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Background: Comparative safety assessments are important for informed treatment decisions. Recently, serious infections related to tofacitinib (TOF) have raised considerable interest. This study aims to compare the risk for serious infections in patients with rheumatoid arthritis (RA) upon receiving TOF versus biologic disease-modifying antirheumatic drugs (bDMARDs) by age at treatment initiation. Methods: We identified adult RA patients exposed to TOF or bDMARDs using data collected by the Swiss registry for inflammatory rheumatic diseases (SCQM) from 2015 to 2018. The event of interest was the first non-fatal serious infection (SI) during drug exposure. Missing or incomplete event dates were imputed as either the lower (left) or upper (right) limit of the interval in which the event must have occurred. Separate analyses were done with the left and right imputed dates and interpreted together. The comparative risk (hazard ratio, HR) of TOF versus bDMARDs was estimated as a function of age using Cox proportional hazards regression adjusted for several possible confounders or predictors. Results: 1687 patients provided time at risk for a first SI during study participation and drug exposure for a total of 2238 different treatment courses, 345 for TOF and 1893 for bDMARDs. Exact dates were missing from 21% of the SIs, with 44 (left imputation) or 43 (right imputation), respectively, identified as first SIs (12/12 on TOF versus 32/31 on bDMARDs). Left and right imputation produced similar results. For ages >= 69 years, HRs were >1 with both imputations. Indicatively, for right imputation, at 69 and 76 years, the HRs (95% confidence intervals) were, respectively: 2.05 (1.04, 4.05; increased), and 2.87 (1.27, 6.52; clinically relevantly increased). For ages < 65 years, the data were insufficient to draw conclusions one way or another. Conclusions: Our results suggest that we should expect an increased risk for SIs upon treatment with TOF compared to bDMARDs in older patients (aged ≥ 69 years). Our study thus supports a cautious use of TOF in these patients. Further research is needed to assess whether the comparative risk is age dependent and, if so, whether it is relevantly increased in older as opposed to younger patients.

Resume Objectif Les resultats mesures d’activite de la maladie telles que le score d’activite clinique (DAS 28) ou les scores echographiques sont souvent divergents. Les objectifs de cette etude etaient de determiner la proportion de desaccords entre ces deux methodes d’evaluation chez des patients atteints de polyarthrite rhumatoide (PR) et de decrire les facteurs associes a ces divergences. Methodes Tous les patients atteints de PR inscrits dans le registre suisse des arthrites inflammatoires (SCQM) pour lesquels au moins un score DAS 28 et un score echographique concomitant etaient disponibles ont ete inclus. L’activite de la maladie a ete classee dans plusieurs categories (remission, faible a moderee et forte) selon des seuils etablis pour les deux scores etudies. Une analyse longitudinale a ete realisee pour les patients ayant beneficie d’au moins deux evaluations. Resultats Sur les 2369 evaluations incluses (1091 patients), 1196 (50,4 %) etaient divergentes. Par rapport au score DAS 28, le score echographique surestimait et sous-estimait l’activite de la maladie (23,5 % et 26,8 %, respectivement). Les facteurs cliniques et demographiques significativement associes aux resultats divergents etaient les composantes individuelles du score DAS 28 lorsque l’echographie etait utilisee comme reference et l’âge, la duree de la maladie et le nombre d’articulations gonflees lorsque la reference etait le score DAS 28. Le principal facteur lie a l’echographie ayant ete associe a une divergence etait la presence d’une tenosynovite echographique. Dans l’analyse longitudinale de 1081 patients, la proportion de desaccords est restee essentiellement la meme. Conclusion Les taux de desaccord entre les evaluations cliniques et echographiques de l’activite de la maladie dans la PR etaient eleves et le sont restes au cours du suivi, meme lorsque les evaluateurs echographiques avaient connaissance des resultats de l’examen clinique. Des facteurs lies a l’examen clinique et a l’echographie ont ete associes aux divergences.

The role of US-detected tenosynovitis (USTS) in the management of rheumatoid arthritis remains controversial. The aim of this study was to investigate whether tenosynovitis can predict a flare in rheumatoid arthritis patients in remission in a real-life cohort.Rheumatoid arthritis patients from the Swiss Clinical Quality Management cohort were included in this study if they were in clinical remission, defined by 28-joint disease activity score (DAS28-ESR)2.6, and had an available B-mode tenosynovitis score. The patients were stratified according to the presence or absence of tenosynovitis (USTS+ vs. USTS-). Cox proportional hazard models were used for time-to-event analysis until the loss of remission, after adjustment for multiple confounders. The impact of baseline US performed early in remission and the advent of flares at different fixed time periods after baseline were investigated in sensitivity analysis.Tenosynovitis was detected in 10% of 402 rheumatoid arthritis patients in remission. At baseline, USTS+ patients in remission had significantly higher DAS28-ESR (mean (SD): USTS- 1.8 (0.5) versus USTS+ 2.0 (0.5);While US-detected tenosynovitis was associated with higher disease activity parameters in rheumatoid arthritis patients in clinical remission, it was not able to predict a flare.

Resume Objectif La calcification de cristaux d’hydroxyapatite (HA) intra- ou peri-articulaires peut provoquer des poussees aigues hyperalgiques. Une etude pilote a suggere que l’inhibiteur de l’interleukine-1β (IL-1β) anakinra etait un traitement efficace. L’objectif de cette etude observationnelle etait de confirmer ce resultat dans un plus grand groupe de patients et de decrire le suivi a long terme. Methodes Une poussee a ete definie comme des douleurs aigues pendant moins de 10 jours. Une calcification intra- ou peri-articulaire (coiffe des rotateurs : 15/23 patients) a ete confirmee par radiographie classique et/ou echographie. Une dose quotidienne de 100 mg d’anakinra a ete administree par voie sous-cutanee pendant un a trois jours consecutifs. Les donnees cliniques collectees avant l’injection et aux jours 3 et 21 comprenaient le score de douleur sur une echelle visuelle analogique (EVA, 0-10 cm) et le taux de proteine reactive C (CRP). Lorsqu’ils etaient disponibles, les resultats de l’echographie a l’inclusion et pendant le suivi ont ete compares. Les donnees de suivi a long terme ont ete collectees dans les dossiers des patients et/ou par telephone. Resultats Vingt trois patients (15 hommes, âge moyen [ET] 58 [11] ans) ont ete inclus. Le score de douleur EVA moyen (ET) a l’inclusion etait de 7,7 (1) cm et la moitie des patients avaient un taux de CRP eleve. Apres traitement, le score de douleur EVA moyen (ET) a diminue rapidement pendant les trois premiers jours pour atteindre 1,6 (1,4) cm (p Conclusion Cette etude suggere que l’inhibition de l’IL-1β peut constituer une approche therapeutique efficace et d’un bon profil de securite pour les poussees d’HA aigues.

Objectives To evaluate grey scale US (GSUS) and power Doppler US synovitis (PDUS), separately or in combination (CombUS), to predict joint damage progression in RA. Methods In this cohort study nested in the Swiss RA register, all patients with sequential hand radiographs at their first US assessment were included. We analysed the summations of semi-quantitative GSUS, PDUS and CombUS assessments of both wrists and 16 finger joints (maximum 54 points) at their upper limit of normal, their 50th, 75th or 87.5th percentiles for the progression of joint damage (ΔXray). We adjusted for clinical disease activity measures at baseline, the use of biological DMARDs and other confounders. Results After a median of 35 months, 69 of 250 patients with CombUS (28%), 73 of 259 patients with PDUS (28%) and 75 of 287 patients with available GSUS data (26%) demonstrated joint damage progression. PDUS beyond upper limit of normal (1/54), GSUS and CombUS each at their 50th (9/54 and 10/54) and their 75th percentiles (14/54 and 15/54) were significantly associated with ΔXray in crude and adjusted models. In subgroup analyses, GSUS beyond 14/54 and CombUS higher than 15/54 remained significantly associated with ΔXray in patients on biological DMARDs, while clinical disease activity measures had no significant prognostic power in this subgroup. Conclusion Higher levels of GSUS and CombUS are associated with the development of erosions. GSUS appears to be an essential component of synovitis assessment and an independent predictor of joint damage progression in patients on biological DMARDs.

Hydroxyapatite (HA) crystal calcifications in or around the joint can induce acute flares with severe pain. A previous pilot study suggested that the interleukin-1β (IL-1β) inhibitor anakinra was effective. The goal of this observational study was to confirm these results in a larger set of patients and to report on the long-term follow-up.Flare was defined as acute pain for10 days. Calcification in or around a joint (rotator cuff: 15/23 patients) was confirmed by conventional radiography and/or ultrasonography (US). Anakinra 100mg daily was administered subcutaneously for 1 to 3 consecutive days. Clinical data collected before the injection and on days 3 and 21 included pain score on a visual analog scale (VAS, 0-10cm) and C-reactive protein (CRP) level. When available, US baseline and follow-up findings were compared. Long-term follow-up data were collected from patient charts and/or after a phone call.23 patients (15 males, mean [SD] age 58 [11] years) were included. Baseline mean (SD) VAS pain was 7.7 (1) cm and CRP level was elevated in half of the patients. After therapy, mean (SD) VAS pain score decreased rapidly in the first 3 days to 1.6 (1.4) cm (P0.001) and remained stable for 3 weeks at 1.8 (2.1) cm. US assessment revealed decreased Doppler intensity but no significant change in size of calcifications. No significant side effects were noted. After long-term follow-up (median duration 24 months), half of the patients still had some chronic pain, but only 4 experienced acute relapse.This study suggests that IL-1β inhibition may be an efficient therapeutic approach for acute HA flare, with a good safety profile.

ObjectiveTo evaluate the discriminatory ability of ultrasound in calcium pyrophosphate deposition disease (CPPD), using microscopic analysis of menisci and knee hyaline cartilage (HC) as reference standard.MethodsConsecutive patients scheduled for knee replacement surgery, due to osteoarthritis (OA), were enrolled. Each patient underwent ultrasound examination of the menisci and HC of the knee, scoring each site for presence/absence of CPPD. Ultrasound signs of inflammation (effusion, synovial proliferation and power Doppler) were assessed semiquantitatively (0–3). The menisci and condyles, retrieved during surgery, were examined microscopically by optical light microscopy and by compensated polarised microscopy. CPPs were scored as present/absent in six different samples from the surface and from the internal part of menisci and cartilage. Ultrasound and microscopic analysis were performed by different operators, blinded to each other’s findings.Results11 researchers from seven countries participated in the study. Of 101 enrolled patients, 68 were included in the analysis. In 38 patients, the surgical specimens were insufficient. The overall diagnostic accuracy of ultrasound for CPPD was of 75%—sensitivity of 91% (range 71%–87% in single sites) and specificity of 59% (range 68%–92%). The best sensitivity and specificity were obtained by assessing in combination by ultrasound the medial meniscus and the medial condyle HC (88% and 76%, respectively). No differences were found between patients with and without CPPD regarding ultrasound signs of inflammation.ConclusionUltrasound demonstrated to be an accurate tool for discriminating CPPD. No differences were found between patents with OA alone and CPPD plus OA regarding inflammation.

ObjectiveTo compare effectiveness of treatment with secukinumab (SEC) with that of alternative tumour necrosis factor inhibitors (TNFis) in patients with axial spondyloarthritis (axSpA) after withdrawal from one or more TNFis.MethodsPatients diagnosed as having axSpA in the Swiss Clinical Quality Management cohort were included if they had initiated SEC (n=106) or an alternative TNFi (n=284) after experiencing TNFi failure. Drug retention was investigated with matching weights propensity score (PS) analyses and multiple adjusted Cox proportional hazards models. Matching weights PS-based analyses and multiple-adjusted logistic regression analyses were used to assess the proportion of patients reaching 50% reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50) at 1 year.ResultsSEC was more often used as third-line or later-line biological drug (76% vs 40% for TNFi). Patients starting SEC had higher BASDAI, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index and C reactive protein levels. A comparable risk of drug discontinuation was found for SEC versus TNFi (HR 1.14, 95% CI 0.78 to 1.68 in the PS-based analysis and HR 1.16, 95% CI 0.79 to 1.71 in the multiple-adjusted analysis). No significant difference in BASDAI50 responses at 1 year was demonstrated between the two modes of biological drug action, with CI of estimates being, however, wide (OR for SEC vs TNFi 0.76, 95% CI 0.26 to 2.18 and 0.78, 95% CI 0.24 to 2.48 in the PS-based and the covariate-adjusted model, respectively).ConclusionOur data suggest a comparable effectiveness of SEC versus an alternative TNFi after prior TNFi exposure.

Objective To investigate whether spinal radiographic progression relates to structural damage at the sacroiliac level in axial spondyloarthritis (axSpA). Methods Patients classified as nonradiographic (nr-) and radiographic (r-) axSpA in the Swiss Clinical Quality Management cohort with radiographs performed every 2 years, scored according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), were included. The relationship between classification status and spinal progression during 2 years was investigated using binomial generalized estimating equations models with adjustment for sex, ankylosing spondylitis disease activity score (ASDAS) and tumour necrosis factor inhibitor treatment. Baseline spinal damage was considered an intermediate variable and included in sensitivity analyses. Results In total, 88 nr-axSpA and 418 r-axSpA patients contributed to data for 725 radiographic intervals. R-axSpA patients were more frequently male, had a longer disease duration and higher structural damage at baseline. Mean (SD) mSASSS change over 2 years was 0.16 (0.62) units in nr-axSpA and 0.92 (2.78) units in r-axSpA, p = 0.01. Nr-axSpA was associated with a significantly lower progression in 2 years (defined as an increase in ≥2 mSASSS units) in adjusted analyses (OR 0.33, 95%CI 0.13; 0.83), confirmed with progression defined as the formation of ≥1 syndesmophyte. Mediation analyses revealed that sacroiliitis exerted its effect on spinal progression indirectly by being associated with the appearance of a first syndesmophyte (OR 0.09, 95%CI 0.02; 0.36 for nr-axSpA vs r-axSpA). Baseline syndesmophytes were predictors of further progression. Conclusion Spinal structural damage is mainly restricted to patients with r-axSpA, leading to relevant prognostic and therapeutic implications.

Background: Acute and chronic shoulder symptoms can be due to calcifications but also to other lesions well detected by Ultrasound (US). Objective: The present study’s objectives were to determine whether, some demographic, clinical and ultrasound features were associated with the presence or absence of calcifications in symptomatic shoulders patients. Methods: As part of this retrospective, transversal, case-control study of 490 patients, the 125 patients with calcifications were compared to 125 patients without calcification randomly extracted from the cohort. Subgroups were defined according to types and durations of symptoms. The frequency and types of associated lesions in the two groups, as well as the different US appearances of the calcifications were compared according to their different clinical presentations. Results: Calcific tendinitis was present in 26% of patients. Demographic characteristics or clinical manifestations, significantly associated with calcifications were: being a woman (p = 0.002), a shorter delay between symptoms and diagnosis (p = 0.007 and have acute symptoms. The presence of calcifications was associated with the absence of associated (42% vs. 6%, p = 0.0001) or less severe associated US lesions, particularly total rotator cuff rupture (5% vs. 18%, p = 0.001). Soft and cystic calcifications without shadowing were found more frequently in patients with hyperalgesic shoulders (p = 0.005) compared to chronic shoulders. Conclusions: Only few demographic and clinical features were significantly more frequent in the presence of calcifications. US revealed fewer additional lesions when calcifications were present and, some US aspects of the calcification suggested the type of symptoms.

Objective Measurements of disease activity, such as the clinical disease activity score (DAS28) or ultrasound (US) scores, often yield discordant results. This study's objectives were to determine the proportion of disagreements between the two assessment methods in patients with rheumatoid arthritis (RA) and to describe factors associated with discrepancy in assessment. Methods All RA patients in the Swiss registry for inflammatory arthritides (SCQM) with at least one concomitant DAS28 and US score, were included. Disease activity was categorized as remission, low-to-moderate, and high, based on previously established cut-offs, for both the DAS28 and the US score. A longitudinal analysis was performed among patients who underwent at least two assessments. Results Of 2369 assessments included (1091 patients), 1196 (50.4%) were discordant. The US score both over- and under-estimated disease activity compared to the DAS28 score (23.5% and 26.8% respectively). Clinical and demographic factors significantly associated with discordant results were the individual components of the DAS28 score when US was used as the reference and age, disease duration, and the swollen joint count when the DAS28 was used as the reference. The main US-related factor associated with discordance was the presence of US tenosynovitis. In the longitudinal analysis of 1081 patients, the proportion of disagreements remained essentially unchanged. Conclusion Rates of disagreement between clinical and US assessments of disease activity among RA patients are high and remain high during follow-up, even when the US assessors were aware of the clinical examination findings. Both clinical- and ultrasound- related factors were associated with discordances.

Background:Data on spinal radiographic progression is more limited in nonradiographic axial spondyloarthritis (nr-axSpA) than in the radiographic disease state (r-axSpA). It remains unclear, whether radiographic sacroiliitis is by itself associated with progression of spinal structural damage.Objectives:To investigate whether spinal radiographic progression relates to structural damage at the sacroiliac level in axSpA by means of statistical mediation analyses in a large prospective real-life cohort of patients with axSpA.Methods:Patients from the Swiss Clinical Quality Management cohort were included if they fulfilled the ASAS classification criteria and could be classified as nr-axSpA or r-axSpA after central scoring of pelvis radiographs. Spinal radiographs performed every 2 years were scored according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The relationship between classification status and spinal progression over 2 years was investigated using binomial generalized estimating equations models with adjustment for sex, ankylosing spondylitis disease activity score (ASDAS) and tumor necrosis factor inhibitor treatment. Baseline spinal damage was considered an intermediate variable and included in sensitivity analyses, as were additional variables potentially influencing radiographic progression.Results:In total, 88 nr-axSpA and 418 r-axSpA patients contributed to data for 725 radiographic intervals (Table 1). Mean (SD) mSASSS change over 2 years was 0.16 (0.62) units in nr-axSpA and 0.92 (2.78) units in r-axSpA, p=0.01. Nr-axSpA was associated with a significantly lower progression over 2 years (defined as an increase in ≥2 mSASSS units) in adjusted analyses (OR 0.33, 95%CI 0.13; 0.83), confirmed with progression defined as the formation of ≥1 syndesmophyte. Mediation analyses revealed that sacroiliitis exerted its effect on spinal progression indirectly by being associated with the appearance of a first syndesmophyte (OR 0.09, 95%CI 0.02; 0.36 for nr-axSpA vs r-axSpA) (Fig. 1 and 2). Baseline syndesmophytes were predictors of further progression.Table 1.Baseline characteristics at first radiograph.ParameterN506nr-axSpAN = 88r-axSpAN = 418PFemale sex, %50654.533.7Age, y50639.5±11.140.4±11.00.52Symptom duration, y49810.0±9.914.0±9.8HLA-B27 positive, %45271.680.70.09BASDAI4274.6±2.04.2±2.30.26ASDAS4082.8±0.92.8±1.10.74Elevated CRP, %42230.640.60.14BASFI4332.8±2.23.1±2.50.71BASMI4351.1±1.42.2±2.0mSASSS5060.9±1.56.8±12.7Syndesmophytes, %5069.135.2On TNFi, %50619.336.40.002Fig. 1.Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) for individual patients plotted as a function of duration since symptom onset.Fig. 2.Two-year mSASSS progression depicted in a cumulative probability plot. Progression was defined as an increase in mSASSS of at least 2 units (dotted line) in 2 years.Conclusion:Spinal structural damage is mainly restricted to patients with r-axSpA, leading to relevant prognostic and therapeutic implications.Disclosure of Interests:Monika Hebeisen: None declared, Raphael Micheroli: None declared, Almut Scherer: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Manouk de Hooge: None declared, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Kristina Buerki: None declared, Michael Nissen Grant/research support from: Abbvie, Consultant of: Novartis, Lilly, Abbvie, Celgene and Pfizer, Speakers bureau: Novartis, Lilly, Abbvie, Celgene and Pfizer, Burkhard Moeller: None declared, Pascal Zufferey: None declared, Pascale Exer: None declared, Adrian Ciurea Consultant of: Consulting and/or speaking fees from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Merck Sharp & Dohme, Novartis and Pfizer.

Eine 91-jahrige Patientin befindet sich auf der geriatrischen Rehastation. Dort kommt es zu einem Status febrilis mit einer Schuttelfrostepisode und diffusen Myalgien.

Une patiente de 91 ans est hospitalisee en readaptation geriatrique. Elle developpe en cours de sejour un etat febrile avec un episode de frissons et des myalgies diffuses.

Background 9The OMERACT Ultrasound (US) in calcium pyrophosphate deposition disease (CPPD) sub-task force has been working on the assessment of the utility of US in CPPD since 2014 first creating definitions for CPPD identification and then demonstrating that US is a reliable tool[1]. Objectives Objective of this study is to assess the diagnostic accuracy of US in CPPD Methods This is a multicentre international diagnostic accuracy study involving 17 centres from 9 countries. We enrolled in this study consecutive patients waiting to undergo knee replacement surgery due to severe osteoarthritis. Each patient underwent US examination of the knee, focusing on the menisci and the hyaline cartilage, the day prior to surgery, scoring each site according to the presence/absence of CPP as defined by OMERACT[1]. After surgery, the menisci and the condyles were collected and examined microscopically. Six samples were collected, both from the surface and from the internal part of menisci and cartilage trying to cover a large part of the structure. All slides were observed under transmitted light microscopy and by compensated polarised microscopy. A dichotomous score was given for the presence/absence of CPP crystals. US and microscopic analysis were performed by blinded operators. Sensitivity and specificity of US were calculated using microscopic findings of the menisci and cartilage as the gold standard. Results These preliminary analyses include 30 patients. The mean age was 71yrs (SD±9.1), 19 (63%) were females. 17 patients were positive at US analysis and 12 at microscopic analysis. Diagnostic accuracy results of US at patient level, are presented in figure 1. Conclusion These preliminary results demonstrate that US is a sensitive exam for identification of CPPD with acceptable specificity. US is the first diagnostic technique with consistent reliability and validity to be applied for non-invasive screening for CPPD in clinical practice. References [1] Filippou G, Scire CA, Adinolfi A, et al. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints—an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. Ann Rheum Dis 2018;:annrheumdis-2017-212542. doi:10.1136/annrheumdis-2017-212542 Disclosure of Interests Georgios Filippou Speakers bureau: Laborest, Abbvie, BMS, Sanofi, Anna Scanu: None declared, Antonella Adinolfi: None declared, Carmela Toscano: None declared, Raquel Largo-Carazo: None declared, Esperanza Naredo Consultant for: Abbvie, Speakers bureau: AbbVie, Roche, Bristol-Myers Squibb, Pfizer, UCB, Lilly, Novartis, Janssen, and Celgene GmbH, Emilio Calvo: None declared, Gabriel Herrero-Beaumont: None declared, Pascal Zufferey: None declared, Christel Madelaine-Bonjour: None declared, Daryl MacCarter: None declared, Stanley Makman: None declared, Zachary Weber: None declared, Ingrid Moller: None declared, Marwin Gutierrez: None declared, Carlos Pineda: None declared, Denise Clavijo Cornejo: None declared, Hector Garcia: None declared, Victor Ilizaliturri: None declared, Jaime Mendoza Torres: None declared, Raul Pichardo: None declared, Luis Carlos Rodriguez Delgado: None declared, Emilio Filippucci: None declared, Edoardo Cipolletta: None declared, Teodora Serban: None declared, Florentin Ananu Vreju Consultant for: abbvie and novartis, Speakers bureau: abbvie, novartis, pfizer, sandoz, eli lilly, ucb pharma, Gael Mouterde: None declared, Maria-Antonietta d’Agostino: None declared, Marcello Govoni: None declared, Leonardo Punzi Consultant for: BMS, Fidia, Grunenthal, Menarini, Speakers bureau: BMS, Fidia, Grunenthal, Menarini, Nemanja Damjanov Grant/research support from: AbbVie, Pfizer and Roche, Consultant for: Abbvie, Gedeon Richter, Merck, Novartis, Pfizer and Roche., Speakers bureau: Abbvie, Gedeon Richter, Merck, Novartis, Pfizer and Roche., Lene Terslev Speakers bureau: Speakers fee from : Roche, Novartis, Pfizer, MSD, BMS, Celgene, Irene Azzolin: None declared, Giulio Guerrini: None declared, Carlo Alberto Scire: None declared, Annamaria Iagnocco: None declared

Background Shoulder pain is a common cause for medical consultation and is commonly linked to lesions of the rotator cuff. Rotator cuff calcification (due to BCP crystal deposition) is also a common finding and can give rise to chronic pain as well as acute inflammatory episodes Objectives The goal of the study was to compare the clinical and the echographic characteristics of patients with BCP calcification in the rotator cuff and shoulder pain to those with no signs of calcification Methods A retrospective case-control study of 465 patients whose primary complaint was shoulder pain presenting between 1997 and 2011 and seen by one rheumatologist. 125 patients who had rotator cuff calcification (RCC) were identified and constituted the study group. We compared the patients with RCC with 125 patients without calcification who were randomly extracted from the same registry which constituted the control group. All had detailed demographic and clinical documentation as well as a precise description of the echographic findings. Subgroups were defined according to the type and the duration of symptoms (Hyperacute painful shoulder, subacute inflammatory symptoms and chronic mechanical pain). Short-term response (up to 6 weeks) to treatment was also analyzed for the two first subgroups Results 25% of the patients consulting for shoulder pain had evidence of RCC as demonstrated by ultrasound. Hyperacute and subacute inflammatory symptoms were not linked to calcification (Hyperacute: 16 pts with 13pts without (p value : ns), subacute: 32 pts in both groups). The mean age (54 years) and female predominance (60%) were also similar in patients with or without calcification. However, patients with hyperacute painful shoulder with RCC were younger (mean years: 49 against 58 years; p: 0.007). None were 60 years old and 75% of them were females. In 60% of cases of hyperacute painful shoulder linked to calcification, the acute flare was the first shoulder complaint compared to More than a 1/3 of the patients with RCC (35% in chronic and 43% in acute symptom groups) had no other echographic lesion compared to Steroid infiltrations were mostly performed with rapid short-term response in the acute and subacute groups linked to calcification: 15/16, 24/34 against 4/13 p:0.001, 10/34 p:0.001 without calcification. Surgery was necessary in 7/101 pts with chronic symptoms without calcification against only 1/95 when calcifications were present (p:0.03). Conclusion Clinical and demographic data cannot clearly predict the presence of RCC in patients presenting with shoulder pain. However, acutely symptomatic RCC is found preferentially in middle aged women, often with no degenerative or traumatic echographic lesions. Steroid infiltration appears to be the treatment of choice when acute inflammatory symptoms linked to RCC are present Disclosure of Interests Orlik Luisa: None declared, Alexander So Consultant for: SOBI, Grunenthal, Speakers bureau: Grunenthal, Farron Alain : None declared, Pascal Zufferey: None declared

Background Secukinumab (SEC), an interleukin-17A inhibitor, is approved for the treatment of ankylosing spondylitis (AS) and has been integrated into the current treatment recommendations of patients with axial spondyloarthritis (axSpA) as an alternative to tumor necrosis factor inhibitors (TNFi). The optimal use of one mode of action over the other remains unclear and longitudinal real-life data are lacking to date. Objectives To compare drug survival of SEC versus TNFi in axSpA patients having previously stopped at least one TNFi in a large prospective cohort. Methods Patients with a clinical diagnosis of axSpA in the Swiss Clinical Quality Management cohort were included if they had previously stopped treatment with at least one TNFi, initiated therapy with either SEC or a next TNFi after approval of SEC and had a baseline clinical visit. Drug survival was evaluated by Cox proportional hazards models adjusted for sex, age, Bath ankylosing spondylitis disease activity index (BASDAI), Maastricht ankylosing spondylitis enthesitis score (MASES), proportion of patients with elevated CRP, number of previous TNFi and interaction between mode of action and number of previous TNFi. Results Baseline characteristics of 382 axSpA patients included (N=107 for SEC and N=275 for next TNFi) are shown in Table 1. The proportion of patients with ≥2 TNFi administered previously was significantly higher in the SEC group. Patients starting SEC had higher baseline disease activity, more enthesitis and greater impairment of spinal mobility, function and quality of life. A history of uveitis was more prevalent in the TNFi group. No differences between the groups could be detected with regards to the reason for discontinuation of the previous TNFi. Unadjusted median (interquartile range) drug maintenance was 1.1 (0.9; 1.3) years for SEC and 2.0 (1.7; 2.2) years for TNFi (p=0.03). The adjusted hazard ratio to stop SEC vs. TNFi in patients without missing data (N=233, 61%) was 1.05 (95% CI 0.42; 2.61; p=0.91) (Table 2). Conclusion SEC was predominantly initiated in axSpA after use of at least 2 TNFi. Patients starting SEC had a higher mean disease activity than patients starting a next TNFi. Adjusted drug survival after previous withdrawal of TNFi was comparable for SEC or a next TNFi. Acknowledgement Supported by a grant from Novartis. Disclosure of Interests Christoph Tellenbach: None declared, Raphael Micheroli: None declared, Kristina Buerki: None declared, Almut Scherer Grant/research support from: Almut Scherer is an employee of SCQM, which receives funding from AbbVie, Celgene, iQONE, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, Sanofi Genzyme, and UCB., Consultant for: Consultant for Pfizer, MSD, and AbbVie, Michael Nissen Consultant for: AbbVie, Lilly, Novartis, and Pfizer, Pascal Zufferey: None declared, Pascale Exer: None declared, Burkhard Moeller Consultant for: Swissmedic Human Medicines Expert Committee Member (regulatory agency), Diego Kyburz: None declared, Adrian Ciurea Consultant for: AbbVie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB

Background: Rituximab (RTX), a monoclonal antibody targeting CD20, is licenced for the treatment of rheumatoid arthritis (RA) for many years and more recently for ANCA-associated vasculitis. RTX is frequently used off-label to treat other auto-immune diseases (AID), especially connective tissue diseases (CTD). There are no published data about off-label use of RTX in AID in Switzerland. Objectives: To describe off-label use of RTX in a real-life setting, when treating AID. Methods: Retrospective cohort study of all patients treated with RTX in the Rheumatology Department between 2005 and 2017. Clinical efficacy of RTX after 12 and 24 months of treatment was evaluated with a semi-quantitative scale (no response (NR), partial (PR) and complete response (CR)). RTX discontinuation rate was also analysed using Kaplan-Meier method and log rank test to evaluate the difference between survival curves. Adverse events (AE), serious AE (SAE) were included in the safety analysis. Occurrences of hypogammaglobulinemia and anti-rituximab antibodies (ADA) were also reported. Results: 178 patients treated with RTX could be identified: 28% for CTD, 63% for RA and 10% for other AID. Rituximab was used off-label in 73% of the patients according to official Swiss indications. No significant differences in terms of clinical response were observed in off-label indication after 12 months (NR: 15%/13%, PR:48%/52%, CR:37%/35%, n=108/31) and 24 months (NR:13%/9%, PR:37%/35%, CR:51%/57%, n=79/23) of treatment when compared with prescriptions following official Swiss indications, respectively. RTX discontinuation rate (HR 1.03 95% CI 0.71-1.49) was also similar between both groups. Clinical response after RTX treatment did not differ significantly between patients with CTD and RA after 12 months (NR:10%/12%, PR:50%/52%, CR:40%/36%, n=42/n=84) and 24 months (NR:7%/9%, PR:32%/44%, CR:61%/47%, n=28/n=64), respectively. Detailed results are available in Table 1. Survival curves of rituximab treatment from CTD group closely matched that from RA group (HR 0.96 95% CI 0.65-1.44). Causes of RTX treatment discontinuation in patients with CTD (n=27) and RA (n=72) consisted of lack of efficiency (63%/56%), adverse event (19%/35%) and remission (19%/10%), respectively. SAE (n=113) occurred in 33% of the patients and consisted mainly of infectious SAE (43%) and perfusion-related AE (6%). 6 patients died during RTX treatment. Low IgG levels were observed in 34% (50/149) of the patients graded as mild (20%), moderate (11%) or severe (3%). The nadir of IgG levels occurred after 4.5(3.5) years (mean (SD)) of RTX treatment. ADA were observed in 6/51 patients. Conclusion: Off-label prescription of rituximab to treat AID was frequent. RTX discontinuation rate was comparable in patients treated for CTD and RA in our population. Disclosure of Interests: Alexandre Dumusc: None declared, Thomas Huegle Grant/research support from: AbbVie, Lilly, Novartis and Pfizer, Speakers bureau: AbbVie, Lilly, Novartis and Pfizer, Pascal Zufferey: None declared

Background The prevalence of Echinococcosis in Western Europe and Switzerland has been rising in the past 20 years: >30 cases per year have been reported since 2005 (1). A few case reports (2) and some experimental animal studies (3) have suggested that the immunosuppression linked to inflammatory arthritis and their treatments could favor the development and the growth of parasitic lesions. On the other hand, a recent French study (4) has a shown that the prevalence of Echinococcosis in arthritis patients was close to the normal population. The characteristics of the parasitic disease were quite similar whether inflammatory arthritis was present or not Objectives To evaluate the yearly recent incidence of this disease among patients with inflammatory arthritis in Switzerland and to search for any interaction between arthritis, the treatment of arthritis and development and evolution of the echinococcosis. Methods We collected all the cases with the diagnosis of echinococcosis among the patients regularly followed and treated for inflammatory arthritis in three different tertiary rheumatology centers of Westen Switzerland (1.7 million inhabitants, 5000 arthritis pts). Results Between 2012 and 2018, 8 cases of echinococcosis (1.3 case/year/5000pts) could be found. The estimated yearly incidence among this arthritis population appears therefore to be significantly higher (p Conclusion The incidence of echinococcosis in autoimmune arthritis appears to be higher than in general population but remains very low. Outcome seems not to be affected by inflammatory arthritis and their treatments but the long-time effects of the combination between arthritis treatments and albendazole need to be further evaluated. References 1:. Vuiton DA, et al. :Veterinary parasitology (2013), 110-20 2:. Weiner SMet al; Rheumatol Int (2011),1399–1400 [3] : Armuda-Fernandez MT, et al.; Parasitology (2016), 1252–1260. [4] : Gauchet A, et al.; Clinical Infectious Diseases (2014),1095–104 Disclosure of Interests Pascal Zufferey: None declared, Zambaz camille: None declared, Rudiger Muller: None declared, Boillat-Blanco Noemie: None declared, Thomas Huegle Grant/research support from: AbbVie, Lilly, Novartis and Pfizer, Speakers bureau: AbbVie, Lilly, Novartis and Pfizer, Hasler paul: None declared, Peter Villiger: None declared

In 2013, EULAR made a number of recommendations regarding the contribution of modern imaging : MRI and ultrasound as an aid to the diagnosis and for the monitoring of rheumatoid arthritis. This article aims to review if these recommendations are still relevant and if some questions have been resolved since then by new studies.En 2013, l’EULAR avait émis un certain nombre de recommandations quant à l’apport de l’imagerie moderne : IRM et échographie comme aide au diagnostic et pour le suivi de la polyarthrite rhumatoïde. Cet article a pour but de revoir si ces recommandations sont toujours d’actualité et si certaines interrogations ont été résolues depuis par de nouvelles études.

ObjectivesTo compare drug survival in patients with axial spondyloarthritis treated with different TNF inhibitors in standard dosage.MethodsPatients fulfilling the Assessment in SpondyloArthritis international Society classification criteria for axial spondyloarthritis in the Swiss Clinical Quality Management cohort were included in this study if a first TNF inhibitor on standard dosage was started after recruitment and if a baseline visit was available. Drug maintenance up to drug discontinuation or dose escalation was compared between TNF inhibitors with multiple adjusted Cox proportional hazards models and multiple imputation for missing baseline covariate data.ResultsA total of 966 patients were included (adalimumab 344, etanercept 237, golimumab 214, infliximab 171). Patients on certolizumab (n = 18) were excluded. Patients starting golimumab had lower disease activity as well as better physical function and quality of life in comparison to patients starting another drug. A higher proportion of patients starting infliximab had a history of extra-articular manifestations. Drug dosage was more often escalated during follow-up in patients treated with infliximab than with subcutaneously administered agents. However, no significant differences in time up to drug discontinuation or dose escalation were observed in multiple adjusted analyses if treatment was initiated after 2009, when all 4 TNF inhibitors were available: hazard ratio for infliximab versus etanercept 1.16 (95% confidence interval 0.80; 1.67), p = 0.44, for golimumab versus etanercept 0.80 (0.58; 1.10), p = 0.17 and for adalimumab versus etanercept 0.93 (0.69; 1.26), p = 0.66.ConclusionIn axial spondyloarthritis, drug survival with standard doses of different TNF inhibitors is comparable.

Background:The OMERACT Ultrasound (US) in calcium pyrophosphate deposition disease (CPPD) sub-task force has been working on the use of US in CPPD since 2014 first creating definitions for CPPD identification and then assessing the reliability[1].Objectives:Objective of this study is to assess the diagnostic accuracy (truth) of US in CPPD.Methods:Consecutive patients waiting to undergo knee replacement surgery due to osteoarthritis were enrolled in 12 centres from 6 countries. Each patient underwent US examination of the knee, focusing on the menisci and the hyaline cartilage, the day prior to surgery, scoring each site for presence/absence of CPP as defined previously[1]. After surgery, the menisci and the condyles were retrieved and examined microscopically. Six samples were collected, both from the surface and from the internal part of menisci and cartilage trying to cover a large part of it. All slides were observed under transmitted light microscopy and by compensated polarised microscopy. A dichotomous score was given for the presence/absence of CPP. US and microscopic analysis were performed by different operators, blind to each other’s findings. Sensitivity and specificity of US were calculated using microscopic findings as the gold standard.Results:101 patients have been enrolled in the study. 33 patients have been excluded due to loss of anatomical pieces at surgery. The mean age of the remaining 68 pts was 71yo (±8), 44 women, 34 were affected by CPPD according to microscopy. Overall and per site diagnostic US accuracy results are presented in table 1Diagnostic accuracySensitivitySpecificityPositive Predictive valueNegative Predictive valueGlobal0.750.910.590.690.87Medial meniscus0.820.870.770.770.87Lateral meniscus0.750.830.680.680.83Medial cartilage0.860.790.920.880.85Lateral cartilage0.820.710.880.770.84Medial side (combined cartilage and meniscus)0.820.880.760.790.87Lateral side (combined cartilage and meniscus)0.780.880.690.730.86Conclusion:Our results demonstrate that US is an accurate exam for identification of CPPD. The best combination of sensitivity and specificity is achieved by examining the medial aspect of the knee.References:[1]Filippou G, Scirè CA, Adinolfi A,et al.Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints—an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force.Ann Rheum Dis2018;:annrheumdis-2017-212542. doi:10.1136/annrheumdis-2017-212542Disclosure of Interests:Georgios Filippou: None declared, Anna Scanu: None declared, Antonella Adinolfi: None declared, Carmela Toscano: None declared, Dario Gambera: None declared, Raquel Largo: None declared, Esperanza Naredo: None declared, Emilio Calvo: None declared, Gabriel Herrero-Beaumont: None declared, Pascal Zufferey: None declared, Christel Madelaine-Bonjour: None declared, Daryl MacCarter: None declared, Stanley Makman: None declared, Zachary Weber: None declared, Fabiana Figus: None declared, Ingrid Möller: None declared, Marwin Gutierrez: None declared, Carlos Pineda: None declared, Denise Clavijo Cornejo: None declared, Héctor García: None declared, Victor Ilizaliturri: None declared, Jaime Mendoza Torres: None declared, Raul Pichardo: None declared, Luis Carlos Rodriguez Delgado: None declared, Emilio Filippucci Speakers bureau: Dr. Filippucci reports personal fees from AbbVie, personal fees from Bristol-Myers Squibb, personal fees from Celgene, personal fees from Roche, personal fees from Union Chimique Belge Pharma, personal fees from Pfizer, outside the submitted work., Edoardo Cipolletta: None declared, Teodora Serban: None declared, Catalin Cirstoiu: None declared, Florentin Ananu Vreju: None declared, Dun Grecu: None declared, Gael Mouterde: None declared, Marcello Govoni: None declared, Leonardo Punzi: None declared, Nemanja Damjanov Grant/research support from: from AbbVie, Pfizer, and Roche, Consultant of: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Speakers bureau: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Lene Terslev Speakers bureau: LT declares speakers fees from Roche, MSD, BMS, Pfizer, AbbVie, Novartis, and Janssen., Carlo Alberto Scirè: None declared, Annamaria Iagnocco Grant/research support from: Abbvie, MSD and Alfasigma, Consultant of: AbbVie, Abiogen, Alfasigma, Biogen, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Sanofi and Sanofi Genzyme, Speakers bureau: AbbVie, Alfasigma, BMS, Eli-Lilly, Janssen, MSD, Novartis, Sanofi

Background The OMERACT ultrasound (US) task force subdivision “US in CPPD” has created definitions for US identification of crystal deposits in joints and tested interobserver agreement for several joints1. The knee and the wrist were the most reliable sites for assessing CPPD. Objectives To assess whether the high level of inter-observer agreement of US for the detection of Calcium Pyrophosphate Deposition Disease (CPPD) in the triangular fibrocartilage complex (TFCC) of the wrist found by the experienced rheumatologists of the OMERACT group2 could be reproduced in real life Methods The OMERACT US criteria for identification of CPPD were utilised for this exercise on pre-recorded static images using a dichotomous score among several radiologists (n=2) and rheumatologists (n=5) with varying level of experience in musculoskeletal ultrasonography (range: 2–10 years). Firstly, the same 15 US images of the wrist that had been evaluated by the OMERACT panel were sent for evaluation to the local participants in order to calculate the inter-observer agreement. Secondly, 22 additional wrist US images extracted from locally performed examinations, in patients with a high suspicion of CPPD arthritis were evaluated. These local US examinations were performed in real life conditions, by different operators, on different machines and without prior standardisation of the procedure. For comparison, interobserver of wrist radiographs was also evaluated for all local patients Results The mean overall agreement and kappa values on the OMERACT panel US images were 0.89 and 0.78 respectively. These values are similar to those obtained previously by the OMERACT panel during the web exercise with the same images (0.80 and 0.68 respectively). The interobserver agreement was lower with the local US images (0.70 and 0.49 respectively), probably due primarily to the absence of strict standardisation of US procedure and inferior image quality. For comparison, the performance on the local radiographs was similar (0.70 and 0.47 respectively). Conclusions Our results confirm that the new OMERACT US definitions for assessing wrist CPPD are reliable when applied to pre-recorded static images. Scanning technique and standardisation of the procedure appear to be an important aspect with regards to the assessment of CPP deposition at the wrist. References [1] Filippou G, Sc Definition and reliability assessment of elementary ultrasonographic findings in Calcium Pyrophosphate Deposition Disease. Results of an international multi-observer study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound sub-task force. J Rheumatol2017. [2] Filippou G. How to identify Calcium Pyrophosphate Deposition Disease by Ultrasound: the reliability of the OMERACT definitions in an extended set of joints. An international multi-observer study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound sub-task force in revisionAnn Rheum Disease. Disclosure of Interest None declared

Background The targeted pharmacodelivery of cytokines by means of antibody-fusion proteins aims at selective accumulation of the active compound at the site of disease while sparing healthy tissues. Dekavil (F8IL10) is a fully human fusion protein composed of the vascular targeting antibody F8 fused to the cytokine interleukin-10. A phase 1 dose escalation study in patients with rheumatoid arthritis (RA) has recently been completed. Dekavil is currently under investigation in a phase 2 clinical study for the treatment of RA. Objectives The phase 1 study investigated safety, tolerability and the maximum tolerated dose of Dekavil when administered in combination with methotrexate (MTX). The currently ongoing phase 2 (in patients with active RA despite MTX therapy who had failed anti-TNF treatment) measures the mean change from baseline in DAS28-CRP between F8IL10 and placebo arms as primary endpoint. Methods The target population of both RA studies comprises patients with active RA despite MTX therapy who had failed anti-TNF treatment. Dekavil is administered once weekly for 8 consecutive weeks by s.c. injection in combination with a fixed dose of MTX (10–25 mg). The recently completed phase 1 study investigated escalating doses of Dekavil (6–600 µg/kg +MTX). The ongoing randomised multicenter, double-blind, placebo-controlled phase 2 trial assesses therapeutic activity in two treatment groups (Dekavil 30 or 160 µg/kg plus MTX) and one placebo group (placebo plus MTX). Results Dekavil was well tolerated up to the highest investigated dose (600 µg/kg) and an MTD was not reached. In 34 out of 35 patients treated in the phase 1 study no SAEs and no SUSARs were reported. One subject (cohort 9, 450 µg/kg) experienced a DLT (G2 purpura), which was accompanied by an SAE (G2 dyspnea, not drug related). The patient fully recovered within one week following corticosteroid administration. The most frequently observed adverse event was mild (G1) injection site reaction and occurred in 60% of the patients. Furthermore, two cases of drug related anaemia (G3 and G2; 160 µg/kg and 450 µg/kg, respectively) were reported in this study. All adverse reactions resolved completely. After 4 cycles of treatment, 36.4% of patients (12/33) exhibited ACR responses. The fraction of responses increased to 45.8% (11/24) after 8 cycles. Two patients achievedan ACR70 for more than 12 months after the last drug administration. As of January 2018, 25 patients have been treated in the phase 2 clinical study and neither SUSARs nor treatment-related deaths were recorded. Immunogenicity assessment is completed for the first 20 study subjects did not reveal an antibody response specific to F8IL10. An interim read-out after 45 patients will provide a more thorough understanding of the therapeutic activity of F8IL10. Conclusions The data obtained in the population studied to date suggest that Dekavil may be a safe and well tolerated novel therapeutic for the potential treatment of RA. Disclosure of Interest M. Galeazzi: None declared, G. Sebastiani: None declared, R. Voll: None declared, O. Viapiana: None declared, J. Dudler: None declared, P. Zufferey: None declared, E. Selvi: None declared, S. Finzel: None declared, F. Bootz Employee of: Philogen Group (Sponsor of the study), D. Neri Shareholder of: Philogen Group (Sponsor of the study)

Background Several studies have demonstrated that the clinical measures of disease activity, such as the DAS-score and ultrasound (US) scores can sometimes yield discordant results. Little research has attempted to understand the reasons for the discordances and how frequently these discordances occur in real life Objectives The objectives of this study were to determine the percentage of patients presenting discordances between DAS and US assessments in a real-life cohort, to describe associated factors and to evaluate the evolution of both measures of disease activity over time. Methods All patients with at least one concomitant US assessment and DAS score, performed since the introduction of validated US scoring in the Swiss registry for inflammatory arthritis SCQM registry between 2009 and 2017 were included. Disease activity was categorised as remission, low, moderate and high activity based on previously established cut-offs (for clinical: DAS categories and for US: on cutoffs of SONAR score established in previous testing among RA patients and asymptomatic subjects1,2). A search for potential clinical and US predictors of discordance was performed. Finally a longitudinal analysis was done in all patients with at least 2 subsequent visits. Discordances were analysed using successively DAS and US categories as references (see table 1) Results 1196 out of 2367 assessments were found discordant (50.4%). The proportion discordant assessments did not significantly differ by clinical disease status or when US categories were considered as the reference. Disease activity was equally frequently over-estimated by DAS compared to US-score (26.9%) and by US-score compared to DAS (23.5%). Factors associated with the presence of discordant results were all the components of the DAS when US categories were the reference. The presence of tenosynovitis was a significant factor when DAS was the reference. For 1181 patients with several DAS and US assessments, the proportion of discordances during follow up remained similar to the initial evaluation. Initial discordance/concordances could however change status without obvious reason in up to 30% of cases. Conclusions Discordances between DAS and US assessments appear to be higher than expected in real life. Both outcome measures could lead to over- or under-estimations of the disease activity. References [1] Zufferey P, Moller B, Brulhart Let al. Persistence of ultrasound synovitis in patients with rheumatoid arthritis fulfilling the DAS28 and/or the new ACR/EULAR RA remission definitions: results of an observational cohort study.Joint Bone Spine. 2014. [2] Zufferey P, Scherer A, Nissen MJ, et al. Can Ultrasound Be Used to Predict Loss of Remission in Patients with RA in a Real-life Setting? A Multicenter Cohort Study. J Rheumatol. 2018. Disclosure of Interest None declared

Background ‘Systemic autoimmunity associated with rheumatoid arthritis’ (RA), is a pre-clinical stage preceding the onset of clinical RA, characterised by the presence of autoantibodies, such as anti-citrullinated protein antibodies (ACPA) or anti-carbamylated protein antibodies (antiCarP). Breastfeeding has been proposed as a protective factor for RA development,1 but there are some controversies.2 To establish the causal role of a putative risk factor, longitudinal studies are needed, in particular in the pre-stages of RA development. Objectives To study the association between breastfeeding and the development of systemic autoimmunity associated with RA. Methods This ongoing prospective study includes individuals genetically at risk of developing RA, namely first-degree relatives of RA patients (RA-FDR). Individuals without clinical evidence of RA were enrolled, and assessed yearly clinically and biologically. We included all RA-FDR women with available ACPA status (anti-CCP 2, 3.1 or 3.0) and information about breastfeeding. The primary outcome was ACPA positivity. The exposure of interest was breastfeeding and duration of breastfeeding (categorised as 0, 1–7 and ≥7 months). The presence of antiCarP was a secondary outcome. We used logistic regression to analyse univariable and multivariable associations. Results A total of 882 women were included, of which 57 (6%) were ACPA positive. The characteristics of ACPA positive and negative participants were balanced, except for an older age in ACPA positives (median 52 versus 45 years; table 1). In the univariable analysis, ACPA positivity was not significantly associated with breastfeeding (OR 1.5, p=0.16) or with breastfeeding duration (OR=1.8, p=0.14). In the multivariable analysis adjusted by age, smoking, number of pregnancies and years of education, there was a weak, but not significant, association between breastfeeding for more than 7 months and ACPA positivity (OR 2.16, p=0.10). Among 728 women with available antiCarP results, 70 (10%) were positive, of which 27 (40%) breastfed. Breastfeeding for more than 7 months was not significantly associated with antiCarP in univariable or multivariable analyses (OR 1.3, p=0.52 and OR 1.9, p=0.16, respectively). Conclusions Among women at risk of RA, breastfeeding was not associated with the presence of ACPA or antiCarP. Our results do not support a protective role of breastfeeding in the development of systemic autommunity associated with RA. References [1] Orellana C, et al. Ann Rheum Dis2017;76:1845–52. [2] Berglin E, et al. Scand J Rheumatol2010;39:454 -60. Disclosure of Interest None declared

Osteoarticular manifestations of Lyme disease are well known features, although a number of controversies persist. These concern both the diagnosis, in particular the interpretation of serology results and the management, notably the role of antibiotics. In the article, we review a number of issues, and strive to shed light on the current evidence based Swiss and international data.Bien que les manifestations ostéoarticulaires de la maladie de Lyme soient connues depuis de nombreuses années, un certain nombre de questions et de controverses persistent. Elles concernent aussi bien le diagnostic, en particulier l’interprétation de la sérologie, que la thérapeutique, notamment les régimes antibiotiques. Dans cet article, nous passons en revue un certain nombre de ces questions et controverses avec des tentatives de réponse au vu des données récentes de la littérature internationale et des données propres à la situation suisse.

Objectives To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints. Methods A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD. Afterwards, 19 members of the panel met in Siena, Italy, for the patient-based exercise. During the exercise, all sonographers examined twice eight patients for the presence/absence of CPPD at the same joints. Intraoberserver and interobserver kappa values were calculated for both exercises. Results The web-based exercise yielded high kappa values both in intraobserver and interobserver evaluation for all sites, while in the patient-based exercise, inter-reader agreement was acceptable for the TFC and the AC. TFC reached high interobserver and intraobserver k values in both exercises, ranging from 0.75 to 0.87 (good to excellent agreement). AC reached moderate kappa values, from 0.51 to 0.85 (moderate to excellent agreement) and can readily be used for US CPPD identification. Conclusions Based on the results of our exercise, the OMERACT US definitions for the identification of CPPD demonstrated to be reliable when applied to the TFC and AC. Other sites reached good kappa values in the web-based exercise but failed to achieve good reproducibility at the patient-based exercise, meaning the scanning method must be further refined.

Objective.To investigate sex differences in connection with the effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS).Methods.A total of 440 patients with AS (294 men; 146 women) initiating a first TNFi in the prospective Swiss Clinical Quality Management Cohort were included. We evaluated the proportion of patients achieving the 20% and 40% improvement in the Assessment of Spondyloarthritis international Society criteria (ASAS20 and ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued TNFi were considered nonresponders. Logistic regression analyses were performed to adjust for important predictors of response.Results.Compared to men, female patients had lower mean C-reactive protein levels, better spinal mobility, and more peripheral disease at the start. There was no sex disparity with regard to the ASDAS, the Bath Ankylosing Spondylitis Disease Activity and Functional indices, and the quality of life. At 1 year, 52% of women and 63% of men achieved an ASAS20 response (OR 0.63, 95% CI 0.37–1.07, p = 0.09). An inactive disease status (ASDAS < 1.3) was reached by 18% of women and 26% of men (OR 0.65, 95% CI 0.32–1.27, p = 0.22). These sex differences in response to TNFi were more pronounced in adjusted analyses (OR 0.34, 95% CI 0.16–0.71, p = 0.005 for ASAS20 and OR 0.10, 95% CI 0.03–0.31, p < 0.001 for ASDAS < 1.3) and confirmed for all the other outcomes assessed.Conclusion.In AS, fewer women respond to TNFi and women show a reduced response in comparison to men.

Resume Objectifs L’objectif primaire de cette etude est d’evaluer si les patients ayant une polyarthrite rhumatoide (PR) consideree comme etant en remission selon les criteres cliniques, ont des synovites persistantes en echographie (US). La capacite de notre score echographique a differencier les patients ayant une maladie active de ceux en remission est l’objectif secondaire. Methodes Il s’agit d’une etude observationnelle incluse dans la cohorte de PR suisse des Maladies rhumatismales inflammatoires (SCQM). L’evaluation echographique est basee sur le score semi quantitatif (SONAR) valide qui comprend a la fois un mode de Doppler (PwD) et un mode B. Les echographies ont ete effectuees par les rhumatologues dans le cadre du bilan clinique de routine. Pour definir les synovites considerees cliniquement pertinentes, ce meme score a ete applique a 38 temoins sains et le percentile 90 a ete utilise comme seuil de synovite « pertinente ». Resultats Trois cent sept patients ont beneficie d’au moins un examen par echographie et un releve d’activite de la maladie. Plus d’un tiers des patients en remission suivant, a la fois les criteres DAS 28 et ACR/EULAR montrent une synovite significative en echelle de gris (respectivement p = 0,001 et 0,0002) et une activite en PwD (respectivement p = 0,005 et 0,0005) en comparaison avec les sujets temoins. La capacite de l’echographie a differencier le groupe en remission clinique des patients ayant une maladie active s’est averee seulement moderee. Conclusion Cette etude observationnelle confirme que beaucoup de patients consideres comme etant en remission clinique suivant les definitions du DAS ou de l’ACR/EULAR ont encore des synovites residuelles en echographie. La signification pronostique de ces synovites echographiques et la place exacte de l’echographie chez les patients atteignant une remission clinique doit etre encore evaluee.

Arthropathies induced by drugs, especially arthralgias, are very frequently reported in pharmacology. The major difficulty often consists in confirming the accountability of the drug in the occurrence of the symptoms. Stopping the drug when it really responsible of the arthralgia is then likely to lead to the disappearance of the symptoms. The aim of this article is to review some of classical known induced arthropathies and some innovations by describing the clinical characteristics as well as the mechanisms linking the drug to the arthropathies when these have been clarified.Les arthropathies induites par les médicaments, en particulier les arthralgies, sont très fréquemment rapportées en pharmacologie. La difficulté majeure consiste souvent à confirmer l’imputabilité du médicament dans la survenue des symptômes. L’arrêt du médicament suspect permet lorsqu’il est véritablement responsable de l’arthropathie d’entraîner alors la disparition des symptômes. Le but de cet article est de revoir les arthropathies classiques induites, ainsi que quelques nouveautés en décrivant les caractéristiques cliniques, ainsi que les mécanismes reliant le médicament à l’arthropathie quand ceux-ci ont été élucidés.

Background Whether tumor necrosis factor inhibitors (TNFi) have an influence on radiographic progression in ankylosing spondylitis (AS) remains controversial. Objectives To investigate the impact of TNFi use on spinal radiographic progression in AS. Methods Patients fulfilling the modified NY Criteria for AS (as assessed by central reading) in the Swiss Clinical Quality Management Cohort with at least 2 years of clinical and radiographic follow-up were included. Spinal X-rays were taken every 2 years and scored independently by 2 blinded readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) in chronological time order. Average score of the readers was used. Radiographic progression was defined as an increase by ≥2 mSASSS units over 2 years. The relationship between TNFi use before a 2 year X-ray interval and progression within the interval was investigated using binomial generalized estimating equation models with adjustment for potential confounding and multiple imputation of missing covariate data. Ankylosing Spondylitis Disease Activity Score (ASDAS) was regarded as a potential intermediate variable mediating the effect of TNFi on radiographic progression. It was added to the model as a time-varying variable in a sensitivity analysis. Results A total of 420 patients with AS contributed to data for 597 x-ray intervals in adjusted analyses (1–5 intervals per patient); BL characteristics: male sex 66%, HLA-B27 81%, mean (SD) age 40.4 (10.9) years, disease duration 13.9 (9.8) years, mSASSS 6.4 (12.4), ASDAS 2.8 (1.1)). 39% of the patients were already on TNFi at first X-ray. Mean mSASSS progression in 2 years was 0.9 (2.7) units. The multivariable model (Table) shows that prior use of TNFi reduced the odds of progression in the next 2 year interval by 49% (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.28–0.92, p=0.03). BL mSASSS and male sex also significantly affected progression. Adding ASDAS as a covariate to the model decreased the estimated effect of TNFi on progression: OR 0.65, 95% CI 0.36–1.17, p=0.15. In this model, a decrease in ASDAS by 1 unit would lower the odds for progression by 0.62 (p=0.001). Conclusions TNFi seem to reduce radiographic progression in patients with AS and this effect is mediated, at least in part, by a decrease in disease activity. Acknowledgements Supported by the Stiftung fur Rheumaforschung and a research grant from the investigator initiated studies program of MSD. Disclosure of Interest C. Molnar: None declared, A. Scherer: None declared, X. Baraliakos: None declared, M. de Hooge: None declared, R. Micheroli: None declared, P. Exer: None declared, R. Kissling: None declared, G. Tamborrini: None declared, L. Wildi: None declared, M. Nissen: None declared, P. Zufferey: None declared, J. Bernhard Consultant for: Merck Sharp & Dohme, Pfizer, Roche, U. Weber Consultant for: Abbvie, R. Landewe: None declared, D. van der Heijde: None declared, A. Ciurea Consultant for: Abbvie, Celgene, Eli Lilly, Janssen-Cilag, Merck Sharp & Dohme, Novartis, Pfizer, UCB

Background Few studies have investigated the impact of obesity on response to tumour necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (axSpA). Objectives To investigate the impact of different Body Mass Index (BMI) categories on TNFi response in a large cohort of patients with axSpA. Methods Patients within the Swiss Clinical Quality Management cohort were included if they fulfilled the ASAS criteria for axSpA, started a first TNFi after recruitement and had available BMI data as well as a baseline and follow-up visit at 1 year (±6mo) (N=632). Patients were categorized according to BMI: normal (BMI 18.5 to 30). We evaluated the proportion of patients achieving the 40% improvement ASAS criteria (ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued the TNFi were considered non-responders. We controlled for age, sex, HLA-B27, axSpA-type, BASDAI, BASMI, elevated CRP, current smoking and physical exercise in multiple adjusted logistic regression analyses. Results In comparison to normal weight and overweight patients, obese individuals were significantly older, had a longer symptom duration and higher BASFI and BASMI levels, while ASDAS levels were comparable between the 3 groups (Table 1). Data to calculate the ASAS40 response was available in 496 patients (78%). It was reached by 44%, 35% and 28% of patients with normal weight, overweight and obesity, respectively, (p=0.02; Table 2). A significantly lower odds ratio (OR) for achieving ASAS40 response was found in adjusted analyses in obese patients vs patients with normal BMI (OR 0.30, 95% confidence interval (CI) 0.11–0.73, p=0.01). Comparable results were found for the other outcomes assessed. The respective adjusted ASAS40 OR in overweight vs. normal weight patients was 0.69, 95% CI 0.38–1.24, p=0.22. Conclusions Obesity is associated with significantly lower response rates to TNFi in patients with axSpA. Disclosure of Interest None declared

Background The management of patients with rheumatic diseases is guided in part by asking patients about their medical history at each clinic visit. Patients often find it difficult to accurately remember the course of their symptoms between these appointments as they are often months apart. Regular app-based patients9 self-monitoring of disease activity (with our without feedback to the rheumatologist) between clinic visits might provide a possible solution for this. The COmPASS I study [1] demonstrated that RA patients9 self-assessments of disease activity via App correlate strongly with rheumatologists9 assessments. Following up on this, the Swiss based COmPASS II study is embedded in the Swiss rheumatology registry (SCQM) and hence allows the linkage of data obtained via the COmPASS II App from the patients with routine clinical data collected in the registry. The main aims of the COmPASS II study are to assess if continuous self-monitoring of the disease by patients optimises disease management and outcome in rheumatic diseases, and to assess the fluctuation of disease activity between clinic visits. Objectives The objectives of this abstract are to describe the set-up and the recruitment of the COmPASS II study in the first 11 months. Methods The COmPASS II App questionnaire consists of the RAPID3 score, a validated, commonly used PRO to self-assess disease activity. Additionally, patients are asked about their therapy compliance and cortisone dose. At inclusion, interested patients with RA, axSpA and PsA are electronically randomized into 3 study arms (Figure 1). In arm 1 patients and rheumatologist are displayed the self-assessed disease activity over time, the patient directly via the App and the rheumatologist via the SCQM registry. In arm 2 only the patients are displayed their disease activity chart and in study arm 3 neither sees the recorded data. Patients are encouraged to fill in the App weekly. Results The COmPASS II App went online on the 15/02/2016. In the first 11 months of COmPASS II, 272 patients were enrolled by their rheumatologist. 64% of patients used the WebApp (32% in arm 1, 38% in arm 2 and 30% in arm 3); 82% of patients filled in the questionnaires for longer than a months, the longest follow-up was 11 months. On average patients use the App every 2 weeks. Patients found the App easy to use “The COmPASS II WebApp is so easy to use. It doesn9t even take me 2 min.” and received feedback included “Now my rheumatologist sees how I was since the last appointment instead of me trying to remember how I was half a year ago.”. Conclusions The COmPASS II study will validate the utility of app-based patients9 self-assessments in enhancing disease control in a treat to target approach and deliver numerous additional scientific data. References Mueller R et al. Patient9s Self-Monitoring Via Smartphone: The Compass Study - COrrelation between PAtient self-ASSessment of rheumatoid arthritis disease activity via smartphone technology and physicians9 validated scores [abstract]. Arthritis Rheumatol. 2014;66(S10). Acknowledgements COmPASS II is supported by an unrestricted grant from AbbVie. Disclosure of Interest None declared

Background Calcifications composed of hydroxyapatite (HA) crystals can induce acute and severe pain accompanied by signs of acute inflammation. In a previous pilot study, we have shown that anakinra was effective in acute flare of calcific periarthritis of the shoulder in the short term Objectives The goal of this retrospective observational study was to confirm these results in a larger set of patients, extending the observation to other localizations and to report on the long-term follow-up. Methods All consecutive patients with an acute flare due to HA deposition and treated with anakinra between March 2011 and November 2016 were included. Flare was defined as symptoms of acute pain at rest present for Results 13 patients fulfilled the inclusion criteria. 12 had a flare at the shoulder, 1 at the first MCP of the hand. The acute inclusion flare was the first episode in 9/13 subjects. At baseline, mean pain VAS:8.8/10 Active and passive motion was severely restricted in all patients. Local inflammation was sufficiently severe to induce an elevation of the CRP and ESR in 10/12 patients. By ultrasound, the mean size of calcifications was 17 mm. Only one had an arc-shaped aspect with shadowing, the others were fragmented. Short term follow-up: Pain diminished drastically and rapidly, typically within hours, in most patients after the first injection and was almost absent at day three (mean VAS 1.7/10), stable at 3 weeks (mean VAS: 2.1). At follow-up ultrasound, the calcification disappeared in none of the patients but, in most cases, a reduction (50% mean size reduction) and a fragmentation was observed.Long term follow-up: The median duration was 24 months, (range 4 to 74 months). Only 2/ 12 patients experienced an acute relapse. These two patients already suffered from chronic shoulder pain and had prior flares before the treatment with anakinra. Mild chronic pain, essentially related to movement (mean VAS: 2.7), was still present in 5 patients. Two patients regularly took NSAIDs; the others did not use any painkiller Conclusions This study suggests that IL-1β inhibition may be an interesting therapeutic approach in acute flares in relation with hydroxyapatite calcification. Moreover this treatment does not seem to be associated with rebound or recurrence of flares in the long term. References Zufferey P, So AK.A pilot study of IL-1 inhibition in acute calcific periarthritis of the shoulder Ann Rheum Dis. 2013 Mar;72(3):465–7. Disclosure of Interest None declared

Background The oral Janus kinase inhibitor tofacitinib (Tofa) was licensed in Switzerland in 2013 for the treatment of moderate to severe rheumatoid arthritis (RA) patients having failed methotrexate. Besides Tofa, rheumatologists in Switzerland have the choice between 7 alternative bDMARDs licensed with similar indications, including 5 TNF inhibitors (TNFi) and 2 bDMARDs with other modes of action (OMA-bDMARDs). Objectives To compare the drug retention rate of three alternative treatment options licensed with a similar indications, namely Tofa, TNFi and OMA-bDMARDs, using data from the Swiss registry. Methods This is an observational cohort study within the Swiss Clinical Quality Management registry (SCQM). All therapies with Tofa, TNFi, and OMA-bDMARDs initiated in adult RA patients between August 1, 2013 and Dec 1, 2016 were considered. The exposure of interest was treatment with Tofa vs TNFi and vs OMA-bDMARDs (Abatacept or Tocilizumab). The primary outcome was drug retention defined as the time from initiation to discontinuation of treatment. We used Kaplan Meier curves to display drug retention and Cox proportional hazard models stratified by seropositivity to analyze the hazard for treatment discontinuation. We adjusted for potential confounders, including gender, age, disease duration, seropositivity, BMI, smoking status, DAS28-CRP and the total number of previous bDMARDs. We applied multiple imputation to account for missing baseline covariate data. Results A total of 1996 therapies were initiated during the study period (376 Tofa, 928 TNFi, 692 OMA-bDMARDs). Some differences in disease and treatment characteristics existed between the 3 groups, in particular TNFi tended to be used in patients with fewer previous bDMARDs experience, younger age and shorter disease duration. The crude overall drug retention was similar between the 3 three drug groups (p=0.24) (Figure 1A). The adjusted analysis demonstrated a slightly higher hazard of drug discontinuation with TNFi compared to Tofa [HR 1.27 (95% CI: 1.02 – 1.57, p=0.03)], while no difference was observed for OMA-bDMARDs and Tofa [HR 1.03 (95% CI: 0.83 – 1.28, p=0.76)] (Figure 1B). Complete case results were consistent with results using multiple imputation of baseline covariates. Other variables significantly associated with drug discontinuation were a higher number of previous bDMARDs (p Conclusions The results of this observational study suggest that Tofa is a valuable alternative to treatment options in RA, with Tofa drug retention at least comparable to other available bDMARDs. Acknowledgements Disclosure. Investigator Initiated Research grant supported by Pfizer. Disclosure of Interest A. Finckh Grant/research support from: BMS, Speakers bureau: Abbvie, BMS, Pfizer, Roche, UCB, L. Herzog: None declared, A. Scherer: None declared, J. Dudler: None declared, B. Moeller: None declared, A. Ciurea: None declared, R. Mueller: None declared, P. Hasler: None declared, P. Exer: None declared, I. von Muehlenen: None declared, D. Kyburz: None declared, C. Gabay: None declared, P. Zufferey: None declared

Background Tenosynovitis is one of the common features of rheumatoid arthritis (RA). The diagnosis of tenosynovitis is frequently made clinically but for the detection of tenosynovitis, ultrasound (US) is more sensitive. US and MRI detected tenosynovitis is a predictor for unstable remission and erosive progression in RA. Objectives The aim of this study was to assess the prevalence and determinants of TS detected in the SONAR (Swiss Sonography Group in Arthritis and Rheumatism) examinations in patients with Rheumatoid Arthritis in the SCQM Cohort. Methods The SONAR ultrasound examination consists of a semi-quantitative score employing both multiplanar gray scale (B-mode) and Doppler-mode (PwD) and a TS composite score (grade 0–3). Pathologic TS was defined as TS grade 2–3. Characteristics of patients with and without TS are shown using standard descriptive methods. In a longitudinal sub-group the change in TS from no TS to pathologic TS or vice versa and DAS28 over time was categorized as “worse” (ΔDAS28 ≥2.1), “same” and “better” (ΔDAS28 ≤-2.1) and the correlation between change DAS28 and in tenosynovitis was evaluated. Results 941 RA patients with TS score were available. 20% of included patients showed signs of TS. The presence of TS was associated with male gender and higher values of disease activity and physical function disability. Furthermore, 15% of patients in DAS28 Remission had sonographic TS. TS was less frequently observed in patients on biologic therapies (Table 1). The longitiudinal sub-group consisted of 348 patients. The correlation between change in DAS28 and change in TS was poor (polychoric correlation 0.28 [0.14, 0.43]). Conclusions In the SCQM RA cohort TS is associated with male gender and an overall higher disease activity. One should actively look for TS even in RA patients in DAS28 remission. Disclosure of Interest None declared

Background The OMERACT US subtask force “US in CPPD” recently created the definitions for US identification of crystal deposits in joints and tested the reliability at the knee [1]. Objectives To assess the inter/intra-observer reliability of US on detecting CPPD at triangular fibrocartilage complex (TFCC) of the wrists, fibrocartilage of the AC joint, hip labrum (HL), hyaline cartilage (HC) of the metacarpal (MC) and femoral head. Methods The OMERACT criteria for CPPD were used for the exercise [1] using a 2 steps approach. First, the panel of experts gave a dichotomous score (presence/absence of CPPD) of 120 images of the sites included, using a web platform. The images were evaluated twice to assess the inter/intra-observer reliability. Then, the experts met in Siena for a patient based exercise. Bilateral evaluation of TFCC, AC, HL /HC of the hip and HC of the II-III MCP of 8 patients was carried out twice in a day, using a dichotomous score for CPPD. 8 US machines (3 GE, 1 Samsung and 4 Esaote) equipped with high resolution linear probes were used. Results Reliability values of static exercise were high for all sites, demonstrating that definitions were clear. The results of the second step are presented in table 1. On live scanning, the TFCC resulted the most reliable site for CPPD assessment, followed by AC. Other sites demonstrated lower kappa values and thus are not reliable for CPPD assessment. Conclusions TFCC of the wrist is the most reliable site for CPPD. By adding these results to the previous [2], we confirm that the OMERACT definitions for CPPD can be applied reliably at the knee (meniscus and HC), TFCC and AC, usually the most involved sites in CPPD. The next step of the OMERACT subtask force will be to test these findings in a longitudinal observational study. References Filippou G, Scire CA, Damjanov N et al. Definition and reliability assessment of elementary US findings in CPPD. Results of an international multi-observer study by the OMERACT sub-task force “US in CPPD”. J Rheumatol, in press. Disclosure of Interest None declared