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EULAR has traditionally been a strong advocate of training and education in rheumatology, which has made EULAR the pre-eminent provider and facilitator of high-quality educational offerings for physicians, health professionals in rheumatology, and people with rheumatic and musculoskeletal diseases. Indeed, the international rheumatology community is set to benefit from high levels of education in rheumatology, with the aim of delivering significant relief to the lives of people with musculoskeletal and rheumatic diseases worldwide.In June 2017, the EULAR School of Rheumatology was launched at the Annual EULAR Congress. This is as a fully integrated operational entity contained within EULAR which combines all educational offers, whether they are live courses, online courses, books, webinars or any other material, under one roof. This new system has the aim of greatly facilitating access to all products, giving personalised overviews and allowing, for those who sign up for a membership, to use the various incentives and special offers. The School will also provide the members a secure means of storing their gained certifications and other personal information. In addition, members of the EULAR School of Rheumatology will be able to benefit from a new accumulative credit point system, which adds points according to educational hours spent in EULAR courses, either live or on-line. Members will also be regularly informed regarding the developments of the School and new educational and training materials.With the purpose of optimising and improving the already very solid educational offerings of EULAR, during the last two years, seven groups of eminent experts in education actively worked to develop new products to be added to the existing educational material of EULAR. Many different projects are currently being developed by these “classrooms” and are addressed to the whole rheumatology community (i.e. rheumatologists, undergraduates, trainees, teachers, researchers, health professionals, and people with rheumatic and musculoskeletal diseases). Indeed, in today’s digital era, education and training possibilities are undergoing constant changes with new approaches, products and technologies coming up. Thus, the EULAR School of Rheumatology represents a model of future learning, reflecting the changing needs of the rheumatology community through offering new educational materials across this medical discipline and the greatest levels of access to the highest quality of education in the field.With the modern developments of the rheumatology discipline, EULAR School of Rheumatology is today taking its educational offerings, services and products to a global audience worldwide.For information about ongoing and new initiatives of the EULAR School of Rheumatology, please go to www.eular.org/school_of_rheumatology.cfm.Disclosure of InterestNone declared

The optimisation of the current therapeutic strategies for RA, with the establishment of early intensive treatment and with the availability of new drugs, has led to a dramatic change in the management of RA, and remission is the target of modern treatment in patients with RA.1 2Remission is ideally characterised by the absence of clinically detectable disease activity, the absence of radiographic progression and the improvement of physical function.3 However, in clinical practice it is frequently difficult to use a comprehensive definition of this condition and apply objective systems for assessing it. Then, subclinical disease activity may be present, even in patients who are in clinical remission, leading to joint damage progression4 and disease flare.2 5 EULAR recommendations for the use of imaging in RA patients include ultrasound (US) as an assessment tool for inflammatory activity and remission, as it is able to detect joint inflammation and predict subsequent joint damage.6 Recent studies have shown that US provides diagnostic and prognostic data in terms of risk of flare, disability and damage progression in RA.8 Furthermore, in addition to joints, US allows the assessment also of periarticular structures, such as tendons, that have been demonstrated to be the site of inflammatory changes also in patients in clinical remission.7 Recently, 427 RA patients in clinical remission have been evaluated in a multicentre study which included the US assessment of wrist and hand tenosynovitis and synovitis by grey scale (GS) and power Doppler (PD).2 Results of this study showed a high prevalence of tenosynovitis (52.5%–95% CI 0.48, 0.57 for GS and 22.7%–95% CI 0.19, 0.27 for PD) and synovitis (71.6%–95% CI 0.67, 0.76 for GS and 42%–95% CI 0.37, 0.47 for PD). Among clinical correlates, PD tenosynovitis associated with lower remission duration and morning stiffness while PD synovitis did not. Only PD tenosynovitis showed a significant association with the flare questionnaire [OR 1.95 (95% CI 1.17, 3.26)]. No cross-sectional associations were found with the HAQ. The presence of radiographic erosions associated with GS and PD synovitis but not with tenosynovitis. This study demonstrated that US-detected tenosynovitis is a frequent finding in RA in clinical remission. Compared with intra-articular synovitis, active tenosynovitis was more associated with RA patients reporting unstable remission. Based on those results, US demonstrated to be a useful imaging modality for assessing tenosynovitis which may help in subsetting RA patients in clinical remission.2 More recently, a multicentre longitudinal study in 361 consecutive patients with RA in clinical remission demonstrated that the conjunct presence of PD positive tenosynovitis and synovitis predicts flare in patients with RA in clinical remission.7 US scanning of RA patients in remission has a crucial role in order to demonstrate active joint and tendon inflammation that are able to predict flare.During this practical skills session at , EULAR Congress 2018 the role of US in detecting subclinical inflammation at joint and tendon level will be discussed and practical demonstration on how to scan patients in remission will be performed.References[1] Smolen JS, et al. Treating rheumatoid arthritis to target: Recommendations of an international task force. Ann Rheum Dis2010.[2] Bellis E, et al. Ultr asound-detected tenosynovitis independently associates with patient-reported flare in patients with rheumatoid arthritis in clinical remission: Results from the observational study STARTER of the Italian Society for Rheumatology. Rheumatology2016.[3] Felson D. Defining remission in rheumatoid arthritis. Ann Rheum Dis2012.[4] Brown AK, et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum2008.[5] Sakellariou G, et al. In patients with early rheumatoid arthritis, the new ACR/EULAR definition of remission identifies patients with persistent absence of functional disability and suppression of ultrasonographic synovitis. Ann Rheum Dis2013.[6] Colebatch AN, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis2013.[7] Filippou G, et al. The predictive role of Ultrasound detected tenosynovitis and joint synovitis for flare in patients with Rheumatoid Arthritis in stable remission. Results of an Italian multicentre study of the Italian Society for Rheumatology Group for Ultrasound: the STARTER studySubmitted.[8] Scirè CA, et al. Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology2009.Disclosure of InterestNone declared

The use of musculoskeletal ultrasound in rheumatology clinical practice has become widespread with increasing demand from rheumatologists attending EULAR Sonography Courses and participating in educational activities in the field. However, musculoskeletal ultrasound is widely considered an operator dependent imaging technique for which high level training and appropriate competency assessment are crucial in order to ensure the quality of ultrasound examinations. EULAR offers a huge educational programme in musculoskeletal ultrasound, with a number of own branded multi-level live sonography courses and an online introductory course on ultrasound, of which high quality structure and content is ensured. In addition, EULAR grants “scientific endorsement” as a mark of scientific quality to selected courses organised by established experts. Moreover, EULAR guidelines and recommendations on how to perform musculoskeletal ultrasound in rheumatology, and for the content and conduct of ultrasound, including teach-the-teachers, courses have recently been published, thus filling a knowledge gap in the field.There was however, still the need for assessing the level of competency of delegates attending these educational courses in order to improve and regulate the skills of rheumatologists performing ultrasound. As a result, the EULAR competency assessment in musculoskeletal ultrasound in rheumatology was launched in 2015 with this objective. This new system represents an example of certification offered by EULAR and is based on 2 levels of competency: 1) Level 1 (i.e. the minimum level required to independently perform full rheumatologic musculoskeletal ultrasound, the contents of which are included in the EULAR online, basic, intermediate and advanced courses). 2) Level 2 (i.e. the minimum level required to teach musculoskeletal ultrasound). The EULAR faculty, a group of highly qualified and experienced experts in the field, assess the attendees of the annual EULAR sonography and teach-the teachers courses in order to provide EULAR certification approving their level of competency. All these procedures are regulated by rules available on the EULAR web site (www.eular.org).The competency assessment requirements are reported below:Level 1–To complete the EULAR online MSUS course successfully.–To attend the Basic and Intermediate EULAR MSUS course, or equivalent EULAR scientifically endorsed MSUS course and the Advanced EULAR MSUS course with a maximum of 2 years in between each course.–To perform and document a minimum of 10 standardized complete MSUS examinations of each joint region (i.e. shoulder, elbow, wrist&hand, hip, knee, ankle&foot) of different normal subjects, after having attended the Basic MSUS course (EULAR or EULAR endorsed).–To perform a minimum of 200 documented MSUS examinations of different anatomic areas(i.e. shoulder, elbow, wrist&hand, hip, knee, ankle&foot) of different patients with rheumatologic diseases that covers the full range of conditions included in the basic and intermediate level, after having attended the Intermediate MSUS course.–The latter requirement of performing normal and pathological ultrasound images can be replaced with the achievement of level 1,2 or 3 of MSUS competency in rheumatology as stated by EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology). (Ref. Terslev L, et al. Ultraschall in Med; published online May 21, 2013; www.efsumb.org/guidelines)–To successfully pass a practical exam that takes place during the Advanced EULAR MSUS course.Level 2–To have achieved level 1 competency.–To attend the annual EULAR MSUS Teach the Teacher course and successfully pass the theoretical and practical examination on MSUS teaching capability that takes place during said course.–The level 2 competency certification can be delivered under particular circumstances (and after having verified the particular requirements, by the EULAR Faculty members) to MSUS experts who have been a teacher in a EULAR MSUS Teach the Teacher course within the previous 3 years or have been a teacher in three Intermediate/Advanced EULAR MSUS courses within the previous 5 years.Key messages:–Appropriate training and competency assessment are highly important to ensure an appropriate and skilled use of musculoskeletal ultrasound by rheumatologists–The EULAR competency assessment in musculoskeletal ultrasound represents a unique opportunity to guarantee a high level of competency of rheumatologist ultrasonographersDisclosure of InterestNone declared

By 2017, EULAR will be a pre-eminent provider and facilitator of high-quality education for physicians, health professionals in rheumatology, and people with rheumatic and musculoskeletal diseases. In addition to educational sessions at the annual congress and the EULAR symposia at AFLAR, PANLAR, APLAR, currently available educational offers cover different fields and are represented by online and live courses, exchange programmes, bursaries, grantsand awards, publications and other materials.In terms of online courses, in recent years, EULAR has put substantial effort and investment into developing e-learning opportunities. All EULAR courses, as electronic ways of continuous medical education in rheumatology, are managed by a scientific course committee responsible for the structure and content of the courses and for ensuring quality control. EULAR teams of expert authors regularly review and update courses to keep up with the newest developments in the field. While the 2-year Online Course on Rheumatic Diseases offers a comprehensive introduction to and update on all aspects of rheumatology, a number of shorter online courses (i.e. US introductory, Paediatric, Health Professionals, Systemic Sclerosis) offer flexible learning for the specialist.Live courses are currently planned and developed with the objective of making a targeted contribution to training and further education to rheumatologists and health professionals, complementing the standard range of opportunities provided by universities, hospitals and other institutions. To this end EULAR offers a number of its own branded courses and, in addition, grants “EULAR scientific endorsement” as a mark of scientific quality to selected courses and meetings run by established providers in Europe. In this context, EULAR invites other courses and scientific meetings in the field of rheumatology to apply for endorsement. EULAR views scientific endorsement as an opportunity to positively influence the quality of rheumatology training in Europe, which is in line with EULAR longer-term goals. Quality control associated with EULAR scientific endorsement focuses on the proposed content and faculty as well as on evaluation of these courses or meetings.The purpose of the EULAR/ACR Exchange Program is to promote the international exchange of clinical and research skills, expertise and knowledge within rheumatology. The program recognizes outstanding rheumatology faculty and provides exposure to the exciting work being done by colleagues overseas. This exchange program allows participants to share knowledge and experience, and creates opportunities for collaboration.Another EULAR objective is the use of bursaries to contribute to the personal and professional development of rheumatologists, health professionals as well as people with rheumatic diseases. To this end, EULAR facilitates attendance at the annual EULAR congress in the form of travel bursaries, also provides bursaries to attend EULAR courses in rheumatology. EULAR is committed to helping individuals develop their skills, expertise and network of contacts and therefore offers a range of educational grants tailored to the needs of researchers and clinicians, health professionals and patient organisations. Educational grants are offered at regular intervals.In terms of publications, in addition to the two EULAR journals (ARD and RMDopen), and next to the EULAR Textbook on Rheumatic Diseases, EULAR has published the Textbook on Systemic Sclerosis, and also endorsed several books which are relevant to the EULAR live and online courses. The new EULAR Texbook on Ultrasound will be launched at the annual Congress in London, on June 2016.Additional opportunities are represented by educational activities such as a network of imaging centres, videos which offer an insight into some EULAR courses and international events, practical DVDs with video production on undergraduate training in history and physical examination of the musculoskeletal system. New activities that will be launched in 2016 are a medical student primer, student webinars on “case of the month” and webinar monthly lecture given by experts.Key messages–By 2017, EULAR will be a pre-eminent provider and facilitator of high-quality education for physicians, health professionals in rheumatology, and people with rheumatic and musculoskeletal diseases.–Currently available educational offers cover different fields with online and live courses, exchange programmes, bursaries, grants and awards, publications and other materials.Disclosure of InterestNone declared

In the last few years the application of musculoskeletal imaging in rheumatology clinical practicehas become more widespread. However recommendations on its use in osteoarthritis (OA) are lacking.ObjectiveTo develop evidence-based recommendations for the use of imaging in OA clinical practiceMethodsAfter the project was approved by the EULAR Executive Committee, a task force of experts in the field of OA and imaging met in order to plan the strategy for a systematic literature review (SLR), subsequently conducted by a research fellow under the supervision of the conveners and the methodologist of the group. The task force identified areas of application of imaging in OA clinical practice and developed the research questions to drive the SLR. The imaging modalities (conventional radiography, ultrasound, magnetic resonance imaging, computed tomography, radioisotope scan) and joints (knee, hip, hand and foot) were first identified. Second, the role of imaging in the diagnosis of OA, identification of OA characteristics, detection of other diseases, managing OA, defining its prognosis, monitoring the disease progression as well asguiding treatment was addressed. A systematic search was performed separately for each question and site using PubMed and Embase.ResultsFrom an initial SLR, 6858 references were found, 1317 papers were reviewed in detail and 380 of them were included. Furthermore, to investigate evidence not addressed by the first SLR,the task force required additional SLRs to evaluate the accuracy and efficacy of imaging-guided compared to blind injections and the comparison of different radiographic projections. For the first SLR, 25 papers out of 5379 abstracts were assessed and 8 included, while for the comparison of different projections 53 papers out of 4774 abstracts were reviewed, with the inclusion of 31 papers. After analysing the results of the SLRs and giving their expert opinion, the task force developed consensus recommendations. These covered different areas such as the lack of need for diagnostic imaging in patients with typical symptoms, the role of imaging in differential diagnosis, the use of imaging in monitoring OA when no significant therapeutic modification isrelated, the first choice imaging modality, how to acquire images, the influence of different joints on selecting the type and use of imaging modalities, and the role of imaging in guiding local injections. Future research recommendations were developed based on areas where there was a paucity of literature.ConclusionsEULAR recommendations for the use of imaging in osteoarthritis clinical practice have been developed thus filling a knowledge gap in the field.Key messages–Recommendations on the use of imaging in OA clinical practice are lacking.–Based on the results of a SLR and expert opinion, recommendations on the use of imaging in the clinical management of OA were developed.Disclosure of InterestNone declared

Musculoskeletal ultrasound (US) is a valuable imaging modality for detecting and quantifying a range of joint pathologies occurring in rheumatic diseases, especially RA. Recently new imaging modalities such as US are emerging as valuable tools for diagnosing, monitoring and remission in RA. US has proven its validity to assess synovitis in RA and has been demonstrated to be superior to clinical examination in the detection of inflammatory abnormalities at joint level [1]. However, RA is characterized by polyarticular and symmetrical involvement of peripheral joints and, in order to be able to assess global disease activity, it is therefore necessary to move from the level of single joints to the level of the patient as a global entity [2]. Thus, the relevance of a global but feasible ultrasonographic assessment surged proposals of different US joint count [3]. The concept of developing an US-based scoring system for synovitis in RA at patient level is based on the need for integrating the components of synovitis (i.e. synovial hypertrophy, synovial Dopper signal and joint effusion) in a unique global score of joint inflammatory activity in RA [4]. The application of a scoring system at patient level by a multi-joint US assessment aims at producing an objective tool for assessing disease activity, monitoring patients under treatment and evaluate the presence of remission [4]. In addition, the availability of a global assessment tool represents a feasible and limited-costs system that is useful in the rheumatology clinical practice as well as in clinical trials. In this context, recent studies applying either extensive or reduced US joint counts have shown the feasibility of US for following patients under treatment. However, currently there is a lack of consensus regarding the optimal number of joints to include in the global assessment as well as the appropriate scoring system to use at single joint level [4]. In addition, many differences in the responsive index applied (i.e. gray-scale synovitis, Doppler, both modalities) as well as in the correlations between US scores and clinical and laboratory findings have been registered [4–10]. Particularly, the proposed scoring systems include a variable number of joints, ranging from a maximum of 78 to a minimum of 6 [3,10]. In between, other innovative US scores have been proposed and include joints selected either bilaterally or at the level only the clinically dominant side of the body [6–8]. More recently, the development of an US global OMERACT synovitis scoring system at patient level has been proposed for being applied in multicenter international therapeutic trials aiming at testing the responsiveness of US scoring system in RA patients [4]. Further randomized controlled studies are needed for confirming these results and explore predictive aspects in respect of development of structural damage and stratification of patients. References Rizzo C et al.Ultrasound in rheumatoid arthritis. Med Ultrason. 2013;15:199-208 Mandl P et al. A systematic literature review analysis of ultrasound joint count and scoring systems to assess synovitis in rheumatoid arthritis according to the OMERACT filter. J Rheumatol. 2011;38:2055-62 Hammer HB et al. A 78-joints ultrasonographic assessment is associated with clinical assessments and is highly responsive to improvement in a longitudinal study of patients with rheumatoid arthritis starting adalimumab treatment. Ann Rheum Dis 2010; 69:1349-51 Iagnocco A et al. Responsiveness in Rheumatoid Arthritis. A Report from the OMERACT 11 Ultrasound Workshop. J Rheumatol. 2014;41:379-82 Naredo E et al. The OMERACT Ultrasound Task Force – Status and Perspectives. J Rheumatol 2011;38:2063-7 Naredo E et al. Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Arthritis Rheum. 2008;58:2248-56 Naredo E et al. Validity, reproducibility, and responsiveness of a twelve-joint simplified power Doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum 2008;59:515-2216. Backhaus M et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: A pilot project. Arthritis Rheum 2009;61:1194-201 Iagnocco A et al Clinical and ultrasonographic monitoring of the response to adalimumab treatment in rheumatoid arthritis. J Rheumatol 2008;35:35-40 Perricone C et al. The 6-joint ultrasonographic assessment: a valid, sensitive-to-change and feasible method for evaluating joint inflammation in RA. Rheumatology (Oxford) 2012;51:866-73 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6184

EULAR has always had a strong commitment in teaching ultrasound in rheumatology. Over time EULAR has developed a broad educational offering in the field which today includes ultrasound courses, both physical and electronic, a textbook as well as practical skills sessions at EULAR Congress. This contribution complements the standard range of opportunities to teach ultrasound provided by universities, hospitals and other institutions. EULAR Ultrasound Course – The course takes place annually prior to the annual EULAR congress, in the same city. The aim of this three level course (basic, intermediate, advanced) is to cover the whole spectrum of conditions in which ultrasound could be used in rheumatology practice. The EULAR sonography course consists of a combination of lectures and hands-on-scanning of healthy individuals and patients with different rheumatic diseases, in small groups with experienced tutors. The basic level course aims at teaching sonoanatomy, standardised ultrasound scanning methods according to EULAR guidelines and basic ultrasound pathology as well as giving an overview of the role of ultrasound in rheumatologic clinical practice [1]. The intermediate level course aims at consolidating standardized scanning methods, as well as assessing pathology by ultrasound and knowing its role in different musculoskeletal pathologies. The advanced course focuses on difficult issues within ultrasound and includes time for discussion with expert rheumatologists and radiologists in the field. EULAR Ultrasound Trainer Course – The course takes place prior to the EULAR Ultrasound Course and the annual EULAR Congress. The course is mainly addressing rheumatologists who are planning to organize an EULAR Endorsed Ultrasound Course and aims at improving teaching skills for both lectures and hands-on ultrasound workshops. Participants also learn how to organize an ultrasound course and evaluate the skills of sonographers. EULAR On-line Introductory Ultrasound Course – This on-line course offers seven modules of theoretical basic skills on ultrasound showing different joint sites, in healthy subjects and in rheumatic diseases, using a wide variety of images and video clips. Each module consists of a main review text with video clips and/or photos, two in-depth discussions expanding on clinical problems and two interactive clinical cases with questions and answers. In addition, assessment questions are presented at the end of each module. The course starts each September and is designed for seven months. Participants finish with an on-line exam and, upon passing, receive a EULAR certificate. Knowledge and skills are targeted at the level felt to be appropriate for European rheumatologists who would like to acquire a basic theoretical knowledge on ultrasound. Participants may later elect to continue with the training program by attending EULAR sonography courses and/or ultrasound courses with EULAR endorsement. Ultrasound Courses with EULAR Scientific Endorsement – In addition to its own branded educational course programme, EULAR invites other ultrasound courses to apply for “EULAR scientific endorsement” according to predefined rules related to the quality of the content, the qualifications of the faculty and the rigor of the course evaluation. To this end, EULAR views scientific endorsement as an opportunity to positively influence the quality of ultrasound training in rheumatology. EULAR Book on Ultrasound in Rheumatology – Essential Applications of Musculoskeletal Ultrasound in Rheumatology assists the readers in most effectively using musculoskeletal ultrasound to diagnose and monitor the progression of rheumatoid arthritis, vasculitis, and other rheumatic and soft tissue disorders. Ultrasound Practical Skills Sessions at EULAR Congress – Ultrasound basic and advanced practical skills sessions are usually included in the scientific programme of the annual EULAR Congress. They consist of a combination of brief lectures and hands-on-scanning of patients with rheumatic diseases and aim at teaching participants how to use ultrasound in clinical practice. References Naredo E, Bijlsma JW, Conaghan PG et al Recommendations for the content and conduct of European League Against Rheumatism (EULAR) musculoskeletal ultrasound courses. Ann Rheum Dis 2008;67:1017-22. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6309

Musculoskeletal ultrasound (US) is a valuable imaging modality for detecting and quantifying a range of joint pathologies occurring in rheumatic diseases (1-2). In inflammatory arthritis and in osteoarthritis (OA) it is able to show early and late findings including cartilage lesions (1-4). Normal hyaline cartilage is imaged by US as a homogeneously anechoic layer lining the bony cortex and having a superficial and a deep margin that appear thin, sharp, continuous and regularly hyperechoic. In OA, loss of the anechoic echotexture, irregularities and loss of sharpness of the margins and progressive thinning of cartilage layer are visualized (1). With disease progression, focal and asymmetric narrowing is usually present up to the complete absence of the cartilaginous layer and cartilage breakdown (5). US has been demonstrated to be a reliable tool for assessing cartilage abnormalities in hand joints of OA patients (1). In rheumatoid arthritis (RA) US detects loss of the sharpness of the cartilage margins, partial or full-thickness defects and complete loss of the cartilage with subchondral bone involvement (6). In addition, cartilage US measurements can be performed at different joint sites (7-10). In crystal arthropathy, the conformation and anatomical location of crystals at cartilage level help in differentiating gout and calcium pyrophosphate deposition disease (CPDD) (11). Hyperechoic enhancement of the superficial margin of the hyaline cartilage is visualized in gout and hyperechoic spots within the cartilage layer are imaged in CPDD. In gout, urate crystals deposit over the superficial margin of the cartilage (double contour sign) with focal or diffuse enhancement of the superficial cartilage margin, whose reflectivity is independent of the angle of insonation. In CPDD, pyrophosphate deposits are visualized within the cartilage layer and the double contour aspect is shown as a thin hyperchoic band with focal, punctate or diffuse features. High sensitivity, specificity and accuracy of US in detecting urate and pyrophosphate crystals deposits at knee cartilage level have been recently reported (11). All cartilaginous changes need to be assessed by using a correct US scanning technique, based on appropriate patient positioning to allow the sonographic beam to penetrate the joint, adequate probe orientation to obtain perpendicular insonation of the US beam and assessment of the contralateral site to perform complete and deep comparisons (5). Key messages: US detects a wide range of cartilage abnormalities in OA, RA and crystal related arthropathies. Mandatory technical aspects should be taken into account when assessing the hyaline cartilage (correct machine setting, multiplanar assessment, dynamic evaluation and comparisons with contralateral side) with limited applications to some anatomic areas, depending on the presence of appropriate acoustic windows. References Iagnocco A et al. The reliability of musculoskeletal ultrasound in the detection of cartilage abnormalities at the metacarpo-phalangeal joints. Osteoarthritis Cartilage 2012 Filippucci E et al. Ultrasound imaging for the rheumatologist. Clin Exp Rheumatol 2006 Keen HI et al. Can ultrasonography improve on radiographic assessment in osteoarthritis of the hands? A comparison between radiographic and ultrasonographic detected pathology. Ann Rheum Dis 2007 Iagnocco A et al. High resolution ultrasonography in detection of bone erosions in patients with hand osteoarthritis. J Rheumatol 2005 Iagnocco A. Imaging the joint in osteoarthritis: a place for ultrasound? Best Pract Res Clin Rheumatol 2010 Filippucci E et al. Interobserver reliability of ultrasonography in the assessment of cartilage damage in rheumatoid arthritis. Ann Rheum Dis 2010 Möller B et al. Measuring finger joint cartilage by ultrasound as a promising alternative to conventional radiograph imaging. Arthritis Rheum 2009 Aisen AM et al Sonographic evaluation of the cartilage of the knee. Radiology 1984 Iagnocco A et al Sonographic evaluation of femoral condylar cartilage in osteoarthritis and rheumatoid arthritis. Scand J Rheumatol 1992 Naredo E et al Ultrasound validity in the measurement of knee cartilage thickness. Ann Rheum Dis 2009 Filippucci E et al. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthritis Cartilage 2009 Disclosure of Interest None Declared

BackgroundIxekizumab is a high-affinity monoclonal antibody that selectively targets interleukin-17A and is indicated for psoriasis, psoriatic arthritis (PsA) and axial spondyloarthritis.Literature highlights efficacy and safety in real life in patients affected by psoriasis[1], instead little are data concerning PsA.[2]ObjectivesTo retrospectively evaluate the effectiveness and safety of ixekizumab, in a cohort of patients with PsA.MethodsPatients with a diagnosis of PsA and treated with ixekizumab who visited our outpatient clinic from October 2019 to December 2022 were included in the study. Clinical data were recorded since the first prescription of ixekizumab and at 6-month follow-up visit. Demographic, clinical and laboratory characteristics, treatment, and causes of discontinuation were analyzed. Differences between baseline and 6-months erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tender joint count (TJC) and swollen joint count (SJC) were analysed.ResultsMain results are reported on Table 1. 76 patients were included in the study, with an average age at the prescription of ixekizumab (T0) of 57.1±13.0 years.Main comorbidities were: hypertension (44.7%), obesity and overweight (44.7%), cardiopathy (19.7%), hepatic steatosis (21.0%), diabetes (13.2%), and hyperlipemia (3.9%). 93.42% of patients presented peripheral arthritis, 30.6% axial involvement, and 42.1 % enthesitis.28,9% of patients were biologic-naïve, 34,0% received one biologic agent before, and 31.5% two or more biologic agents. 88,2% of patients initiated ixekizumab in combination with a csDMARDs, mainly methotrexate.The indications for the prescription of ixekizumab as a first biologic agent were: multiple comorbidities, severe psoriasis, and intolerance to csDMARDs.28.9% of patients stopped ixekizumab because of primary failure (31.8%), secondary failure (22.7%), or adverse events (45.5%). 40% of the adverse events were relevant skin reactions at the injection site. No severe adverse events were registered.60 patients completed 6 months of treatment (T6). In those patients, a statistically significant decrease between the SJC and TJC at baseline and T6 was found (p-value 0.0011 and 0.0006 respectively). No difference in the values of ESR and CRP values between T0 and T6 was present.ConclusionThere are few data in real life concerning efficacy and safety in patients affected by PsA. In our cohort, ixekizumab significantly improved peripheral arthritis, and it revealed a good safety profile, without severe adverse events during the follow up. Further real-life evaluations on axial involvement, which was not included in this study, are warranted.References[1]Malagoli P. et al. Real life long-term efficacy and safety of ixekizumab in moderate-to-severe psoriasis: A 192 weeks multicentric retrospective study-IL PSO (Italian landscape psoriasis). Dermatol Ther. 2022[2]Manfreda V. et al. Efficacy and safety of ixekizumab in psoriatic arthritis: a retrospective, single-centre, observational study in a real-life clinical setting. Clin Exp Rheumatol. 2020Table 1.General characteristics of our cohort and clinical and laboratory findings at baseline and follow-up for patients who completed 6 months of treatment with ixekizumab.Male/female n. (%)22 (28.9%)/54 (71.1%)Mean age at diagnosis (years)50.0Years from diagnosis at the first prescription of ixekizumab (years)6.7Patients: n. 60T0T6p-valueESR (mm/h)27.44±23.327.56±22.20.9741CRP (mg/dl)1.58±2.470.98±1.70.1569TJC9.17±6.985.02±6.650.0011SJC1.57±2.750.28±0.640.0006Acknowledgements:NIL.Disclosure of InterestsElisa Bellis Consultant of: Bristol-myers Squibb Srl - Temas, Grant/research support from: Pfizer, DENISE DONZELLA: None declared, Gloria Crepaldi Speakers bureau: Eli-Lilly, BMS, Consultant of: Galapagos, Janssen, Valeria Data: None declared, Marinella Gammino: None declared, Valeria Guardo: None declared, Claudia Lomater Speakers bureau: Eli-Lilly, Janssen, Formedica, Bristol-myers, Elena Marucco: None declared, Marta Saracco: None declared, Annamaria Iagnocco Speakers bureau: Abbvie, MSD, Alfasigma, Celltrion, BMS, Celgene, Eli-Lilly, -Sanofi Genzyme, Pfizer, Galapagos, Gilead, Novartis, SOBI, Janssen, Consultant of: Abbvie, MSD, Alfasigma, Celltrion, BMS, Celgene, Eli-Lilly, -Sanofi Genzyme, Pfizer, Galapagos, Gilead, Novartis, SOBI, Janssen, Grant/research support from: Pfizer, Abbvie.

To systematically review the role of ultrasound (US) in the assessment of the joint-enthesial-nail apparatus in patients with psoriatic arthritis (PsA) or psoriasis (PSO) in terms of prevalence, diagnosis, prognosis, monitoring and treatment. A systematic literature review was conducted through medical databases (PubMed, Embase) and the grey literature up to February 2018. The main areas of application of nail US were first identified, allowing the development of research questions, which were rephrased following the PICOs methodology to develop inclusion criteria. Of the 585 studies produced by PubMed and Embase searches, 17 studies met the criteria for inclusion. Five additional studies were included: 1 from the hand search and 4 from the 2016–2017 ACR and EULAR congresses. The prevalence of nail plate changes varied from < 10 to 97%, for power Doppler signal from 20–30 to 96% and distal interphalangeal joint (DIJ) involvement from 8.9 to 100%. The performance of US nail/DIJ abnormalities in the diagnosis of PsA and PSO elementary lesions was analysed by five studies, with a wide heterogeneity. Reproducibility and reliability of US nil/DIJ were assessed by interclass correlation coefficient or Cohen’s k and their values ranged from 0.6 to 0.9. The value of US nail/DIJ in the monitoring of the lesions was analysed only by a single study. The analysis revealed applications for US nail/DIJ in PsA and PSO and highlights limitations. Validation is strongly needed to demonstrate its appropriateness in the clinical practice and to define its diagnostic and prognostic role.