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Objectives To investigate SI joint MRI inflammation, structural and degenerative lesion characteristics in patients with axial spondyloarthritis (axSpA) and various control groups. Methods Patients with axSpA (n = 41) and lumbar disc herniation (n = 25), women with (n = 46) and without (n = 14) post-partum (childbirth within 4–16 months) buttock/pelvic pain, cleaning assistants (n = 26), long-distance runners (n = 23) and healthy men (n = 29) had MRI of the SI joints prospectively performed. MRI lesions were assessed on nine slices covering the cartilaginous compartment by two experienced readers according to the definitions of the Spondyloarthritis Research Consortium of Canada SI joint inflammation and structural scores, and were evaluated according to depth and extent. Other morphological characteristics were also analysed. Results Total depth scores for bone marrow oedema (BME) and fat lesion (FAT) and total extent score for erosion were statistically significantly highest in axSpA, while scores for sclerosis were numerically highest in women with post-partum pain. Maximum BME depth >10 mm was frequently and exclusively found in axSpA and post-partum women (39% vs 14–17%) while FAT depth >5 mm was predominantly found in axSpA (76% vs 0–10%). Erosions were primarily seen in axSpA, especially when extensive (≥4 or confluent; 17% vs 0%). Capsulitis was absent in non-axSpA groups. BME and FAT in the ligamentous compartment were primarily found in axSpA (17/22% vs 0/2% in non-axSpA groups). In non-axSpA, osteophytes (axSpA vs non-axSpA: 0% vs 3–17%) and vacuum phenomenon (7% vs 30–66%) were more frequent, and the joint space was wider [mean (s.d.) 1.5 (0.9) vs 2.2 (0.5) mm]. Conclusions FAT depth >5 mm, but not BME depth >10 mm, could almost differentiate axSpA patients from all other groups. When excluding post-partum women, BME >5 mm and erosion were highly specific for axSpA.

Objective To investigate the anatomic location and distribution of lesions on magnetic resonance imaging (MRI) in the sacroiliac (SI) joints in patients with axial spondyloarthritis (SpA), women with and without postpartum pain (childbirth within 4-16 months), patients with disc herniation, cleaning staff, runners, and healthy persons. Methods In a prospective cross-sectional study of 204 participants, MRI of the entire cartilaginous compartment of the SI joint was scored blindly by 2 independent, experienced readers, according to Spondyloarthritis Research Consortium of Canada definitions of SI joint inflammation and structural lesions in each SI joint quadrant or half and in each of 9 slices. The locations of the lesions (unilateral/bilateral, upper/lower, sacral/iliac, and anterior/central/posterior slices) were analyzed based on concordant reads. Results Bone marrow edema (BME) occurred in all quadrants in nearly all participant groups, but rarely bilaterally, except in patients with axial SpA and women with postpartum pain. Fat lesions were mainly found in axial SpA and occurred in all quadrants, but mostly bilaterally in sacral quadrants. Erosion was rare, except in axial SpA, where it was mainly iliac and often bilateral. Sclerosis was exclusively iliac and most frequent in women with postpartum pain. Conclusion The location and distribution of common SI joint lesions in axial SpA and non-axial SpA were reported, and group-specific patterns were revealed. BME distributed bilaterally or unilaterally, both locally and more widespread in the SI joint, is common in both postpartum women with pain and axial SpA patients, which limits the use of BME to differentiate these groups. This study indicates that the presence of fat lesions, especially when widespread, and/or erosion, particularly when located centrally or posteriorly, are diagnostically important and should be investigated further.

Objective To assess the ability of ultrasound to predict successful tapering and successful discontinuation of biological DMARDs (bDMARDs) at the 2-year follow-up in RA patients in sustained remission. Methods Patients in sustained remission (DAS28-CRP ≤ 2.6) and with no radiographic progression the previous year tapered bDMARDs according to a standardized regime. A total of 119 of these patients were included in this ultrasound substudy. At baseline, clinical assessment, MRI, X-ray and ultrasound of 24 joints were performed. Ultrasound-detected synovitis was defined and scored 0–3 using the OMERACT scoring system at the joint level for both grey-scale and Doppler activity. Sum scores for each ultrasound modality were calculated for 24 joints at the patient level. The final state of treatment was assessed after 2 years. The predictive value of ultrasound measures for successful tapering and discontinuation at the 2-year follow-up was assessed via logistic regression analyses. Results Negative IgM-RF [odds ratio (OR) = 0.29, 95% CI: 0.10–0.85; P = 0.024] and lower Doppler sum score of 24 joints (OR = 0.44, 95% CI: 0.15, 0.87; P = 0.014) were independent predictors for successful discontinuation of bDMARDs at the 2-year follow-up. The predictive value of the Doppler sum score was independent of MRI findings. Previous numbers of bDMARDs were predictive of successful tapering (OR = 0.58, 95% CI: 0.35, 0.91; P = 0.018), whereas ultrasound was not. Clinical parameters were not predictive of successful tapering/discontinuation. Conclusion Doppler sum score was an independent predictor for successful discontinuation of bDMARDs at the 2-year follow-up—the odds for achieving successful discontinuation decreased by 56% per one-unit increase in Doppler sum score. Ultrasound could not predict successful tapering.

OBJECTIVE To investigate whether magnetic resonance imaging (MRI) pathologies in the wrist/hand of rheumatoid arthritis (RA) patients are associated with patient-reported outcomes (PROs) at clinical remission and relapse. METHODS Wrist/hand MRIs and wrists/hands/feet radiographs were obtained in 114 established RA patients in clinical remission, before tapering their biologic disease-modifying antirheumatic drugs. MRIs were assessed according to the Outcome Measures in Rheumatology (OMERACT) RA MRI score (RAMRIS) for inflammation (synovitis/tenosynovitis/bone marrow edema) and damage (bone erosion/joint space narrowing) at baseline (ie remission) and in case of a relapse (n = 70). Radiographs were assessed according to the Sharp/van der Heijde (SvH) method at baseline. These scores were assessed for associations with health assessment questionnaires (HAQ), visual analog scales (VAS global/pain), EuroQol-5 dimensions and Short-Form 36 physical and mental component summary (SF-36 PCS/MCS) using Spearman correlations, univariate/multivariable linear regression analyses and generalized estimating equations. Furthermore, MRI pathologies were assessed for association with specific hand-related HAQ items using Jonckheere trend tests. RESULTS Magnetic resonance imaging-assessed damage was associated with impaired HAQ and SF-36 PCS at remission and relapse (P

ObjectiveTo identify predictors of flare in a 2-year follow-up study of patients with rheumatoid arthritis (RA) in sustained clinical remission tapering towards withdrawal of biological disease-modifying anti-rheumatic drugs (bDMARDs).MethodsSustained clinical remission was defined as Disease Activity Score for 28 joints (DAS28)-C reactive protein (CRP) ≤2.6 without radiographic progression for >1 year. bDMARDs were tapered according to a mandatory clinical guideline to two-thirds of standard dose at baseline, half of dose at week 16 and discontinuation at week 32. Prospective assessments for 2 years included clinical evaluation, conventional radiography, ultrasound and MRI for signs of inflammation and bone changes. Flare was defined as DAS28-CRP ≥2.6 with ∆DAS28-CRP ≥1.2 from baseline. Baseline predictors of flare were assessed by logistic regression analyses.ResultsOf 142 included patients, 121 (85%) flared during follow-up of which 86% regained remission within 24 weeks after flare. Patients that flared were more often rheumatoid factor positive, had tried more bDMARDs and had higher baseline ultrasound synovitis sum scores than those not flaring. For patients on standard dose, predictors of flare within 16 weeks after reduction to two-thirds of standard dose were baseline MRI-osteitis (OR 1.16; 95% CI 1.03 to 1.33; p=0.014), gender (female) (OR 6.71; 95% CI 1.68 to 46.12; p=0.005) and disease duration (OR 1.06; 95% CI 1.01 to 1.11; p=0.020). Baseline predictors for flare within 2 years were ultrasound grey scale synovitis sum score (OR 1.19; 95% CI 1.02 to 1.44; p=0.020) and number of previous bDMARDs (OR 4.07; 95% CI 1.35 to 24.72; p=0.007).ConclusionThe majority of real-world patients with RA tapering bDMARDs flared during tapering, with the majority regaining remission after stepwise dose increase. Demographic and imaging parameters (MR-osteitis/ultrasound greyscale synovitis) were independent predictors of immediate flare and flare overall and may be of importance for clinical decision-making in patients eligible for tapering.

Objectives To investigate the diagnostic utility of different combinations of SI joint MRI lesions for differentiating patients with axial SpA (axSpA) from other conditions with and without buttock/pelvic pain. Methods A prospective cross-sectional study included patients with axSpA (n = 41), patients with lumbar disc herniation (n = 25), women with (n = 46) and without (n = 14) post-partum (birth within 4–16 months) buttock/pelvic pain and cleaning assistants (n = 26), long-distance runners (n = 23) and healthy men (n = 29) without pain. Two independent readers assessed SI joint MRI lesions according to the Spondyloarthritis Research Consortium of Canada MRI definitions and pre-defined MRI lesion combinations with bone marrow oedema (BME) and fat lesions (FAT), respectively. Statistical analyses included the proportion of participants with scores above certain thresholds, sensitivity, specificity, positive and negative predictive values and likelihood ratios. Results BME adjacent to the joint space (BME@joint space) was most frequent in axSpA (63.4%), followed by women with post-partum pain (43.5%), but was present in nearly all groups. BME adjacent to fat lesions (BME@FAT) and BME adjacent to erosions (BME@erosion) were only present in axSpA patients and in women with post-partum pain, but scores ≥3 and ≥4, respectively, were only seen in axSpA patients. FAT@erosion was exclusively recorded in axSpA patients. FAT@joint space and FAT@sclerosis were present in most groups, but with higher scores in the axSpA group. Conclusion BME@joint space and FAT@joint space were frequent in axSpA but also in other conditions, reducing the diagnostic utility. FAT@erosion, and BME@FAT, BME@erosion and FAT@sclerosis above certain thresholds, were exclusively seen in axSpA patients and may thus have diagnostic utility in the differentiation of axSpA from other conditions.

OBJECTIVE: To evaluate whether different types of sacroiliac (SI) joint lesions identified by magnetic resonance imaging (MRI) could differentiate axial spondyloarthritis (SpA) from conditions with buttock or pelvic pain attributable to other reasons, including postpartum women and healthy subjects.METHODS: The study was designed as a prospective, cross-sectional study involving 204 participants, comprising patients with axial SpA (n = 41) and control groups of subjects with or without SI joint pain, including patients with lumbar disc herniation (n = 25), women with (n = 46) or without (n = 14) postpartum buttock/pelvic pain (having given birth within the preceding 4-16 months), hospital cleaning staff (n = 26), long-distance runners (n = 23), and healthy men (n = 29). Participants underwent clinical examination and MRI, and MRIs were evaluated in a blinded manner by 2 readers according to the Spondyloarthritis Research Consortium of Canada (SPARCC) SI joint inflammation and structural lesion scores. SPARCC score cutoff levels were defined as scores above a certain threshold. Primary analyses were based on reader agreement with regard to the presence of SI joint pathologic features on MRI ("concordant reads"). Sensitivity, specificity, and positive and negative predictive values were calculated.RESULTS: SI joint ankylosis and backfill were detected by MRI only in patients with axial SpA (32% and 37%, respectively), while bone marrow edema (BME) and fat lesions were seen in all non-axial SpA control groups (3-39% with BME and 4-14% with fat lesions). SI joint erosion was present only in patients with axial SpA and in women with postpartum buttock/pelvic pain (at erosion score cutoffs of >1 and >4, 61% and 34%, respectively, in patients with axial SpA, and 9% and 2%, respectively, in women with postpartum buttock/pelvic pain). A SPARCC BME score of ≥5 was present only in patients with axial SpA (56%) and in women with postpartum buttock/pelvic pain (24%), while fat lesions were present, albeit rarely, at high SPARCC cutoff scores in nearly all groups. Of the 38 women from the non-postpartum control groups who had given birth (mean time since birth 9.7 years), 2 (5%) had BME, whereas none had SI joint erosion or fat lesions, and none had a BME score of ≥4.CONCLUSION: BME and fat lesions were most pronounced in patients with axial SpA, but also occurred in other groups, particularly women with postpartum buttock/pelvic pain. Erosion above a certain SPARCC score threshold as well as backfill and ankylosis were highly specific for axial SpA.

Background:Bone marrow edema (BME) on sacroiliac joint (SIJ) MRI is central in the Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (axSpA). However, BME can be seen in other conditions and healthy persons. The presence of structural lesions may contribute to diagnosing axSpA.Objectives:To investigate the location and distribution of SIJ MRI lesions in patients with axSpA and disc herniation, women with and without post-partum pain (PPP), cleaning staff, runners, and healthy persons.Methods:In a prospective cross-sectional study of 204 participants, MRI of the SIJs was evaluated by two readers. MRI images were scored according to the SPARCC SIJ Inflammation1and Structural (SSS)2lesion definitions. Based on concordant reads, lesions were analysed according to location (unilateral/bilateral SIJ, upper/lower sacral/iliac quadrant/joint half, anterior (slice1-3)/central (slice 4-6)/posterior (slice 7-9) SIJ sections.Results:BME was present in nearly all groups, in all quadrants, and primarily in the anterior SIJ section (Figure 1), but rarely as a bilateral feature, except in axSpA and women with PPP (Table 1). Fat lesion (FAT) was mainly found in axSpA, in all slices, and mostly bilaterally in the sacrum. In the other groups FAT was primarily located in the anterior and central SIJ sections. Sclerosis was only seen in the ilium, and was present in most groups, particularly in women with PPP, often bilaterally. Erosion was only seen in women with PPP (mostly unilaterally) and in axSpA (mainly bilaterally in the ilium). Backfill and ankylosis were only seen in axSpA.Table 1.Participant characteristics and distribution of lesions – unilaterally/bilaterally in iliac/sacral quadrantsAxSpAWomen with post-partum painWomen without post-partum painDisc herniationCleaning staffLong distancerunnersHealthy menNumber of participants41461425262329Age30.9 (6.4)32.6 (3.3)*33.1 (4.1)35.2 (5.7)**39.1 (4.6)***32.7 (6.2)30.9 (6.4)Male sex630***0***440***78100***Low back pain VAS (0-10)3.8 (2.8)5.5 (2.4)**0.4 (0.7)***5.5 (2.4)*0.8 (1.8)***0.2 (0.5)***0.1 (0.3)***HLA-B27 positive8111***7***0***0***4***14***C-Reactive Protein >3 mg/l5917***21**20**15**17**3***Quadrant:UNI / BIUNI / BIUNI / BIUNI / BIUNI / BIUNI / BIUNI / BIBMEIliumUpperLower27 / 722 / 1711 / 915 / 130 / 021 / 00 / 00 / 00 / 40 / 40 / 04 / 00 / 00 / 0SacrumUpperLower29 / 2224 / 2017 / 99 / 929 / 04 / 04 / 04 / 04 / 00 / 00 / 00 / 00 / 00 / 0FATIliumUpperLower20 / 1717 / 292 / 00 / 07 / 07 / 04 / 04 / 00 / 00 / 00 / 00 / 00 / 70 / 3SacrumUpperLower22 / 4417 / 422 / 42 / 20 / 74 / 70 / 40 / 00 / 00 / 04 / 04 / 03 / 33 / 3SclerosisIliumUpperLower5 / 20 / 04 / 49 / 90 / 77 / 04 / 40 / 44 /415 / 00 / 04 / 03 / 70 / 0SacrumUpperLower0 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 0ErosionIliumUpperLower22 / 2417 / 244 / 02 / 20 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 0SacrumUpperLower10 / 522 / 22 / 02 / 20 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 0Values are % or mean (SD)Mann-Whitney test was applied, tests are patients with axSpA compared with all other groups. PBI: bilateral; BME: Bone marrow edema; FAT: fat lesion; HLA-B27: Human Leukocyte Antigen B27;UNI: unilateral; VAS: Visual Analogue scaleConclusion:Typical locations of common SIJ lesions in axSpA and non-axSpA were reported. In non-axSpA, except women with PPP, bilateral as well as posterior lesions were rare, while backfill and ankylosis were absent.References:[1]Maksymowych et al,Arthritis Rheum, 2005[2]Maksymowych et al,J of Rheumatol,2015Acknowledgments:Disclosure of Interests: Sengül Seven Grant/research support from: Novartis, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Lone Morsel-Carlsen: None declared, Inge Juul Sørensen: None declared, Birthe Bonde: None declared, Gorm Thamsborg: None declared, Jens Jørgen Lykkegaard: None declared, Susanne Juhl Pedersen Grant/research support from: Novartis

Background MRI detected bone marrow edema (BME) plays a central role in the ASAS (Assessment of Spondyloarthritis International Society) classification criteria for axial spondyloarthritis (axSpA)[1, 2]. However, BME in the sacroiliac joints (SIJs) is also present in other conditions[3-7]. Objectives The aim was to investigate the diagnostic utility of MRI BME and its relation to different types of MRI SIJ lesions to separate patients with axSpA from persons with other conditions. Methods The MASH study is a prospective cross-sectional study of 204 participants, aged ≤45 yrs. The study included patients with axSpA (n=41), women with (n=46) and without (n=14) postpartum pain, patients with lumbar disc herniation (n=25), persons with hard physical labor (cleaning assistants) (n=25), long-distance runners (≥30 km/week) (n=23) and healthy men (n=29). Participants with pain should all have VAS pain >2 (on a scale 0-10) for ≥2 months. Participants in the non-axSpA groups were not allowed to have any clinical SpA features or rheumatological conditions. Participants underwent clinical, laboratory and MRI examination (semi-coronal STIR and T1W sequences) of the SIJs. MRIs were evaluated for BME, erosion, fat, ankylosis, and sclerosis according to the SPARCC MRI definitions of lesions[8, 9] by two independent readers. In nine slices of the cartilaginous compartment each SIJ was separately assessed for the presence of BME in relation to joint space and each of the above-mentioned structural lesions (range of total score per patient: 0-18). Results The table shows the clinical characteristics of each group, the mean MRI scores and MRI cut-off levels for the concordant reads. BME located adjacent to joint space, adjacent to erosions and adjacent to fat were more frequent in patients with axSpA, but these lesions were also seen in the other study groups, mainly women with postpartum pain. When increasing amounts of lesions were required (higher cut-offs), almost only AxSpA patients fulfilled the requirements. BME adjacent to sclerosis was most frequent in women with postpartum pain, whereas BME adjacent to ankylosis was only seen in patients with axSpA. Conclusion BME located adjacent to joint space, adjacent to erosion and adjacent to fat was most frequently, but not exclusively, occurring in patients with axSpA, whilst BME adjacent to sclerosis was most frequent in women with postpartum pain. Detailed analysis of lesions and their anatomical location may help differentiate axSpA from other conditions. References [1] Rudwaleit, et al. Ann Rheum 2009. [2] Lambert, et al. Ann Rheum 2016. [3] Weber, et al. Arthritis Rheum 2010. [4] Varkas, et al. Rheumatology (Oxford) 2018. [5] de Winter, et al. Arthritis Rheumatol 2018. [6] Arnbak, et al. Eur Radiol 2016. [7] Seven, et al. Ann Rheum 2018. [8] Maksymowych, et al. Arthritis Rheum 2005. [9] Maksymowych, et al. J Rheumatol 2015. Disclosure of Interests Sengul Seven: None declared, Pernille Hededal: None declared, Mikkel Ǿstergaard Grant/research support from: Abbvie, Celgene, Centocor, Merck, Novartis, Consultant for: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Lone Morsel-Carlsen: None declared, Inge Juul Sorensen: None declared, Birthe Bonde: None declared, Gorm Thamsborg: None declared, Jens Jorgen Lykkegaard: None declared, Oliver Hendricks Grant/research support from: AbbVie, Novartis, Niklas Rye Jorgensen: None declared, Susanne Juhl Pedersen: None declared

Background:Axial spondyloarthritis (axSpA) is a common chronic inflammatory disease, associated with extracellular matrix (ECM) remodeling of the cartilage, bone and connective tissues. The primary symptom of axSpA is back pain, caused by inflammation. However, there is a medical need to truly identify patients with axSpA from other subjects with buttock or low back pain attributable to other reasons. Tissue-derived extracellular (ECM) markers quantified in serum may serve to differentiate axSpA patients from other diagnostic entities.Objectives:To investigate circulating ECM turnover markers as potential biomarkers to differentiate patients with axSpA from a control group of subjects with buttock or pelvic pain attributed to other reasons, including postpartum women and healthy subjects.Methods:Biomarkers of ECM degradation/chronic inflammation (C1M, C3M, C4M, C6M, CRPM, C10C and COL10NC) and ECM formation (PRO-C3 and PRO-C6) were measured in 204 participants from the MASH study [1] (Table 1). Biomarker levels were compared among patients with axSpA and control group, and two new variables (Type 3 and Type 6) were included, corresponding to the index of formation/degradation of type III and type VI collagen respectively. The biomarker data was log10 transformed for normalization when necessary and linear regression models with pairwise comparisons were performed. Clinical scores and the SPARCC MRI scores for sacroiliac joint (SIJ) inflammation were correlated with the biomarkers data (data not shown).Table 1.Comparison of blood-tested biomarkers levels in MASH study. Data was adjusted for confounders age, gender, and body mass index (BMI).Biomarkers(Mean (SD))Patientswith axSpA(n = 41)Control groups (n=163)pC1M84.3 (85.8)36.2 (22.1)C3M15.6 (4.0)13.9 (3.0)0.011C4M34.9 (10.2)27.9 (7.7)C6M20.5 (5.8)17.4 (4.2)CRPM11.9 (2.9)11.0 (5.9)0.027C10C2567 (462)2568 (560)0.31COL10NC9.15 (5.81)9.43 (8.27)0.43PRO_C310.2 (2.5)11.3 (3.0)0.0052PRO_C66.94 (2.45)6.86 (2.53)0.93Type 3 (PRO-C3/C3M)0.70 (0.28)0.86 (0.31)0.0004Type 6 (PRO-C6/C6M)0.36 (0.16)0.41 (0.14)0.0024Results:We found that patients with axSpA had significantly increased MMP-mediated degradation of type I (C1M), type III (C3M), type IV (C4M) and type VI (C6M) collagens (pConclusion:Biomarkers of type I, III, IV and V collagen and a CRP-metabolite showed an altered turnover in patients with axSpA compared with the control group including subjects with or without buttock or pelvic pain attributable to other reasons. Such biomarkers may be used in combination with MRI or independently to separate patients with axSpA from other back pain conditions.References:[1]Seven, S., Østergaard, M., Morsel-Carlsen, L., Sørensen, I. J., Bonde, B., Thamsborg, G., ... & Pedersen, S. J. (2019). Magnetic Resonance Imaging of Lesions in the Sacroiliac Joints for Differentiation of Patients With Axial Spondyloarthritis From Control Subjects With or Without Pelvic or Buttock Pain: A Prospective, Cross-Sectional Study of 204 Participants. Arthritis & Rheumatology, 71(12), 2034-2046.Acknowledgements:The study was supported by Innovation Fund Denmark, Rigshospitalet and the Danish Rheumatism Association (grant no. R102-A2132-B98, R159-A5061 and R150-A4467-B98).Disclosure of Interests:Helena Port Employee of: Industrial PhD student at Nordic Bioscience and University of Copenhagen, Signe Holm Nielsen Employee of: Full time employee at Nordic Bioscience, Joseph Blair Employee of: Full time employee at Nordic Bioscience, Sofie Falkenløve Madsen Employee of: Full time employee at Nordic Bioscience A/S, Anne-Christine Bay-Jensen Shareholder of: Nordic Bioscience A/S, Employee of: Full time employee at Nordic Bioscience A/S, Morten Karsdal Shareholder of: Nordic Bioscience A/S, Employee of: Full time employee at Nordic Bioscience A/S, Sengül Seven: None declared, Inge Juul Sørensen: None declared, Lone Morsel-Carlsen: None declared, Mikkel Østergaard: None declared, Susanne Juhl Pedersen: None declared

In Table 3, in the first row, 'Number of participants', all numbers had accidentally been moved one column to the left. This has now been corrected. The Publisher apologises for the error.

Objectives A cohort of routine care RA patients in sustained remission had biological DMARD (bDMARDs) tapered according to a treatment guideline. We studied: the proportion of patients whose bDMARD could be successfully tapered or discontinued; unwanted consequences of tapering/discontinuation; and potential baseline predictors of successful tapering and discontinuation. Methods One-hundred-and-forty-three patients (91% receiving TNF inhibitor and 9% a non-TNF inhibitor) with sustained disease activity score (DAS28-CRP)⩽2.6 and no radiographic progression the previous year were included. bDMARD was reduced to two-thirds of standard dose at baseline, half after 16 weeks, and discontinued after 32 weeks. Patients who flared (defined as either DAS28-CRP ⩾ 2.6 and ΔDAS28-CRP ⩾ 1.2 from baseline, or erosive progression on X-ray and/or MRI) stopped tapering and were escalated to the previous dose level. Results One-hundred-and-forty-one patients completed 2-year follow-up. At 2 years, 87 patients (62%) had successfully tapered bDMARDs, with 26 (18%) receiving two-thirds of standard dose, 39 (28%) half dose and 22 (16%) having discontinued; and 54 patients (38%) were receiving full dose. ΔDAS28-CRP0-2yrs was 0.1((-0.2)-0.4) (median (interquartile range)) and mean ΔTotal-Sharp-Score0-2yrs was 0.01(1.15)(mean(s.d.)). Radiographic progression was observed in nine patients (7%). Successful tapering was independently predicted by: ⩽1 previous bDMARD, male gender, low baseline MRI combined inflammation score or combined damage score. Negative IgM-RF predicted successful discontinuation. Conclusion By implementing a clinical guideline, 62% of RA patients in sustained remission in routine care were successfully tapered, including 16% successfully discontinued at 2 years. Radiographic progression was rare. Maximum one bDMARDs, male gender, and low baseline MRI combined inflammation and combined damage scores were independent predictors for successful tapering.

PURPOSE: To summarise recommendations about 20 non-surgical interventions for recent onset (METHODS: Two multidisciplinary working groups formulated recommendations based on the GRADE approach.RESULTS: Sixteen recommendations were based on evidence, and four on consensus. Management of LBP and LR should include information about prognosis, warning signs, and advise to remain active. If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy. The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids.CONCLUSION: Recommendations are based on low to moderate quality evidence or on consensus, but are well aligned with recommendations from international guidelines. The guideline working groups recommend that research efforts in relation to all aspects of management of LBP and LR be intensified.

Transient osteoporosis of the hip (TOH) affects pregnant women in the third trimester of pregnancy. Magnetic resonance imaging plays an important role in the diagnosis and shows a pattern of bone marrow oedema. We report a case of TOH post-partum with involvement of both hips in a 34-year-old woman. She was known with undifferentiated spondyloartritis since 2004, which posed a diagnostic challenge. The reported patient was treated conservatively avoiding lactation, weight bearing activities, increased intake of calcium and vitamin D and recovered without further medical treatment.