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ObjectiveThe aim of this study was to assess the predictive value of tenderness in the absence of swelling with consideration of other potential risk factors for subsequent radiographic progression in rheumatoid arthritis (RA) and psoriatic arthritis (PsA).MethodsClinical and sonographic (grey scale and power Doppler (PD)) examination of 22 joints of the hand were performed in patients with RA and PsA. The impact of tenderness on progression after 2 years was analysed in non-swollen joints for RA and PsA separately with multilevel mixed logistic regression analysis.ResultsWe included 1207 joints in 55 patients with RA and 352 joints in 18 patients with PsA. In RA, tenderness was associated with radiographic progression after 2 years (model 2: OR 1.85 (95% CI 1.01 to 3.27), p=0.047), although the association of PD (OR 2.92 (95% CI 1.71 to 5.00), pConclusionOur findings imply that tenderness in non-swollen joints in RA is associated with subsequent damage. In both diseases, additional risk factors, such as sonographic signs for synovitis and baseline radiographic damage are associated with radiographic progression.

Background The 2020 postpolypectomy surveillance guideline update of European Society for Gastrointestinal Endoscopy defines a more restrictive group of individuals in need for surveillance 3 years after colonoscopy. Aim The aim of this cohort study was to validate the new guideline recommendation. Methods Based on a national quality assurance program, we compared the 2020 risk group definition with the previous 2013 recommendations for their strength of association with (1) colorectal cancer death, and (2) all‐cause death. Results A total of 265,608 screening colonoscopies were included in the study. Mean age was 61.1 years (SD ±9.0), and 50.6% were women. During a mean follow‐up of 59.3 months (SD ±35.0), 170 CRC deaths and 7723 deaths of any cause were identified. 62.4% of colonoscopies were negative and 4.9% were assigned to surveillance after 3 years according to the 2020 guidelines versus 10.4% following the 2013 guidelines, which corresponds to a relative reduction in colonoscopies by 47%. The strength of association with CRC mortality was markedly higher with the 2020 surveillance group as compared to the 2013 guidelines (HR 2.56, 95% CI 1.62–4.03 vs. HR 1.73, 95% CI 1.13–2.62), while the magnitude of association with CRC mortality for low risk individuals was lower (HR 1.17, 95% CI 0.83–1.63 vs. 1.25, 95% CI 0.88–1.76). Conclusions Adherence to the updated guidelines reduces the burden of surveillance colonoscopies by 47% while preserving the efficacy of surveillance in preventing CRC mortality., Key summary Summarize the established knowledge on this subject Individuals who had colorectal polyps removed are advised to undergo surveillance; intervals are based on the number, size, and histopathological features of the resected lesions.In 2020, the European Society for Gastrointestinal Endoscopy (ESGE) updated their postpolypectomy surveillance guideline. What are the significant and/or new findings of this study? The risk stratification introduced in the new guideline leads to a substantial reduction (by 47%) in the number of individuals in need for surveillance while preserving the efficacy of surveillance in preventing colorectal cancer mortality.

ObjectivesTo determine whether clinical tenderness can be considered a sign of inflammatory joint activity in patients with rheumatoid arthritis (RA), osteoarthritis (OA) or psoriatic arthritis (PsA) and to assess other possible factors associated with tenderness.MethodsPatients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Radiographs of the hands were scored for erosions, joint space narrowing (JSN), osteophytes and malalignment. A binary damage score (positive if ≥1 erosion, JSN and/or presence of malalignment) was calculated. Differences in grey scale signs of synovitis and power Doppler (PD) between tender non-swollen (TNS) versus non-tender non-swollen (NTNS) joints were calculated. Disease duration was assessed,5 years as long-standing arthritis.ResultsIn total, 34 patients (9 early and 14 long-standing) from patients with RA, 31 patients (7 early and 15 long-standing) with PsA and 30 with OA were included. We found equal frequencies of PD signal between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96). However, PD had a significant association with tenderness in early arthritis both in RA (p=0.02) and in PsA (p=0.02). The radiographic damage score showed significant association with tenderness in RA (pConclusionTenderness might not always be a sign of active inflammation in RA, PsA and OA. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment.

Objective: Similar to pregnant women, women taking an oral contraceptive (OC) might have elevated iodine requirements due to the altered hormonal state. This is the first study aimed at investigating the prevalence of iodine deficiency and possible influences of OC intake on urine creatinine and iodine levels in young women. Methods: One hundred fifty-five women between the age of 18 and 35 years (62 taking an OC and 93 controls) participated in a cross-sectional pilot study at the Medical University of Vienna, which included a 1-spot urine sample and a questionnaire on OC intake as well as a food questionnaire. Results: The median urinary iodine concentration (UIC) in this study was 68 μg/L (41, 111 μg/L) suggesting an inadequate iodine status in the women according to the WHO guidelines. Median UIC (OC: 89 μg/L, IQR 55–120; control: 59 μg/L, IQR 39–91, p = 0.010) and urine creatinine (OC: median = 99.0 μg/L, IQR 74.9–175.5; control: 77.0 μg/L, IQR 49.6–147.2, p = 0.030) levels were significantly higher in OC women than in the control group. UIC corrected for urine creatinine was comparable between both groups. Conclusion: With similar creatinine-corrected UICs in both groups, OC intake might not have a significant impact on iodine status. However, the low median UIC in a vulnerable group of young women potentially conceiving in the following years points at the necessity of optimizing the iodine intake in the Austrian population and reiterates the insufficiency of the current iodine supplementation measures.

ObjectivesA third COVID-19 vaccination is recommended for immunosuppressed patients. However, data on immunogenicity and safety of a third COVID-19 vaccination in patients with immune-mediated inflammatory diseases (IMIDs) are sparse and therefore addressed within this clinical trial.Methods60 immunosuppressed patients and 48 healthy controls (HCs) received a third vaccination with an mRNA vaccine. The primary endpoint was defined as the presence of antibody levels against the receptor-binding domain (RBD)>1500 BAU/mL in patients with IMIDs versus HCs. Further endpoints included differences in neutralising antibodies and cellular immune responses after the third vaccination. Reactogenicity was recorded for 7 days, and safety was evaluated until week 4.ResultsRate of individuals with anti-RBD antibodies>1500 BAU/mL was not significantly different after the third vaccination between patients with IMIDs and HCs (91% vs 100% p=0.101). Anti-RBD and neutralising antibody levels were significantly lower in patients with IMIDs after the third vaccination than in HCs (p=0.002 and p=0.016, respectively). In contrast, fold increase in antibody levels between week 0 and 4 was higher in patients with IMIDs. Treatment with biological (b) disease-modifying anti-rheumatic drugs (DMARD) or combination of bDMARDs and conventional synthetic DMARDs was associated with reduced antibody levels. Enhanced cellular immune response to wild type and Omicron peptide stimulation was observed after the third vaccination. No serious adverse event was attributed to the third vaccination.ConclusionOur clinical trial data support the immunogenicity and safety of a third COVID-19 vaccination in patients with IMIDs. However, effects of DMARD therapy on immunogenicity should be considered.Trial registration numberEudraCT No: 2021-002693-10.

Hot snare (HS) is widely used for the resection of adenomas5 mm. The cold snare (CS) has a better safety profile and is more cost-effective. The aims of this study were to evaluate effectiveness and safety of CS polypectomy (CSP) compared to HS polypectomy (HSP) for adenomas sized 5-10 mm and 11-20 mm.4018 colonoscopies performed within "quality certificate for screening colonoscopy" with one polypectomy of an adenoma sized 5-20 mm each were included. Retrieval rates, complete resection rates and complication rates were assessed and compared between CSP and HSP for adenomas sized 5-10 mm and 11-20 mm. Histologic subgroups were additionally assessed.Complete resection rates (5-10 mm: CSP: 89.4% vs. HSP: 87.9%, p = 0.33; 11-20 mm: CSP: 81.8% vs. 80.9%; p = 1), retrieval rates (5-10 mm: CSP: 99.5% vs. HSP: 99.4%, p = 0.76; 11-20 mm: CSP: 100% vs. HSP: 99%, p = 1) and complication rates (5-10 mm: CSP: 0.2% vs. HSP: 0.2%; p = 1; 11-20 mm: CSP: 0% vs. HSP: 1%, p = 1) were equal between CSP and HSP for adenomas sized 5-10 mm as well as 11-20 mm. For serrated adenomas sized 5-10 mm, HSP was superior to CSP (88.7% vs. 77.2%, p 0.05) regarding the complete resection rate, but not for advanced adenomas (HSP: 89.1% vs. 87.3%, p = 0.69) or adenomas with high-grade dysplasia (HSP: 76.7% vs. 75%, p = 1).This study further supports the use of CSP for polyps sized 5-10 mm and additionally suggests also using CSP for polyps sized 11-20 mm. These findings, as well as the best method for resection of serrated polyps should be validated in further studies.

The primary aim of this study was to evaluate adenomas per positive participant (APP) and adenomas per colonoscopy (APC) as new quality parameters in screening colonoscopy. Furthermore, we wanted to assess whether these parameters differ depending on the setting or profession.Colonoscopy records were obtained from the database of the Austrian certificate of quality for screening colonoscopy. The Spearman correlation was calculated to compare the adenoma detection rate (ADR), APC, APP, and advanced ADR. The parameters were compared between surgeons and internists and between private practices and hospitals by using the t test.A total of 44,142 colonoscopies performed by 202 endoscopists were included. APC showed a strong correlation with ADR (r = 0.94; P .01), and both showed a similar correlation with the advanced ADR (ADR: r = 0.47; P0.01, APC: r = 0.46; P .01). APP showed weaker correlations compared with all other parameters (ADR: r = 0.36; P .01; advanced ADR: r = 0.19; P .01). Private practices did not differ in ADR, APP or APC from hospitals. Among endoscopists with ADRs of ≥25%, 7 (10.3%) had an APP in the lowest quartile, whereas no endoscopists had an APC in the lowest quartile.APC did not reveal additional information to ADR, and thus there is no need to use it instead of or additionally to ADR. Although the APP identifies endoscopists who find few adenomas per procedure despite acceptable ADRs, this additional information might not be important in regard to sufficient colorectal cancer prevention, because these endoscopists still had high advanced ADRs.

Objectives To identify and synthesize the evidence for the use and measurement properties of musculoskeletal ultrasound in assessing structural joint damage in patients with rheumatoid arthritis (RA). Methods A systematic literature search (SLR) of the PubMed, Embase and Cochrane Library was performed. Original articles were included published in English reporting on ultrasound of bone erosion, cartilage damage and the measurement properties of ultrasound according to the OMERACT filter 2.1. Results Of the 1.495 identified articles 149 were included in the final review, most of which reported on cross-sectional studies and used the OMERACT definitions for ultrasonographic pathology. Among these, bone erosions were assessed in 139 (93.3%), cartilage damage in 24 (16.1%), enthesophytes in 8 (5.4%), osteophytes in 15 (10.1%) and malalignment and ankylosis in a single (0.9%) study, respectively. Most studies (126/149, 84.6%) assessed the joints of the hands. The overwhelming majority of studies (127/149, 85.2%) assessed structural joint damage bilaterally. Validity, reliability and responsiveness were assessed in 21 (14.1%), 34 (22.8%) and 17 (11.4%) studies, respectively. Conclusion While the results of this SLR suggest that ultrasound is a sensitive, reliable and feasible tool to detect damage in RA, they also highlight the need for further research and validation. Findings of this SLR will inform the next steps of the OMERACT Ultrasound Working Group in developing an ultrasound score for assessing structural joint damage in patients with RA.

The adenoma detection rate (ADR) and characteristics of previously resected adenomas are associated with colorectal cancer (CRC) incidence and mortality. However, the combined effect of both factors on CRC mortality is unknown.Using data of the Austrian quality assurance program for screening colonoscopy, we evaluated the combined effect of ADR and lesion characteristics on subsequent risk for CRC mortality. We analyzed mortality rates for individuals with low-risk adenomas (1-2 adenomas10 mm), individuals with high-risk adenomas (advanced adenomas or ≥3 adenomas), and after negative colonoscopy (negative colonoscopy or small hyperplastic polyps) performed by endoscopists with an ADR25% compared with ≥25%. Cox regression was used to determine the association of combined risk groups with CRC mortality, adjusted for age and sex.We evaluated 259,885 colonoscopies performed by 361 endoscopists. A total of 165 CRC-related deaths occurred during the follow-up period, up to 12.2 years. In all risk groups, CRC mortality was higher when colonoscopy was performed by an endoscopist with an ADR25%. Compared with negative colonoscopy with an ADR ≥25%, CRC mortality was similar for individuals with low-risk adenomas irrespective of ADR (for ADR ≥25%: adjusted hazard ratio [HR], 1.22; 95% confidence interval [CI], 0.59-2.49; for ADR25%: adjusted HR, 1.25; 95% CI, 0.64-2.43) and after negative colonoscopy with ADR25% (adjusted HR, 1.27; 95% CI, 0.81-2.00). Individuals with high-risk adenomas were at significantly higher risk for CRC death if colonoscopy was performed by an endoscopist with an ADR25% (adjusted HR, 2.25; 95% CI, 1.18-4.31) but not if performed by an endoscopist with an ADR ≥25% (adjusted HR, 1.35; 95% CI, 0.61-3.02).Our study adds important evidence for mandatory assessment and monitoring of performance quality in screening colonoscopy. High-quality colonoscopy was associated with a lower risk for CRC death, and the impact of ADR was strongest for individuals with high-risk adenomas.

Background Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of self‐expandable metal SX‐ELLA Danis stents (SEMS) are limited. Methods Cirrhotic patients receiving SEMS for VB at four tertiary care centres were included in this retrospective multicentre study. Rates of failure‐to‐control bleeding (within 5 days) and bleeding‐related mortality (6 weeks) were assessed. Results SEMS controlled VB in 79.4% (27/34) of patients. In the rest of patients, other rescue treatments including endoscopic band ligation (EBL, n = 3), SEMS renewed (n = 2) or Linton (n = 2) were applied; however, VB was only controlled in one patient. Early rebleeding within six weeks occurred in 17.6% (6/34) patients. Median SEMS dwell time was three (IQR:6) days. Overall n = 13/34 (38.2%) patients died with SEMS in situ. After SEMS removal, rebleeding and bleeding‐related death occurred in n = 7 (35%) and n = 5 (14.7%) patients respectively. Only 32.4% (10/34) patients did not experience any rebleeding within six weeks after SEMS removal. Bleeding‐related mortality was 47.1% (n = 16/34) and the median survival after SEMS placement was 2.1 months. Notably, no patient received an early transjugular intrahepatic portosystemic shunt (TIPS). The most common adverse events were stent dislocations (n = 13; 38.2%), while ulcers/necrosis of the oesophageal mucosa was seen in only four (11.8%) patients. Conclusion SEMS controlled refractory VB in most patients. However, bleeding‐related mortality remained high. While SEMS dislocations were frequent, ulcers/necrosis of the oesophagus was rare. Further studies should investigate whether the wider use of early TIPS reduces bleeding‐related mortality after SEMS placement.

Background In inflammatory joint diseases, joint swelling is regarded as a sign of inflammation, which is associated with structural progression [1-3]. However, the significance of tenderness without swelling is unclear. Objectives To determine whether clinical tenderness can be considered a sign of inflammatory joint activity in patients with rheumatoid arthritis (RA), osteoarthritis (OA), or psoriatic arthritis (PsA) Methods 36/24/30 patients respectively with RA, OA and PsA were included in the study. Each patient underwent clinical examination, followed by an ultrasound examination of bilateral MCP 1-5 (metacarpophalangeal), PIP 1-5 (proximal interphalangeal) joint and wrists; the sonographer was blinded to clinical data. On clinical examination synovial swelling and tenderness were evaluated using a binary scoring method, and tender, non-swollen joints (TNS) were identified. Grey-scale signs of synovitis (GS) and Power Doppler signal (PD) were evaluated using a semiquantitative grading system. Differences of PD signals between groups (RA vs. OA, RA vs. PsA, TNS vs. non-tender non-swollen joints) were calculated by Chi-Square test. Furthermore, joints of RA and PsA patients were tracked back for up to 6 years to identify the time point of the last swelling of that respective joint. Kaplan-Meier estimates for the occurrence of the last time point of swelling were compared between PD positive and PD negative TNS joints. Results TNS joints more often showed PD signal in RA patients as compared to those with OA and PsA (18.7% vs. 11.5% vs. 9.2%, respectively, p=0.135 for RA vs. OA; p Conclusion The results of this study confirm the current practice of considering tenderness a sign of active inflammation in RA, but imply that this may not be the case in PsA or OA. The fact that shorter time to last swelling was associated with positive PD in TNS joints suggests that, at least in RA, tenderness might reside after prior clinical swelling has resolved. References [1] Conaghan PG, et al., Arthritis Rheum2003; 48: 64-71. [2] Aletaha D, et al. Ann Rheum Dis2011; 70: 1975-1980. [3] Aletaha D, et al. Arthritis Rheum2011; 63: 3702-3711. Disclosure of Interests Irina Gessl Grant/research support from: Travel Grant, Mihaela Popescu: None declared, Victoria Schimpl: None declared, Gabriela Supp: None declared, Michael Zauner: None declared, Michaela Loiskandl: None declared, Martina Durechova: None declared, Josef S. Smolen Grant/research support from: AbbVie, Eli Lilly, Janssen, MSD, Pfizer, Roche, Consultant for: AbbVie, Amgen, Astra-Zeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, MedImmune, MSD, Novartis, Pfizer, Roche, Samsun, Sanofi, UDB, Speakers bureau: AbbVie, Amgen, Astra-Zeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, MedImmune, MSD, Novartis, Pfizer, Roche, Samsun, Sanofi, UDB, Daniel Aletaha Grant/research support from: AbbVie, Bristol-Myers Squibb, and MSD, Consultant for: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Medac, Merck, MSD, Pfizer Inc, Roche, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Medac, Merck, MSD, Pfizer Inc, Roche, and UCB, Peter Mandl: None declared

Background Tenosynovitis and consequent tendon damage are common findings in inflammatory arthritides. In contrast to rheumatoid arthritis (RA) and psoriatic arthritis, little is known about the frequency of tendon involvement in hand osteoarthritis (HOA) and the influence thereof on hand function. Ultrasound has been reported to have a high specificity in diagnosing tenosynovitis and tendon damage. Objectives We aimed to appraise the frequency of tendon involvement in HOA and to assess the agreement between ultrasound (US) and clinical diagnosis of tenosynovitis and tendon damage in HOA. In addition, we wanted to assess the influence of tendon involvement on hand function. Methods We included 73 patients with HOA in the study. Each patient underwent a clinical as well as a US examination of the 6 extensor tendon compartments and 6 flexor tendons of the hand (fig. 1). They were assessed for US signs of tenosynovitis and tendon damage as well as osteophytes (presence/absence) by a sonographer blinded to clinical information, as well as for clinical tendon involvement (presence/absence) by a biometrician blinded to the US results. Difference in frequency of sonographically detected tendon involvement between flexor and extensor tendons and between right and left hand were calculated by Chi-Square test. Osteophytes were also evaluated on standard radiographs. Agreement between US and clinical examination was calculated by Cohen’s kappa. Hand function was quantified using the Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (SACRAH) questionnaire as well as the Moberg pick-up test (MPUT). Correlation between MSACRAH and tendon involvement was calculated by Spearman’s correlation. Results In 41 patients (56.2%), at least one tenosynovitis was observed and in 8 (11%) patients, at least one tendon damage was detected by US. Tendon damage was found more often in flexor tendons (0.2% vs. 2.2%, p Clinically, any tendon involvement was observed in 57 (78.1%) patients. There was no agreement between the US and the clinical examination on the level of individual tendons (kappa -0.0007) and only slight agreement on the level of individual patients (any affected tendon yes/no) (kappa 0.16). We also found no association between osteophytes (radiographic or US) and tendon involvement regardless of assessment. Neither total MSACRAH nor the MPUT correlated with the number of affected tendons detected by US. However, there was a slightly significant correlation between the number of clinically affected tendons and the MSACRAH subtest for hand function and stiffness. Conclusion This study revealed a high frequency of tendon involvement in HOA. The prevalence of tenosynovitis was similar as reported for RA and other inflammatory arthritides. The fact that we could demonstrate marked differences in the distribution of tenosynovitis and tendon damage between and among flexor and extensor tendons as assessed on US, coupled with the overall homogeneous clinical involvement, suggests that clinical examination may be less specific for tendon involvement as compared to US. Tendon involvement on US does not seem to have an impact on hand function in HOA. Disclosure of Interests Irina Gessl Grant/research support from: Travel Grant, Anna Vinatzer: None declared, Gabriela Supp: None declared, Michael Zauner: None declared, Michaela Loiskandl: None declared, Martina Durechova: None declared, Valentin Ritschl: None declared, Josef S. Smolen Grant/research support from: AbbVie, Eli Lilly, Janssen, MSD, Pfizer, Roche, Consultant for: AbbVie, Amgen, Astra-Zeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, MedImmune, MSD, Novartis, Pfizer, Roche, Samsun, Sanofi, UDB, Speakers bureau: AbbVie, Amgen, Astra-Zeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, MedImmune, MSD, Novartis, Pfizer, Roche, Samsun, Sanofi, UDB, Daniel Aletaha Grant/research support from: AbbVie, Bristol-Myers Squibb, and MSD, Consultant for: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Medac, Merck, MSD, Pfizer Inc, Roche, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Medac, Merck, MSD, Pfizer Inc, Roche, and UCB, Peter Mandl: None declared

Objectives To develop and test the reliability of a new semiquantitative scoring system for the assessment of cartilage changes by ultrasound in a web-based exercise as well as a patient exercise of patients with RA. Methods A taskforce of the Outcome Measures in Rheumatology Ultrasound Working Group performed a systematic literature review on the US assessment of cartilage in RA, followed by a Delphi survey on cartilage changes and a new semiquantitative US scoring system, and finally a web-based exercise as well as a patient exercise. For the web-based exercise, taskforce members scored a dataset of anonymized static images of MCP joints in RA patients and healthy controls, which also contained duplicate images. Subsequently, 12 taskforce members used the same US to score cartilage in MCP and proximal interphalangeal joints of six patients with RA in in a patient reliability exercise. Percentage agreement and prevalence of lesions were calculated, as intrareader reliability was assessed by weighted kappa and interreader reliability by Light’s kappa. Results The three-grade semiquantitative scoring system demonstrated excellent intrareader reliability (kappa: 0.87 and 0.83) in the web-based exercise and the patient exercise, respectively. Interreader reliability was good in the web-based exercise (kappa: 0.64) and moderate (kappa: 0.48) in the patient exercise. Conclusion Our study demonstrates that ultrasound is a reliable tool for evaluating cartilage changes in the MCP joints of patients with RA and supports further development of a new reliable semiquantitative ultrasound scoring system for evaluating cartilage involvement in RA.

Background:The detection of damage in patients with rheumatoid arthritis (RA) is crucial for monitoring of therapy targets as well as for early diagnosis. Conventional radiography (CR) is commonly used to detect structural damage, in the form of bone erosions or loss of hyaline cartilage. Over the last years, musculoskeletal ultrasound (MSUS) was shown to be a sensitive and reliable method to detect erosion and cartilage loss as well as damage to soft tissue structures.Objectives:To identify and synthesize the evidence for the use and measurement properties of MSUS in assessing structural damage in patients with RA.Methods:A systematic literature search (SLR) of the PubMed, Embase and Cochrane Library was performed. Original articles were included that were published in English until 01/01/2019, reporting MSUS of bone erosion, cartilage loss or damage and tendon damage, and the measurement properties of MSUS according to the OMERACT Filter 2.1.Results:Of the 1.266 identified articles 79 were finally included, most of which reported on cross-sectional studies. The majority of the studies used the OMERACT definitions for ultrasonographic pathology. Among these, erosions were assessed in 72 (91.1%), cartilage damage in 12 (15.2%), tendons in 4 (5.1%) studies and enthesophytes in a single (1.3%) study. Erosions were rated by binary grading in 56 (77.8%) studies and by semiquantitative scoring in 27 (37.5%) studies. Global or sum scores were calculated in only 9 (12.5%) studies. Among 23 studies assessing erosions both by US and CR, only 1/23 (4.3%) study found a higher sensitivity of CR as compared to MSUS. Among studies assessing tendons, 3 (75%) used a semiquantitative score and one scored tendon rupture as being present or absent. Cartilage damage was graded in binary fashion, quantitatively by measuring cartilage thickness or semi-quantitatively. Hand joints were the most frequently evaluated joints (58, 73.4%). The overwhelming majority of studies assessed structural damage bilaterally (68, 86.1%), with 5 (6.3%) studies assessing only the dominant hand, 5 (6.3%) studies evaluating the clinically more affected side and 1 (1.3%) study assessing only the right hand. Validity, reliability and responsiveness were assessed in only 8 (10.1%), 10 (12.7%) and 4 (5.1%) studies respectively. Feasibility was not considered in any of the studies.Conclusion:While the results of this SLR suggest that US is a sensitive and feasible tool to detect damage in RA, they also highlight the need for further research and validation. Findings of this SLR will inform the next steps of the Working Group in developing an ultrasound score for assessing structural damage in patients with RA.Disclosure of Interests:None declared

Despite modern therapeutics and treatment strategies, a subset of rheumatoid arthritis (RA) patients remains insufficiently responsive to multiple therapies. Here, we identify predictors of such refractory RA ("reRA").Patients from a longitudinal academic clinical database with reRA (defined as failing to reach the treatment target of at least low disease activity with ≥3 DMARD courses, including ≥1 biological, over a total of ≥18 months) were compared to patients who did respond within the first two treatments (treatment amenable RA, "taRA"). We performed logistic regression analysis to identify risk factors for refractory disease, and several sensitivity analyses concerning different potential definitions for reRA to confirm the robustness of the results; key findings were also validated in an independent community cohort.We enrolled 412 patients, of whom 70 were reRA and 102 taRA; 240 patients fulfilled neither definition. ReRA patients were more frequently female (92.9 vs. 70.6%, p 0.001), younger (44.37 vs. 51.14 years, p = 0.002), and had higher CDAI levels at first presentation (26.06 vs. 15.39, p 0.001). Treatment delay was significantly longer for reRA than for taRA (3.17 vs. 1.45 years, p = 0.001). In multivariable analyses, treatment delay, female gender and higher disease activity remained as independent predictors of refractory disease. Based on the identified predictors, we developed a matrix model for risk of future reRA.Our data identified delay to initial treatment, female gender and higher disease activity as important predictors of a later refractory course of RA. Delay of treatment initiation is the single most important modifiable risk factor of refractory disease.

Background Pristane induced lupus (PIL) is an established murine model of induced systemic lupus erythematosus (SLE). Mice develop specific autoantibodies and show symptoms of SLE including arthritis, glomerulonephritis and haemorrhagic pulmonary capillaritis. Objectives To investigate the therapeutic effects of in vitro-induced regulatory T cells (iTreg) in the murine model of PIL. Methods BALB/c mice were injected i.p. with 0.5 ml of pristane (PIL) or PBS (control). Naive CD4+ thymocytes were sorted and cultured and cell suspensions with >80% CD4+FoxP3+ cells (iTreg) were injected i.v. (i) once when PIL was induced (5 × 106 iTreg (iTreg-single)) or (ii) every 4 weeks (1 × 106 iTreg, iTreg-rep). Mice were monitored for paw swelling and grip strength. After 8 months, histological analysis quantified cartilage degradation, number of osteoclasts, extent of inflammation and bone erosion. Glomerulonephritis and pneumonitis were quantified using the kidney biopsy score and a histomorphometric image analysis system; inflammatory tissue was analysed by tissue cytometry. Serum levels of auto-antibodies were measured by ELISA. Frequencies of B cells, activated and regulatory CD4+ T cells and Th1, Th2, Th17 cells were measured by flow cytometry. FlowCytomix Pro was used to measure serum cytokines. RT-qPCR was used to measure expression levels of interferon (IFN)-signature and T-cell subset related as well as inflammation-associated genes. Results Monthly injections of 1 × 106 iTreg reduced the clinical and histological severity of PIL-arthritis. This was seen by a higher mean grip strength, less mean paw swelling, retardation of symptom onset and a lower summative arthritis severity score (figure A). There was significant reduction of arthritis severity in all histological parameters and in the percentage of affected mice with erosive arthritis (33% of iTreg-rep mice vs 62% of PIL-mice). A single boost of 5 × 106 iTreg could not prevent joint manifestation, however a slight retardation in ‘loss of grip strength’ and significantly less erosive area was seen. In regards to cellular composition of the inflammatory tissue in paws, a significantly increased relative amount of CD4 +Foxp3+cells was seen in the iTreg-rep group compared to PIL group. Repeatedly injected mice (iTreg-rep) had significantly less renal disease (glomerular activity score) (figure B) and pulmonary involvement (perivascular inflammatory area) (figure C) compared to PIL. iTreg-rep mice had significantly lower serum levels of disease-associated auto-antibodies (figure D). Upon restimulation, splenic CD4+ cells in iTreg-rep showed a less pronounced Th1, Th2 and Th17 response as well as lower percentages in B- and activated T-cells, whereas the percentage of Treg was higher than in all other groups (figure E). FlowCytomix analysis showed reduced cytokine production after repeated iTreg administration. Correspondingly, iTreg-rep showed decreased expressions of IFN-signature-, T-cell subset- and inflammatory cytokine related genes (figure F). Conclusions Repeated injections of iTreg ameliorate the clinical, histological, serological as well as the genetic severity of PIL-manifestations. A single boost of iTreg at time of disease induction does not prevent manifestations, but retards the onset of symptoms. Thus iTreg have significant positive effects on PIL, which may have consequences for future approaches in treating SLE. Disclosure of Interest None declared

The wrist and the small joints of the hand are among the most frequently involved anatomical sites in rheumatic and musculoskeletal diseases (RMDs). Consequentially, they are also frequently evaluated by sonographers both in routine clinical practice and within the framework of clinical trials, providing an opportunity for rheumatologists performing ultrasound to gain a deeper understanding of the pathological processes involved in rheumatic diseases. We provide an extensive introduction into the sonographic examination of the structures of the hand and wrist commonly evaluated by rheumatologists.

European guidelines for quality assurance in colorectal cancer screening recommend snare resection for polyps 5 mm. The aim of this study was to investigate polypectomy technique according to lesion size and shape, and to assess adherence of endoscopists enrolled in the national quality assurance program to the European guidelines.This cohort study included screening colonoscopies performed between 2007 and 2013 within a quality assurance program in Austria. Resection technique was analyzed according to lesion characteristics and endoscopy facility (private practices, hospitals, outpatient clinics) before publication of the EU guidelines (2007 - 2010) and adherence to the guidelines after publication (2011 - 2013). All surveillance colonoscopies and examinations with missing data were excluded.A total of 128 969 screening colonoscopies performed by 278 endoscopy units were included. The polyp detection rate was 39.6 % (n = 47 797) and 95.6 % of polyps were resected. Of polyps ≥ 5 mm, 46.0 % were resected using forceps and were therefore not treated in accordance with the guidelines. Forceps polypectomy of lesions 5 - 10 mm and 10 mm decreased significantly in hospitals after implementation of the guidelines (both P 0.0001). In private practices, there was no difference in forceps usage for polyps of 5 - 10 mm (P = 0.41) before and after the guidelines, and for polyps 10 mm forceps usage even increased (P 0.0001). Endoscopists' forceps removal rates for polyps ≥ 5 mm correlated significantly with respective adenoma detection rates (P = 0.0007, r p - 0.187) and cecal intubation rates (P = 0.0001, r p - 0.303). Among endoscopists in private practices, internists had slightly lower forceps removal rates for polyps ≥ 5 mm than surgeons, both before (47.2 % vs. 50.7 %; P = 0.014) and after publication of the guidelines (51.9 % vs. 53.5 %; P = 0.161).This study confirmed the importance of the European guidelines. The inclusion of adequate resection technique as a quality indicator in colorectal cancer screening programs is recommended.

Background and study aim The European guidelines for quality assurance in colorectal cancer screening and diagnosis contain postpolypectomy surveillance recommendations. They recommend follow-up intervals depending on the findings at index colonoscopy, and divide patients into a low-, intermediate- or high-risk group. The aim of this study was to assess the adherence of Austrian endoscopists to the European guidelines and to determine whether sending a reminder letter resulted in better adherence. Methods A single reminder letter containing the guidelines was sent to all endoscopists who participated in the Certificate of Quality for Screening Colonoscopy program in Austria. Adherence was assessed before and after the letter had been sent. Factors associated with adherence were investigated. Results We found poor baseline adherence to the guidelines. After the reminder letter, the adherence slightly improved in the low-risk group, but did not change in the intermediate-risk or high-risk groups. An adenoma detection rate of at least 20 % was associated with higher adherence rates. Generally, internists and hospitals showed better adherence compared with surgeons and private practices, respectively, both before and after the reminder letter. Conclusion A single reminder letter was not enough to improve the poor adherence to the European postpolypectomy surveillance guidelines. Thus, future studies are required to identify and eliminate all factors responsible for nonadherence to postpolypectomy guidelines in order to reach the goal of a safe, effective, and cost-effective colorectal cancer prevention tool in the near future.

Background Persistent tenosynovitis and degenerative tendinitis is associated with pain and can lead to dysfunction and tendon damage. While tenosynovitis is a common finding in rheumatoid arthritis, data on tendon involvement in hand osteoarthritis (HOA) is clearly limited. The clinical assessment of tendons is difficult and not fully standardized, but muculoskeletal ultrasound (MSUS) has been used successfully in inflammatory rheumatic disease as a sensitive method to detect tenosynovitis, tendon damage and osteophytes. Objectives To characterize tendon involvement in hand osteoarthritis and compare ultrasound with clinical assessment. Methods In this cross-sectional observational study 34 patients with HOA underwent MSUS and clinical examination on the same day. Each flexor and extensor tendon of the hand was scored independently for tenosynovitis and tendon damage (presence/absence) respectively by an expert in MSUS, blinded to the results of the clinical examination. Additionally, osteophytes in the proximal and distal interphalangeal joints of the fingers were assessed. Clinical assessment of tendons for tendon involvement included volar or dorsal pain, crepitus and swelling involving the hand, wrist or forearm during active movement of the tendon against resistance according to the Birmingham consensus criteria, by assessors who were blinded to the results of the MSUS. Conventional radiographs (CR) of the hands were also acquired and evaluated by the Interphalangeal Osteoarthritis Radiographic Simplified score. Results The majority of patients (30/34, 88.2%) were female, with a mean age of 69.5±8.5 years and a median of 10 (9–22.5) years disease duration. Clinical examination revealed tendon involvement in 21 (61.8%) patients with a median of 3 (range 1–14) affected tendons. In MSUS tenosynovitis was detected in 17/33 patients (51.5%) with a median of 1 (1–4) tendon involved. Tendon damage was found in 8/33 patients (24.2%) with a median of 2 (1–11) tendons involved. A total of 20/33 (60.6%) patients exhibited sonographic signs of tendon involvement (tenosynovitis/tendon damage) with a median of 2 (1–12) involved tendons. Tendon damage was found more often on the right hand (p Conclusions The findings of our study reveal a high prevalence of tendon involvement in patients with hand OA. Sensitivity of MSUS in detecting tendon involvement coupled with the lack of agreement between clinical examination and MSUS on the level of individual tendons may suggest that while clinical examination is able to identify patients with overall tendon involvement, it does not allow the specific identification of involved tendons. Disclosure of Interest None declared

Background Joint destruction in rheumatoid arthritis (RA) is comprised of hyaline cartilage and bone damage, with the former more clearly associated with irreversible physical disability than bony damage. Objectives To test the reliability of a semiquantitative scoring system for the assessment of cartilage by musculoskeletal ultrasound (US) in a web-based exercise as well as a patient-based reliability study of patients with RA. Methods Static images of metacarpophalangeal (MCP) joints 2–5 in RA patients and healthy controls were acquired and a dataset of 123 anonymized images including 25 duplicate images was circulated among an international EULAR-OMERACT taskforce of 25 rheumatologist experts in US who independently scored the images using a semiquantitative scoring system. Subsequently 12 taskforce members participated in a patient-based reliability study. During this meeting MCP joints 2–5 of 6 patients with RA were assessed twice on the same day by all experts using US machines (GE) equipped with high-frequency transducers (18–22MHz) with presets calibrated for the appropriate assessment of cartilage. Participants assessed metacarpal cartilage both in the standardized longitudinal midline scan as well as by freehand technique utilizing multiple planes and scored by the semiquantitative scoring system. Intraobserver reliability was assessed by Cohen9s kappa and interobserver reliability by Fleiss9 kappa. Results The three-grade semiquantitative (Grade 0, normal cartilage; Grade 1, minimal change; Grade 2, severe change) scoring system demonstrated excellent (kappa: 0.87) to good (kappa: 0.73) intraobserver reliability in the web-based exercise and the patient-based reliability study respectively. Interobserver reliability was good in the web-based exercise (kappa: 0.64) and moderate (kappa: 0.49) in the patient-based reliability study. The dynamic technique performed slightly better than the longitudinal midline scan alone. Conclusions A semiquantitative scoring system demonstrated good intra- and moderate to good inter-observer reliability in a web-based exercise and patient-based reliability study. Our study demonstrates that US is a reliable tool for evaluating cartilage and supports the use of a new semiquantitative US scoring system for evaluating cartilage change in RA. Acknowledgements The patient-based reliability study was supported by a research grant from UCB. Disclosure of Interest None declared

BACKGROUND Endoscopic band ligation (EBL) is used for primary (PP) and secondary prophylaxis (SP) of variceal bleeding. Current guidelines recommend combined use of non-selective beta-blockers (NSBBs) and EBL for SP, while in PP either NSBB or EBL should be used. AIM To assess (re-)bleeding rates and mortality in cirrhotic patients receiving EBL for PP or SP for variceal bleeding. METHODS (Re-)bleeding rates and mortality were retrospectively assessed with and without concomitant NSBB therapy after first EBL in PP and SP. RESULTS Seven hundred and sixty-six patients with oesophageal varices underwent EBL from 01/2005 to 06/2015. Among the 284 patients undergoing EBL for PP, n = 101 (35.6%) received EBL only, while n = 180 (63.4%) received EBL + NSBBs. In 482 patients on SP, n = 163 (33.8%) received EBL only, while n = 299 (62%) received EBL + NSBBs. In PP, concomitant NSBB therapy neither decreased bleeding rates (log-rank: P = 0.353) nor mortality (log-rank: P = 0.497) as compared to EBL alone. In SP, similar re-bleeding rates were documented in EBL + NSBB vs EBL alone (log-rank: P = 0.247). However, EBL + NSBB resulted in a significantly lower mortality rate (log-rank: P

Objective We herein examine the role of endogenous miR155 in the development of systemic manifestations in pristane induced lupus. Materials and methods Systemic lupus in miR155-deficient and wild type mice was induced upon injection of pristane and analyzed after 8 months, PBS-injected mice served as controls. Glomerulonephritis and pneumonitis were quantified using the kidney biopsy score and a newly adapted histomorphometric image analysis system; lung tissue was further analyzed by tissue cytometry. Serum levels of anti-dsDNA, anti-histone and anti-chromatin antibodies were measured by ELISA. Frequencies of B cells, activated and regulatory CD4+ T cells as well as Th1, Th2, Th17 cells were measured by flow cytometry. RT-qPCR was used to measure expression levels of interferon-signature and T-cell subset related as well as miR155-associated genes. Results After induction of lupus, miR155-deficient mice had significant less pulmonary involvement (perivascular inflammatory area in mm2/mm2 lung area 0.00092±0.00015 vs. 0.0027±0.00075, p = 0.0347) and renal disease (glomerular activity score 1.95±0.19 vs 3±0.26, p = 0.0029) compared to wild types. MiR155-deficient mice had significantly lower serum levels of disease-associated auto-antibodies and decreased frequencies of activated CD4+CD25+ (Foxp3-) cells. Upon restimulation, CD4+ cells showed a less pronounced Th2 and Th17 and a slightly decreased Th1 response in mir155-deficient mice. Pristane-treated wild types showed significantly up-regulated expression of genes related to the INF-signature (MX1, IP10, IRF7, ISG15). Conclusions MiR155-deficient mice had less severe organ involvement, lower serum auto-antibody levels, a less prominent T cell response and lower expressions of genes jointly responsible for disease development. Thus, antagonizing miR155 might be a future approach in treating SLE.

An endoscopists adenoma detection rate (ADR) of less than 20 % correlates with high risk for occurrence of interval cancer. The impact of high-definition (HD) imaging on the ADR is discussed controversially. We aimed to investigate whether detection rates of individual endoscopists increase within 1 year before and 1 year after the switch from standard to HD endoscopy.This cohort study analyzed 6,330 screening colonoscopies (2,968 with standard and 3,362 with HD) performed by 42 endoscopists between November 2007 and March 2013 within a nationwide quality assurance program for screening colonoscopy.The ADR of endoscopists with a low ADR (20 %) increased significantly higher (from 11.8 to 18.1 %, p = 0.003) than of those with a high ADR (≥ 20 %) (from 28.6 to 30.7 %, p = 0.439) after switch from standard to HD colonoscopes (p = 0.0076). The proportion of endoscopists with an ADR20 % decreased from 45 to 42.9 % (p = 0.593). There was no significant increase in age- and sex-adjusted detection rates of adenomas (20.2 vs 23.7 %; p = 0.089), advanced adenomas (4.7 vs 5.5 %; p = 0.479), flat adenomas (2.7 vs 3.1 %; p = 0.515), polyps (38.8 vs 41.5 %; p = 0.305), proximal polyps (18.5 vs 20 %; p = 0.469) and hyperplastic polyps (15 vs 17.2 %; p = 0.243) of endoscopists after switch to HD colonoscopes. There was no difference in detection rates of flat polyps (5.5 vs 5.5 %; p = 0.987).The use of HD scopes is associated with marginal improvement in adenoma detection rates limited to those endoscopists with low adenoma detection rates prior to its introduction.

Background and study aim: Screening colonoscopy only effectively prevents colorectal cancer if performed with high quality. The aim of this study was to analyze the detection rates of premalignant colorectal lesions in screening colonoscopies performed within a nationwide quality control program for screening colonoscopy in Austria. Methods: Data from electronic records of the screening program from its implementation in 2007 until December 2014 were analyzed in order to calculate detection rates for adenomas, advanced adenomas, polyps, and proximal lesions, and rates of cecal intubation, sedation, complications, and adequate bowel preparation. Results were evaluated to identify trends and changes in quality parameters over the 8-year study period. Results: During the study period, 301 endoscopists provided data from 159 246 screening colonoscopies. Mean age of screened individuals was 61.1 years, and 49.1 % were women. Significant increases over time were found for age- and sex-adjusted adenoma detection rates (ADRs), which increased from a mean of 22.2 % (SD 10.7 %) in 2007/2008 to 24.2 % (SD 11.6 %) in 2013/2014. On average, each endoscopist increased their individual ADR by + 1.5 percentage points per 2-year period (95 % confidence interval [CI] 0.9 – 2.2 percentage points; P Conclusions: This study showed an improvement in the quality of screening colonoscopies performed within a quality assurance program in Austria between 2007 and 2014. Although, overall ADR increased significantly during the study period, there was a decrease in the rate of advanced adenoma detection.

Background Deregulation of endogenous miR155 was observed in many autoimmune conditions, including systemic lupus erythematosus (SLE). Objectives We herein examined the role of miR155 in the development of systemic manifestations in mice with pristane-induced lupus (PIL). Methods MiR155-deficient and C57/Bl6 mice were injected with pristane or PBS as control and analyzed after 8 months. Glomerulonephritis and pneumonitis were quantified by using the composite kidney biopsy score (KBS) and by analyzing the numbers of affected lung-vessels and the area of the inflammatory lung-infiltrate, respectively. Specimens were stained with B220 (B), CD3 (T), Neu7/4 (neutrophils) and F4/80 (macrophages) and analyzed by cell-identification algorithms for nuclear segmentation (HistoQuest). Serum levels of anti-dsDNA, anti-histone and anti-chromatin antibodies were measured by ELISA. Frequencies of B cells, activated and regulatory CD4+ T cells as well as Th1, Th2, Th17 cells were measured by flow cytometry. Quantitative real-time polymerase chain reaction was used to measure expression levels of interferon-signature and T-cell subset related as well as miR155-associated genes. Results All pristane-injected mice showed signs of pneumonitis, while controls did not. Compared to wild types treated with pristane, similarly treated knockouts showed significantly decreased perivascular inflammatory area with B cells being the most prominent inflammatory cell. Wildtypes had a more severe renal involvement in the KBS than knockouts. Corresponding with reduced organ involvement, miR155 deficient mice had significantly lower serum levels of anti-dsDNA antibodies, anti-chromatin and anti-histone antibodies and decreased frequencies of activated CD4 + CD25 + (Foxp3 – ) cells. Interestingly, also frequencies of CD4 + CD25 + Foxp3 + regulatory T cells were lower in these mice. Upon restimulation, CD4 + cells showed a more pronounced Th2 response in wild types, but no significant differences in Th1 and Th17 phenotype. Regarding INF-signature and T-cell subset activation, pristane-treated wild types showed significantly up-regulated gene-expression patterns whereas equivalently treated mutants showed the same levels as PBS-treated controls. Conclusions MiR155 deficiency in PIL mice did not prevent disease, but was associated with less severe organ involvement, lower serum auto-abs levels, lower frequencies of Th2 cells, whereas lower expressions of genes jointly responsible for disease development may be one key mechanism. Thus, antagonisation of miR155 might be a future approach in treating SLE. Disclosure of Interest None declared

Background Even though joint involvement is a major burden in patients suffering from systemic lupus erythematosus (SLE), it is not focus of scientific research and treatment strategies continue to be limited. Studying lupus arthritis and possible treatment options can be done with the murine model of Pristane-induced lupus (PIL). Objectives We herein investigate if in vitro induced regulatory T-cells ( i Treg) are capable of ameliorating PIL arthritis and help us evaluate possible new treatment options. Methods BALB/c mice were injected i.p. with either 0.5ml of pristane (PIL-group) or PBS (controls). Naive CD4 + thymocytes were sorted and cultured and cell suspensions with >80% of CD4 + FoxP3 + cells ( i Treg) were injected intravenously (i) once when PIL was induced (5x10 6 i Treg, i Treg-boost), or (ii) every 4 weeks (1x10 6 i Treg, i Treg-rep). Animals were monitored for paw swelling and grip strength. After 8 months histological analysis evaluated for cartilage degradation, number of osteoclasts and the extent of inflammation and bone erosion. In addition, the cellular composition of the inflammatory tissue was determined by a cell-identification algorithm for nuclear segmentation (HistoQuest). Serum levels of anti-dsDNA, anti-histone and anti-chromatin antibodies were measured by ELISA. Results Monthly injections of 1x10 6 i Treg reduced the clinical as well as the histological severity of PIL-arthritis, seen by a higher mean grip strength (2.964±0.024 vs. 2.732± 0.063, p i Treg-rep mice had erosive arthritis. There was a significant reduction of arthritis severity in all histological parameters (inflammatory area 0.188±0.0574 vs. 0.688±0.113; erosive area 0.011 ±0.009 vs. 0.069±0.017; number of osteoclasts 2.000± 1.125 vs. 9.143±1.999; cartilage degradation 0.059±0.004 vs. 0.187±0.033). The single boost of 5x10 6 i Treg could not prevent joint manifestation. However, a slight retardation in “loss of grip strength” and a significantly less erosive area was seen. In regards to the cellular composition of the inflammatory tissue, a significantly increased relative amount of Foxp3 cells was seen in the i Treg-rep group compared to the PIL group (5.2±2.3 vs. 0.6±0.2). Corresponding to the reduced severity in joint involvement, the i Treg-group had significantly lower serum levels of antibodies. Conclusions Repeated injections of i Treg ameliorate the clinical and histological severity of PIL- arthritis. A single boost of i Treg at the time of disease induction does not prevent joint manifestation, but retards the onset of symptoms and progression of erosive bone degradation. Thus, i Treg have significant positive effects on PIL arthritis, which may have consequence for future therapeutic considerations. Disclosure of Interest None declared