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Background There is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet. Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score. Methods RA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. dorsal regions (chi-square test). The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. Analyses were also performed separately for early and established RA. Results A total of 435 patients (N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). The dorsal vs. palmar side of the wrist by GS/PD (p p No major differences between the groups of early and established RA could be detected. Conclusions The wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level.

BackgroundThere is no international consensus on an optimal ultrasound scoring system in patients with rheumatoid arthritis (RA) yet.ObjectivesTo assess the musculoskeletal ultrasound score on seven joints (‘US7 score’) (1) for the identification of the most frequently pathologic and responsive joint regions during 3 and 6 months of therapy in order to optimize the score. Furthermore, to evaluate the impact of disease duration on the performance of the score.MethodsRA patients were recruited from 54 German rheumatology centers when starting or changing DMARD therapy. Patients were assessed by the US7 score in greyscale (GS) and power Doppler (PD) at baseline, after 3 and 6 months. The frequency of pathologic joint/tendon regions and their responsiveness to therapy were assessed including the comparison of palmar vs. dorsal regions.Differences between the palmar and the dorsal sides were analyzed using Chi-square test, the gradings of the US-joint inflammation were compared between baseline, 3 months, and 6 months by Friedman test with Dunn test as post-hoc test.We used standard response mean to determine the responsiveness of possible reduced scores and linear regression to assess the amount of information retained from the original score. Analyses were also performed separately for early and established RA.ResultsA total of 435 patients (n=138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons out of 7 joints were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p≤0.003 in GS/PD).The dorsal vs. palmar side of the wrist by GS/PD (pConclusionThe wrist, MCP2, EDC and ECU tendons were most frequently pathologic and responsive to therapy, representing an optimized score for monitoring of RA patients for both early and established RA and should therefore be included in comprehensive scores for monitoring RA patients.References[1]Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, Hartung W, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 2009;61(9):1194-201.AcknowledgementsWe thank Gabriela Schmittat for logistical support in the study.Disclosure of InterestsAnnika Franziska Podewski: None declared, Anne-Marie Glimm: None declared, Imma Fischer: None declared, George Bruyn: None declared, Petra Hanova: None declared, Hilde Berner Hammer Speakers bureau: Paid speaker for Lilly, Novartis and AbbVie, Employee of: Advisory board for AbbVie, Anna-Birgitte Aga Speakers bureau: AbbVie, Eli Lilly, Novartis, Pfizer and UCB, Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer and UCB, Espen A Haavardsholm: None declared, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Gerd Rüdiger Burmester: None declared, Marina Backhaus Speakers bureau: Speaker fee from AbbVie, BMS, Galapagos, UCB, Novartis, Sarah Ohrndorf: None declared

Additional file 1: Figure S1. Flow-Chart: Patient recruitment. Figure S2. Subdermal skin enhancement read in “Temperature mode”. Table S1. Current medication. Table S2. Cardiovascular risk factors.

Additional file 2: FOI Atlas_subclinical skin enhancement.

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

Im Hafen Hamburg lagern die Kranschienen bei zwei neuen Kaianlagen auf langen fugenlosen Stahlbetonbalken. Die Balkenlange betragt bei der ersten Anlage am Burchardkai 360 m und bei der zweiten Anlage in Altenwerder 1430 m. Die Besonderheit der Balken ist, das sie keine Dehnfugen haben. Arbeitsfugen waren jedoch erforderlich. Um die Rechenannahmen zu uberprufen, wurden Temperatur- und Dehnungsmessungen kontinuierlich uber mehrere Jahre durchgefuhrt.

Der Hafen von Hamburg liegt im Tidebereich der Elbe. Der mittlere Tidenhub betragt ca. 3,50 m. Fur die Bemessung von Hochwasserschutzanlagen und Uferbauwerken ist es erforderlich, die Einflusse der Tiden auf die Bauwerke zu berucksichtigen. Aufgrund hoher auflaufender Tidewasserstande wurde es erforderlich, neue Bemessungsvorgaben fur die Hafenbauwerke festzulegen. Hierzu wurden an unterschiedlichen Querschnittstypen instationare Berechnungen der tideabhangigen Grundwasserstromung nach der Methode der Finiten Elemente durchgefuhrt. Die angesetzten Materialparameter wurden durch Vergleich der berechneten mit den an Bauwerken gemessenen tideabhangigen Grundwasserstanden kalibriert. Aus den Rechenergebnissen wurden Bemessungsvorgaben abgeleitet, die Eingang in die neu aufgestellten "Technischen Rahmenbedingungen fur die Fordermasnahme PROJEKT PRIVATER HOCHWASSERSCHUTZ" der Freien und Hansestadt Hamburg fur Uferbauwerke an Tidegewassern von Bedeutung.