March 2008 and December 2015 were added to the previous systematic reviews.A total of 95 RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this update. Generally, the methodological quality of these RCTs has improved since the last update, with more studies describing their methods for randomization, blinding, and allocation concealment. However, RCTs continue to be weakened by a lack of consistent case definition and a lack of standardized outcome assessments specific to hand OA. The number and location of evaluated hand joints continues to be underreported, and only 25% of RCTs adequately described the method used to ensure allocation concealment. These remain major weaknesses of published RCTs. A meta-analysis could not be performed because of marked study heterogeneity, insufficient statistical data available in the published RCTs, and a small number of identical comparators.Hand OA is a complex area in which to study the efficacy of therapies. There has been an improvement in the overall design and conduct of RCTs, however, additional large RCTs with a more robust methodological approach specific to hand OA are needed in order to make clinically relevant conclusions about the efficacy of the diverse treatment options available.

To explore whether smoking and alcohol use are associated with hand osteoarthritis (OA) features in two different OA cohorts.We studied 530 people with radiographic hand OA from the Musculoskeletal pain in Ullensaker STudy (MUST) and 187 people from the Oslo hand OA cohort [mean (sd) age 65 (8.0) and 62 (5.7) years, 71% and 91% women, respectively]. Smoking, alcohol use and hand pain were self-reported. Participants underwent conventional hand radiographs and ultrasound examination of 30 hand joints. The Kellgren-Lawrence sum score for radiographic OA severity (0-120 scale) and the proportion of participants having at least one joint with grey-scale synovitis (grade ≥1) were calculated. We studied whether smoking and alcohol use were cross-sectionally associated with radiographic OA, synovitis, and pain using adjusted linear and logistic regression analyses.Smoking was associated with less radiographic OA in both cohorts [β = -4.71, 95% confidence interval (CI) -8.36 to -1.06 for current smoking in MUST and β = -0.15, 95% CI -0.29 to -0.02 for smoking pack-years in the Oslo hand OA cohort]. Stratified analyses indicated that the association was present in men only. Being a monthly drinker (examined in MUST only) was significantly associated with present synovitis compared to never drinkers (odds ratio = 2.35, 95% CI 1.27 to 4.34) (no gender differences). Neither smoking nor alcohol was associated with hand pain.Smoking was associated with less radiographic hand OA whereas alcohol consumption was associated with present joint inflammation in hand OA. Future longitudinal studies are needed to explore the causal associations and explanatory mechanisms behind gender differences.

Background Identifying patient phenotypes using machine-learning (ML) techniques amidst the variability and heterogeneity of the clinical manifestations of psoriatic arthritis (PsA) could be the first critical step towards better understanding of the disease eventually leading to individualized medicine.1 Objectives To identify distinct clusters of patients with PsA based on patients’ tender joint (TJ) and swollen joint (SJ) counts and correlation patterns among TJ and SJ counts at baseline as captured in the secukinumab FUTURE trials program. Methods Pairwise correlations were explored among 76 SJ and 78 TJ measurements of >2,700 patients with PsA across 5 phase III studies with ≈425,000 data entries at baseline and were visualized using heatmaps. Due to high correlations between SJs and corresponding TJs, a composite variable “swollen/tender joint count” was constructed for each joint. Hierarchical clustering was then performed on the composite using “1-correlation” as the dissimilarity metric and Ward’s agglomeration method for pairwise grouping of joints. A dendrogram was used to visualize and assess the resulting joint groupings. Results The hierarchical clustering algorithm grouped the 78 individual joints into distinct and natural clusters (Figure 1A). At higher level of the dendrogram, the algorithm grouped separately all foot, larger (jaws, clavicles, ankles, hips, wrists, knees, shoulders, elbows), and hand joints. Cutting the dendrogram at 15 clusters separated all the joints into distinct groups; hand joints (distal and proximal phalanges, metacarpals and thumbs), and foot joints (distal and proximal phalanges, metatarsals and big toes). Similar clustering algorithms were explored to identify patient clusters at baseline with distinct swelling and tenderness patterns across the identified joint groups. High correlation between swelling/tenderness of the left and swelling/tenderness of the corresponding right joint was observed across all individual joints (Figure 1B); a high correlation was also observed between swelling and tenderness at all individual joints. More localized patterns showed that there is a gradual decrease in correlation (from highest to lowest) among TJs and SJs in adjacent vs non-adjacent fingers, which is evident from grey-scale patterns (Figure 1C). Specifically, a gradual decrease in correlation between the swelling of 2nd distal interphalangeal joint and the tenderness of the 2nd–5th distal phalanges was noted. Conclusion Machine learning methodology confirmed a natural grouping of joints in patients with psoriatic arthritis based on baseline swelling and tenderness and revealed complex correlation patterns. Additional cluster analyses have demonstrated distinct patient clusters across the identified joint groups. Further investigating potential associations of other disease manifestations such as skin and nail involvement to define additional phenotypes may explain differences in disease pathogenesis and treatment outcomes. Reference [1] Grys BT, et al., J Cell Biol. 2017; 216(1): 65-71. Disclosure of Interests Matthias Kormaksson Shareholder of: Novartis, Employee of: Novartis, Effie Pournara Shareholder of: Novartis, Employee of: Novartis, Gregory Ligozio Shareholder of: Novartis, Employee of: Novartis, Luminita Pricop Shareholder of: Novartis, Employee of: Novartis, Ken Abrams Shareholder of: Novartis, Employee of: Novartis, Bruce Kirkham Grant/research support from: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Consultant for: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Speakers bureau: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Kristian Reich Consultant for: Abbvie, Affibody, Amgen, Biogen, Boehringer Ingelheim Pharma, Celgene, Centocor, Covagen, Forward Pharma, Fresenius Medical Care, GlaxoSmithKline, Janssen-Cilag, Kyowa Kirin, Leo, Lilly, Medac, Merck Sharp & Dohme Corp., Novartis, Miltenyi Biotec, Ocean Pharma, Pfizer, Regeneron, Samsung Bioepis, Sanofi, Takeda, UCB Pharma, Valeant, Xenoport; Speakers bureau: Abbvie, Affibody, Amgen, Biogen, Boehringer Ingelheim Pharma, Celgene, Centocor, Covagen, Forward Pharma, Fresenius Medical Care, GlaxoSmithKline, Janssen-Cilag, Kyowa Kirin, Leo, Lilly, Medac, Merck Sharp & Dohme Corp., Novartis, Miltenyi Biotec, Ocean Pharma, Pfizer, Regeneron, Samsung Bioepis, Sanofi, Takeda, UCB Pharma, Valeant, Xenoport, Iain McInnes Grant/research support from: AstraZeneca, Celgene, Compugen, Novartis, Roche, UCB Pharma, Consultant for: AbbVie, Celgene, Galvani, Lilly, Novartis, Pfizer, UCB Pharma

Background: Cyclic citrullinated peptides antibodies (anti-CCP) were described in primary Sjogren’s syndrome (pSS). However, its possible associations with joint erosions, synovitis and tenosynovitis on high resolution ultrasonography of hands and wrists (US) in pSS are uncertain. Objectives: To assess in pSS the US findings, and their possible associations with anti-CCP. Methods: We have evaluated 97 consecutive pSS patients (2016 ACR/EULAR Classification Criteria), of both sexes, aged 18-76 years, and without meeting the 1987 ACR classification criteria for rheumatoid arthritis (RA). Twenty RA patients (disease duration Results: Frequency of tenosynovitis on US was higher in the pSS group than in healthy controls (36.1 vs. 3.8%, p Conclusion: US detected higher frequencies of tenosynovitis and erosions in pSS patients than in healthy controls, and the numbers of synovitis and tenosynovitis correlated with ESSDAI, suggesting that US is an important tool for the evaluation of these patients. Moreover, grade 2/3 synovitis and moderate/large erosions appear to be relevant for the distinction between pSS and RA. The additional observation that erosions are associated with anti-CCP in pSS seems to characterize a subgroup of patients with a severe underlying mechanism of joint damage. Grant from FAPESP: 2015/03756-4. References: [1] Riente L, Scire CA, Delle Sedie A, et al. Ultrasound imaging for the rheumatologist. XXIII. Sonographic evaluation of hand joint involvement in primary Sjogren’s syndrome. Clin Exp Rheumatol. 2009;27(5):747-50. Disclosure of Interests: Lissiane Guedes: None declared, Elaine Leon: None declared, Margarete Vendramini: None declared, Tamyris Bocate: None declared, Karina Bonfiglioli Speakers bureau: Has received speaking fees from Roche, Pfizer, Bristol-Myers Squibb, Abbvie and Janssen., Eloisa Bonfa: None declared, Sandra Pasoto: None declared

Background Development of rheumatoid arthritis (RA) is characterized by a several years lasting phase of autoimmunity, characterized by the presence of anti-modified protein antibodies (AMPA), recognizing citrullinated, carbamylated or acetylated proteins, as well as rheumatoid factor (RF) which precedes the onset of clinical disease (1,2).High resolution peripheral quantitative (HR-pQCT) technique enables the depiction of small cortical changes in peripheral joints (3). Objectives To describe microstructural bone lesions in rheumatoid arthritis (RA) at-risk individuals using HR-pQCT technique, their relation to rheumatoid arthritis specific autoimmunity, particularly osteoclast-inducing citrullinated vimentin (cVIM) antibodies and their impact on the later development of RA. Methods Cortical micro-channels (CoMiCs) as well as volumetric cortical and trabecular bone densities were analyzed by high-resolution computed tomography in the hand joints of RA at-risk individuals. Anti-modified protein antibody (AMPA) response was profiled including reactivities against citrullinated proteins (vimentin, enolase, fibrinogen) as well as carbamylated and acetylated vimentin. All subjects were followed for the development of RA. Results RA at-risk subjects (all N=75) with high-level (>1000U) cVIM antibodies showed a broader AMPA response and significantly more severe microstructural changes (higher CoMiCs, lower cortical and trabecular bone volume) compared to subjects with low/no cVIM reactivity. High cVIM antibodies and microstructural changes (>15 radial CoMiCs/joint) were associated with the presence of arthralgia. Furthermore, progression to RA was high in subjects with high cVIM (53%) vs. those with low (22%) or no (5%) antibodies and those with microstructural changes (46%) vs. those without such changes (16%). Conclusion: cVIM antibodies are associated to microstructural changes in RA at-risk individuals and predict the onset of RA. These data support the concept of structural priming of joints by autoimmunity before the onset of RA. References [1] McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011;365:2205-19. [2] Catrina AI, Svensson CI, Malmstrom V, Schett G, Klareskog L. Mechanisms leading from systemic autoimmunity to joint-specific disease in rheumatoid arthritis. Nat Rev Rheumatol. 2017;13:79-86. [3] Werner D, Simon D, Englbrecht M, et al. Early Changes of the Cortical Micro-Channel System in the Bare Area of the Joints of Patients With Rheumatoid Arthritis. Arthritis Rheumatol. 2017;69:1580-7. Disclosure of Interests Arnd Kleyer Grant/research support from: Lilly, Consultant for: Lilly, Speakers bureau: Abbvie, David Simon Grant/research support from: Novartis, Consultant for: Lilly, Speakers bureau: Janssen, Cong Duy Bui: None declared, Axel Hueber Grant/research support from: Novartis, Pfizer, Consultant for: Lilly, Speakers bureau: Lilly, Novartis, Janssen, Abbvie, Holger Bang Employee of: Dr. Bang is employee of the diagnostic company Orgentec Diagnostika., Andreas Ramming Grant/research support from: Novartis, Jurgen Rech Grant/research support from: Bristol-Myers Squibb and Celgene (greater than $10,000), Consultant for: Bristol-Myers Squibb, Celgene, Chugai, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Roche, Sanofi Aventis, and UCB (in total more than $10,000), Speakers bureau: Bristol-Myers Squibb, Celgene, Chugai, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Roche, Sanofi Aventis, and UCB (in total more than $10,000), Gerhard Kronke Grant/research support from: Lilly, Pfizer, Speakers bureau: Novartis, Georg Schett: None declared

Background The Patient-Rated Wrist Evaluation (PRWE) is a patient-reported questionnaire focusing on symptoms and function in wrist pathologies. It consists of 15 questions regarding pain and functional activities of the wrist. Rheumatoid arthritis (RA) is a multi-systemic disease characterized by inflammation of the wrist and hand joints in almost all patients. This study aims to test the validity of PRWE in patients with RA. Method Seventy-five patients with RA from a single outpatient clinic participated in the study. Patients filled out the Michigan Hand Outcomes Questionnaire (MHOQ) and grip strength of both hands were measured. Patients filled out the PRWE questionnaire consecutively once for the dominant and once for the non-dominant hand. Correlations between PRWE and MHOQ and grip strength scores were analyzed by Spearman's correlation method. Results Our results demonstrated that there was a very strong correlation between the PRWE and the MHOQ and a moderate correlation between the PRWE and grip strength (P < .001). PRWE also showed negative and fair correlation with grip strength of both hands (P < .001). Conclusions The Patient-Rated Wrist Evaluation is a valid tool for evaluating wrist involvement in patients with RA. PRWE may be preferred in the busy clinical setting since it has simple and short questions. Additionally, it may provide a sensitive follow-up tool for patients separately using its subscales of pain and function.

It has been found that obese people have a higher proportion in suffering from osteoarthritis (OA), not only in the weight-bearing joints like knee and hip joints, even in non-weight-bearing joints such as hand joints. One of the reasons is because the large amount of adipose tissue secretes some factors, which can promote the occurrence of arthritis. As an important structure of the knee joint, the infrapatellar fat pad (IPFP) is actually a piece of adipose tissue. The aim of this review is to offer a comprehensive view of the anatomy and physiological characteristics of IPFP and its relationship with the pathological process of OA, indicating the important function of IPFP in OA. At the same time, with the development of adipose derived stem cells in the treatment of OA, owing to its special advantages, the IPFP is becoming a kind of important, minimally invasive fat stem cell source, providing a new approach for the treatment of OA. We hope that this review will offer an overview of all published data regarding the IPFP and will indicate novel directions for future research.

Background Positron emission tomography (PET) imaging of macrophages using the translocator protein (TSPO) tracer (R)-[11C]PK11195 has shown the promise to image rheumatoid arthritis (RA). To further improve TSPO PET for RA imaging, second generation TSPO tracers [11C]DPA-713 and [18F]DPA-714 have recently been evaluated pre-clinically showing better imaging characteristics. Objective A clinical proof of concept study to evaluate [11C]DPA-713 and [18F]DPA-714 to visualize arthritis in RA patients. Methods RA patients (n = 13) with at least two active hand joints were included. PET/CT scans of the hands were obtained after injection of [18F]DPA-714, [11C]DPA-713 and/or (R)-[11C]PK11195 (max. 2 tracers pp). Standardized uptake values (SUVs) and target-to-background (T/B) ratios were determined. Imaging data of the 3 different tracers were compared by pooled post-hoc testing, and by a head to head comparison. Results Clinically active arthritis was present in 110 hand joints (2–17 pp). Arthritic joints were visualized with both [11C]DPA-713 and [18F]DPA-714. Visual tracer uptake corresponded with clinical signs of arthritis in 80% of the joints. Mean absolute uptake in PET-positive joints was significantly higher for [11C]DPA-713 than for [18F]DPA-714, the latter being not significantly different from (R)-[11C]PK11195 uptake. Background uptake was lower for both DPA tracers compared with that of (R)-[11C]PK11195. Higher absolute uptake and lower background resulted in two-fold higher T/B ratios for [11C]DPA-713. Conclusions [11C]DPA-713 and [18F]DPA-714 visualize arthritic joints in active RA patients and most optimal arthritis imaging results were obtained for [11C]DPA-713. Second generation TSPO macrophage PET provides new opportunities for both early diagnosis and therapy monitoring of RA.

Current assessment of osteoarthritis (OA) is primary based on visual grading of joint space narrowing and osteophytes present on radiographs. The approach is observer-dependent, not sensitive enough for the detection of the early stages of OA and time consuming. A promising solution is through fractal analysis of trabecular bone (TB) textures on radiographs. The goal is to develop an automated decision support system for the detection and prediction of OA based on TB texture regions selected on knee and hand radiographs. In this review, we describe our progress towards this development which was conducted in five stages, i.e., (i) development of automated methods for the selection of TB texture regions on knee and hand radiographs (ii), development of fractal signature methods for TB texture analysis, (iii) applications of the methods in the analysis of x-ray images of knees and hands, (iv) development of TB texture classification system, and (v) development of ReadMyXray website for knee x-ray analysis. The results achieved so far are encouraging and it is hoped, that once the system is fully developed and evaluated, it will be used to aid medical practitioners in the decision-making, i.e., in designing OA preventative measures, treatments and monitoring the OA progression.

Pachydermodactyly (PDD) is a rare, benign disease associated with progressive swelling of the periarticular soft tissue of phalangeal hand joints typically treated with local steroid injections. We present a case of a 37-year-old man with PDD treated with local steroid injections. He later developed heterotopic ossification and para-articular calcifications in the injection sites. Heterotopic ossification is not associated with PDD nor is it a recognised complication of local steroid injections. This is the first case in literature of heterotopic ossification occurring after local steroid injection and brings to attention a new potential complication of a widely performed procedure.

Background:We have previously reported that the presence of musculoskeletal pain in psoriasis patients is associated with a higher risk of developing psoriatic arthritis (PsA) (1). Furthermore, a subset of psoriasis patients shows evidence for structural entheseal lesions (SEL) in their hand joints (2), sometimes also referred as “Deep Koebner Phenomenon”, which are highly specific for psoriatic disease and virtually absent in healthy controls, rheumatoid arthritis and hand osteoarthritis patients (2-4). However, it remains unclear whether SEL alone or in combination with musculoskeletal pain are associated with the development of PsA.Objectives:To test whether the presence of SEL in psoriasis patients increases the risk for progression to PsA and how this is related to the presence of musculoskeletal pain.Methods:Psoriasis patients without evidence of PsA were enrolled in a prospective cohort study between 2011 and 2018. All patients underwent baseline assessment of SEL in their 2ndand 3rdMCP joints by high-resolution peripheral quantitative computed tomography (HR-pQCT). The risk of PsA development associated with SEL and arthralgia was explored using survival analyses and multivariable Cox regression models.Results:114 psoriasis patients (72 men/42 women) with a mean (SD) follow-up duration of 28.2 (17.7) months were included, 24 of whom developed PsA (9.7 /100 patient-years, 95%CI 6.2 to 14.5) during the observation period. Patients with SEL (N=41) were at higher risk of developing PsA compared to patients without such lesions (21.4/100 patient-years, 95%CI 12.5 to 34.3, HR 5.10, 95%CI 1.53 to 16.99, p=0.008) (Kaplan Meier plot A). Furthermore, while patients without arthralgia and without SEL had a very low progression rate to PsA (1/29; 3.4%), patients with arthralgia but no SEL showed higher progression (5/33; 15.2%), which was in line with previous observations (1) (Kaplan Meier plot B). Presence of SEL further enhanced the risk for progression to PsA both in the absence (6/16; 37.5%) and presence (6/14; 42.8%) of arthralgia with the highest progression rate in those subjects with both arthralgia and SEL (pConclusion:Presence of SEL is associated with an increased risk of developing PsA in patients with psoriasis. If used together with pain, SEL allow defining subsets of psoriasis patients with very low and very high risk to develop PsA.References:[1]Faustini F et al. Ann Rheum Dis. 2016;75:2068-2074[2]Simon D et al. Ann Rheum Dis. 2016;75:660-6[3]Finzel S et al. Ann Rheum Dis. 2011;70:122-7[4]Finzel S et al. Arthritis Rheum. 2011;63:1231-6Disclosure of Interests:David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Koray Tascilar: None declared, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Sara Bayat Speakers bureau: Novartis, Eleni Kampylafka Speakers bureau: Novartis, BMS, Janssen, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Louis Schuster: None declared, Klaus Engel: None declared, Michael Sticherling Grant/research support from: Novartis, Consultant of: Advisory boards Abbvie, Celgene, Janssen Cilag, Lilly, Pfizer, MSD, Novartis, Amgen, Leo, Sanofi, UCB, Speakers bureau: Abbvie, Celgene, Janssen Cilag, Leo, MSD, Novartis, Pfizer, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB

In many studies, interest lies in determining whether members of the study population will undergo a particular event of interest. Such scenarios are often termed 'mover-stayer' scenarios, and interest lies in modelling two sub-populations of 'movers' (those who have a propensity to undergo the event of interest) and 'stayers' (those who do not). In general, mover-stayer scenarios within data sets are accounted for through the use of mixture distributions, and in this paper, we investigate the use of various random effects distributions for this purpose. Using data from the University of Toronto psoriatic arthritis clinic, we present a multi-state model to describe the progression of clinical damage in hand joints of patients with psoriatic arthritis. We consider the use of mover-stayer gamma, inverse Gaussian and compound Poisson distributions to account for both the correlation amongst joint locations and the possible mover-stayer situation with regard to clinical hand joint damage. We compare the fits obtained from these models and discuss the extent to which a mover-stayer scenario exists in these data. Furthermore, we fit a mover-stayer model that allows a dependence of the probability of a patient being a stayer on a patient-level explanatory variable.

Background Synovial fibroblasts (SF) promote chronic joint inflammation and joint destruction in rheumatoid arthritis (RA). We have shown recently that SF from different joints exhibit profound differences in their transcriptomes, epigenomes and functions, which creates a unique microenvironment in each joint. This might influence the susceptibility of distinct joints to develop RA or lead to joint-specific differences in the disease severity or therapeutic response. Objectives To analyse differences in the JAK-STAT pathway in SF from different joints. Methods SF were isolated from knee, shoulder and hand joints of RA and osteoarthritis patients undergoing joint replacement surgery and from knee synovial biopsies of non-arthritic subjects with arthralgia. Transcriptomes and epigenomes of SF were determined by RNA-seq, Illumina HiSeq 2000 n=21), ChIP-seq (Illumina HiSeq 2500, n=7) and Infinium HumanMethylation450 BeadChip (n=12). We used MetaCore (Thomson Reuters) for the pathway enrichment analysis of RNA-seq data. SF were stimulated with IL-6/soluble IL-6 receptor (IL-6/sIL-6R, 50 ng/ml each). The amount of STATs and phospho-STAT3 (p-STAT3) was measured by Western blot with normalisation to α-tubulin. Results The JAK-STAT pathway was enriched in knee SF versus hand and shoulder SF (FDR Conclusions Here we show substantial quantitative and qualitative differences in the JAK-STAT signalling pathway in SF from different joints. Knee SF, in particular, exhibit increased expression of Janus kinase and STAT genes and enhanced JAK-STAT signalling upon stimulation with IL-6/sIL-6R. This suggests that RA in different joints might not be equally sensitive to Janus kinase inhibitors or blockade of IL-6. This has important implications in clinical practice and drug discovery in RA. Disclosure of Interest T. Masterson: None declared, K. Klein: None declared, E. Karouzakis Grant/research support from: BTCure, GSK, O. Distler Grant/research support from: Abbvie, Actelion, Bayer, BiogenIdec, Boehringer Ingelheim, ChemomAb, espeRare foundation, Genentech/Roche, GSK, Inventiva, iQone, Lilly, medac, MedImmune, Mepha, MSD, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Pharmacyclics, Sanofi, Sinoxa and UCB, Consultant for: Abbvie, Actelion, Bayer, BiogenIdec, Boehringer Ingelheim, ChemomAb, espeRare foundation, Genentech/Roche, GSK, Inventiva, iQone, Lilly, medac, MedImmune, Mepha, MSD, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Pharmacyclics, Sanofi, Sinoxa and UCB, C. Ospelt Grant/research support from: euroTEAM, BTCure, CABMM, IRR, Promedica, M. Frank Bertoncelj Grant/research support from: AbbVie Rheumatology grant 2017 euroTEAM, BTCure, IRR, Promedica, Georg und Berta Schwyzer Winiker Grant

Background One of the most prevalent clinical phenotype of osteoarthritis (OA) is hand OA (HOA), which in some patients can evolve to erosive HOA. In erosive HOA central erosions and subchondral destruction are seen, and imaging studies have indicated that in erosive HOA hand joints display more inflammatory signs than in non-erosive HOA. Autoantibodies directed against post-translationally modified proteins, such as citrullinated (ACPA) and carbamylated (anti-CarP antibodies) proteins, are a hallmark of rheumatoid arthritis (RA), and are associated with more severe joint damage and inflammation. Interestingly, these antibodies are present in a small subset of SLE patients as well, in which they associate with bone erosions. This suggests the possible involvement of autoantibodies in inflammation and joint damage in other conditions than RA. Therefore, we hypothesised that autoantibodies are present in HOA and associate with erosive disease. Objectives To investigate whether three RA-associated antibodies, Rheumatoid Factor (RF), ACPA and anti-CarP antibodies, are present in hand OA and associate with erosive OA. Methods Anti-CarP IgG, ACPA IgG and RF IgM were measured by ELISA in baseline sera of HOA patients from 3 cohorts: HOSTAS (n=510, mean age 61.0 years, 85.7% women, 27.2% EOA), ECHO (n=47, mean age 63.4 years, 89.4% women) and EHOA (n=23, mean age 57.1 years, 73.9% women), and in sera of healthy controls (HC; n=196, mean age 44.1 years, 51.0% women). The prevalence of autoantibodies was compared between HOA and HC and between erosive and non-erosive HOA. In HOSTAS, hand radiographs were scored (Kellgren-Lawrence, OARSI osteophyte and joint space narrowing scores) and C-reactive protein (CRP) levels, representing inflammation, were assessed. Groups were compared using non-parametric tests. Results In both ECHO and EHOA cohorts, only one patient was positive for RF IgM and none were positive for ACPA IgG. In all three cohorts, a low prevalence of anti-CarP IgG was detected and this was not different between HOA patients and HC (6.6% vs 3.6%, p=0.12). Moreover, in HOSTAS, the prevalence of all tested autoantibodies was low and not significantly different from HC (anti-CarP 7.1% vs 3.6%, p=0.08; ACPA 0.8% vs 1.5%, p=0.37; RF 6.1% vs 4.1%, p=0.30). Likewise, no difference was found between erosive and non-erosive HOA (anti-CarP 7.2% vs 7.1%, p=0.94; ACPA 0.7% vs 0.8%, p=0.92; RF 4.3% vs 6.5%, p=0.36). Radiographic damage and CRP levels were similar in anti-CarP positive vs negative, and RF positive vs negative HOSTAS patients. Conclusions The prevalence of autoantibodies is similar in HOA patients and healthy controls. Moreover, these autoantibodies are not associated with erosive disease, structural damage or inflammation in HOA patients, indicating that another mechanism is driving erosive disease. Acknowledgements We thank J.C. Kwekkeboom for her help in collecting the samples, C. Kromme for his help with designing the data file and W. Damman for her help in the scoring of the radiographs. Disclosure of Interest M. van Delft: None declared, S. Van Beest: None declared, M. Kloppenburg: None declared, L. Trouw Consultant for: Listed as inventor in a patent application regarding the detection of anti-CarP antibodies for rheumatoid arthritis, A. Ioan-Facsinay: None declared

Osteoarthritis (OA) usually affects certain joint groups selectively and the hand joints (HJ) are one of its classical locations. Hand OA is widespread in the population. In their practice rheumatologists encounter HJ injury in OA in 38% of cases. It is conventional to identify three main types of hand OA. These are 1) interphalangeal OA that may or may not be accompanied by nodulation; 2) first carpometacarpal OA; and 3) erosive OA. At the same time, the rate of clinical forms ranges from 2.0 to 6.2%; it is 4.7 to 20.4% in the elderly. Nonsteroidal antiinflammatory drugs (NSAIDs) are most commonly used to relieve pain that is the main manifestation of the disease. The risk for NSAID-related adverse gastrointestinal (GI) events is substantially reduced by the drugs that exert their effects mainly on cyclooxygenase 2. These include nimesulide in particular. Undesirable GI effects may be also considerably minimized by using NSAIDs that have both their gastroprotective and antiinflammatory activities. By suppressing pain and inflammatory changes, the recently designed NSAID amtolmetin guacil simultaneously exerts a protective effect on the GI mucosa, by elevating its nitric oxide levels.

WOS: 000393320300008 Gout is a disease cauising severe and sudden pain, tenderness, rash, edema and temperature rise in the joints. Although it appears generally in males, it can also be seen especially in postmenopausal women and it can rise in the joints except toe joint. It should be kept in mind for differential diagnosis and clinical approach in chronic hand arthritis. Sixty-one years old female patient admitted to our clinic with swelling and pain in the right second finger existing for several months. She had hypertension and was on 5 mg/day amlodipin and she was diagnosed with gout 9 years ago and was on colchicine 1 mg/day, allopruinol 300 mg/day. There were gray color changing, swelling, movement restriction and pain on 2. distal interphalengeal joint. Body mass index of the patient was 38 kg/m(2). Blood analyses values were normal and uric acid level was detected 6.2 mg/dL (normal 4.2-5.4 mg/dL). There were subchondral osteopenia, severe intraarticular narrowing and degenerative changes at X-ray examination. The medical treatment of patient was planned and she was consulted for surgery to orthopedics clinic. Uric acid crystals cumulate in joints and their environment in chronic gout patients. These accumulations are called tophus when they get together abundantly. They occur under the skin as swelling. Tophuses generally located at affected joints and their environment, on fingers, on elbows or external ear. Tophuses can damage joints. Although it appears generally in males, it can also be seen especially in postmenopausal obese women and it can rise in the joints except toe joint. It should be kept in mind for clinical approach, treatments and preventing unnecessary surgeries chronic gout arthritis.

Joint hypermobility syndrome (JHS) is a hereditary connective tissue disorder characterized by symptomatic generalized joint hypermobility. Other features such as luxations and subluxations, periarticular lesions and cutaneous or other organ manifestations due to collagen defects are included in JHS clinical criteria. JHS may be clinically indistinct from Ehlers-Danlos syndrome hypermobility type (EDS). We report the case of a 14 year old male patient, with chronic low back pain and generalized joint hypermobility. He also presented a marfanoid habitus, hand joint alterations and striae in the right dorsal region. He fulfilled the Brighton Criteria therefore, after excluding other connective tissue diseases, the diagnosis of JHS was established. JHS is an underestimated and underdiagnosed disease, and must be contemplated in front of musculoskeletal pain associated with generalized hypermobility. The authors describe this case highlighting the importance of looking for signs and symptoms which allow the earlier diagnosis and management.

WOS: 000384674200014 PubMed ID: 27075802 Charcot's neuroarthropathy (CNA) is a destructive disease associated with a reduced proprioceptive sensation. Diabetes mellitus (DM) is one of the most common etiological factor for CNA which typically affects ankles and small joints of feet. Neuroarthropathy seen in upper extremity in patients with DM is a rare clinical condition.In this report, we presented a case of CNA with hand involvement who had type-II DM. Neuroarthropathy was rapidly progressed and destructive changes were observed in right hand joints after a minor trauma in current case.Charcot's neuroarthropathy may rarely occur in the joints of hand in patients with DM. Early diagnosis of CNA is important in order to protect joints and avoid further disability.

The goal of our study was to evaluate the associations between various definitions of radiographic hand osteoarthritis (OA) and self-reported hand pain. We conducted a cross-sectional study with 3604 participants from the Osteoarthritis Initiative (OAI). Posteroanterior radiographs of the dominant hand were read using a modified Kellgren–Lawrence (KL) scale. For our primary analysis, hand OA at person level was defined as two or more finger joints with KL grade 2 or higher. In addition, for the purpose of exploratory analyses, we explored more conservative definitions of hand OA as well as different sum scores and digit- and row-based scores. The majority of definitions of radiographic hand OA were statistically significantly associated with self-reported hand pain. In our main analysis, persons with two or more finger joints with KL grade > 2 were approximately two times more likely to self-report hand pain than persons without radiographic hand OA. Increasing KL grades and increasing number of joints affected lead to stronger associations. Almost all definitions of hand OA were related to pain. Individuals with more severely affected joints or with higher number of affected joints are more likely to report hand pain than their peers. Specifically, individuals with hand joints with KL 3 or 4 have the greatest likelihood of hand pain.

Objectives Although some studies have shown a negative relationship between grip strength and hand osteoarthritis (OA), little is known about how grip strength is related to specific radiographic features of hand OA, such as osteophytes, joint space narrowing, and erosion. In addition, no reported study has examined whether grip strength, as a measure of muscle activity, is related to knee OA, which may also show a one-way effect of reduced muscle strength on OA. In this large, population-based cohort study, we took advantage of the availability of subjects without hand pain to evaluate the effect of grip strength on OA using a novel, semi-quantitative grading system. We also examined whether grip strength was related to detailed radiographic features of OA. Methods Data from 2,251 subjects enrolled in the Dong-gu study, who had no hand joint pain, were analyzed to investigate the relationship between grip strength and OA. Hand grip strength was measured using a hand-held dynamometer, and radiographs of the hand and knee were scored according to a semi-quantitative grading system. Multiple linear regressions were used to explore associations between grip strength and radiographic features of OA. Results Grip strength in men and women was negatively related to hand (both p p p =0.010) OA after adjusting for confounders. Hand (men, p p =0.001) and knee (both p p =0.001), knee osteophytes in men ( p =0.006), hand malalignment (men, p =0.008; women, p =0.041), and subchondral cysts (men, p p =0.007) was correlated with low grip strength in both sexes. Conclusions Among subjects without hand joint pain, low grip strength was associated significantly with hand and knee radiographic OA, regardless of sex. Among all types of OA radiographic damage, low grip strength showed the strongest association with joint space narrowing. Disclosure of Interest None declared

Background Imaging techniques play an important role in making a diagnosis and in the evaluation of treatment effectiveness as well as in the outcome assessment of juvenile idiopathic arthritis (JIA). Fluorescence optical imaging (FOI) has been shown to visualize inflammation in arthritis of wrist and finger joints. FOI is a simple and cost-effectively imaging technique that is well tolerated by the patients. Objectives Firstly, to determine the association and agreement of FOI with ultrasonography (US) and physician9s assessment of swollen and active joints. Secondly, to estimate the predictive power of FOI to distinguish between patients with and without inflammatory pediatric rheumatic joint diseases. Methods A total of 95 patients were enrolled in three pediatric rheumatology centers in Berlin, Germany. FOI and US (in greyscale (GS) and power Doppler (PD)) were performed in each patient. The FOI software automatically generated the PrimaVista mode (PVM). Furthermore, three phases (P1, P2, P3) were defined dependent on the signal intensity in the fingertips. Each joint was scored semiquantitatively (0=no signal up to 3=strong signal, more than 50% of affected joint area) in each of the three phases and PVM. US was additionally graded by a semiquantitative score of each joint for synovitis (synovial thickening and joint effusions) in GS and hyperperfusion in PD mode. The joints were defined as active if the FOI or US reached a score of at least 1, respectively. We report the results on 27 patients in this interim analysis. Results The mean disease duration was 3.5 years (SD=3.2), the mean cJADAS-10 was 11.0 (SD=12.3), the mean number of active joints in the hand was 3.4 (SD=5.8). Half of the patients had polyarthritis (51.8%) and one third had a non-inflammatory rheumatic disease. A total of 810 joints in 27 patients could be analyzed. Among those, 140 (17.3%) had a positive US synovitis score, 87 (10.7%) a positive US power Doppler signal, 93 (11.5%) a clinically active joint and 133 (16.4%) a positive FOI PVM. Taking the US synovitis score as reference, the FOI PVM had a sensitivity of 40%, a specificity of 86% and an overall agreement of 79%. Taking the active joint count as reference, the FOI PVM had a sensitivity of 46%, a specificity of 88% and an overall agreement of 83%. The area under curve was 0.91 for US power Doppler, 0.84 for US GS synovitis, 0.76 and 0.93 for FOI PVM and P2 for the ability to distinguish between patients with and without inflammatory rheumatic diseases. FOI and US scores correlated highly with the cJADAS-10 and the physicians global. In contrast, the patient-reported outcomes pain and fatigue did not show any correlation with FOI and US scores. Conclusions FOI and US had a comparable predictive power to distinguish between patients with and without inflammatory rheumatic diseases in pediatric/ juvenile patients. The agreement between active joint count, US and FOI was high. FOI may provide a cost-effective method to evaluate inflammation in finger and hand joints. Acknowledgements The study was supported by an unrestricted educational grant by Pfizer. Disclosure of Interest None declared

Background There have been no previous report of hand joint destruction prevalence in Chinese rheumatoid arthritis (RA) patients. Therefore, the aim of this study was to investigate the prevalence and potential factors of hand joint destruction among RA patients from Nantong China. In addition, we wanted to examine the differences between functional capacity, psychological status, and quality of life in patients with hand joint destruction compared to those without hand joint destruction. Methods A cross-sectional study was conducted from the Affiliated Hospital of Nantong University between July 2015 and June 2016. RA patients completed questionnaires for demographic or clinical variables, the 10-cm Visual Analog Scale for pain, the 28-joint Disease Activity Score-erythrocyte sedimentation rate for disease activity, the Health Assessment Questionnaire-disability index for physical function, the Hospital Anxiety and Depression Scale for anxiety and depression, and the Short Form 36 health survey for quality of life. Laboratory examinations were taken to obtain some biochemical indicators (e.g., rheumatoid factor, anti-cyclic citrullinated peptide antibody). X-ray assessment of hand was performed and hand joint destruction was defined as Sharp score > 0. Independent sample t-test, Mann–Whitney U-test, Chi-square test, and multivariate analysis using backward stepwise logistic regression model were used to analyze these data. Results One hundred and sixty-one RA patients were included in this study. Radiographic findings revealed that almost 47.2% (n = 76) of patients had hand joint destruction. Multivariate analysis found that education ≤ 9 years (p = 0.041), anti-cyclic citrullinated peptide antibody positive (p = 0.021), high disease activity (p = 0.020), and long disease duration (p