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Objective Several prediction models for rapid radiological progression (RRP) in the first year of rheumatoid arthritis have been designed to aid rheumatologists in their choice of initial treatment. The association was assessed between RRP and disability and joint damage progression in 8 years. Methods Patients from the BeSt cohort were used. RRP was defined as an increase of ≥5 points in the Sharp/van der Heijde score (SHS) in year 1. Functional ability over 8 years, measured with the health assessment questionnaire (HAQ), was compared for patients with and without RRP using linear mixed models. Joint damage progression from years 1 to 8 was compared using logistic regression analyses. Results RRP was observed in 102/465 patients. Over 8 years, patients with RRP had worse functional ability: difference in HAQ score 0.21 (0.14 after adjustment for disease activity score (over time)). RRP was associated with joint damage progression ≥25 points in SHS in years 1–8: OR 4.6. Conclusion RRP in year 1 is a predictor of worse functional ability over 8 years, independent of baseline joint damage and disease activity. Patients with RRP have more joint damage progression in subsequent years. RRP is thus a relevant outcome on which to base the initial treatment decision.

Both osteoporotic fractures and cardiovascular events can be devastating events, which are more commonly in the elderly. This could be related to some risk factors that play a role in the pathogenesis of both events: postmenopausal estrogen deficiency, smoking, immobility and low-grade inflammation. A systematic review on the association of cardiovascular diseases and osteoporosis in the general population will be mentioned. The relationship between osteoporotic fractures and cardiovascular events could be even stronger in patients with systemic inflammatory diseases such as RA or AS. Finally, it will be discussed whether in patients with a recent cardiovascular event, it is useful to screen for underlying osteoporosis, and whether in patients with a recent fracture, cardiovascular risk factors should be determined.Disclosure of InterestNone declared

Fragility fractures in women and men older than 50 years are among the most frequent musculoskeletal manifestations for which patients consult healthcare workers from more than one medical specialty. Immediately following a fracture, the patient needs acute fracture care, supplied by an orthopaedic or trauma surgeon. This is followed in a later phase by subsequent fracture prevention in patients identified at high risk for a subsequent fracture, usually under the responsibility of rheumatologists or other bone disease experts. Thus, at a local level, a close collaboration between these specialities is necessary. Both the European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) have recognised the importance of optimal fracture care and prevention of subsequent fractures in high-risk patients and have therefore collaboratively initiated this recommendation.The recommendations will be discussed during the meeting. Some overarching principles that play a crucial role in the recommendations are:–especially in the frail elderly with a major fracture, an orthogeriatric and multidisciplinairy approach in an in-hospital setting is warranted, to avoid complications, delirium, and prevent increased morbidity and mortality–optimal care in the preoperative, operative and postoperative phase has an important effect on clinical outcome. As a consequence, it is very likely that limited mobility and a low quality of life in the postoperative phase may have an elevated risk of future fractures.–for prevention of subsequent fractures, it is important that in all patients fracture risk will be investigated systematically, including DXA, imaging of the spine, fall risk evaluation and screening for secondary osteoporosis.–for subsequent prevention of fractures in high risk patients, not only effective and safe drugs should be prescribed, but non-pharmacological treatment options and patient education are also crucial.Disclosure of InterestNone declared

In this post-hoc analysis of a randomized, double blind, placebo controlled trial, we measured the sensitivity and specificity of Helicobacter pylori IgG-antibody titer changes, hematoxylin and eosin (H&E) stains, immunohistochemical (IHC) stains and culture results in NSAID using patients, following H. pylori eradication therapy or placebo. 347 NSAID using patients who were H. pylori positive on serological testing for H. pylori IgG-antibodies were randomized for H. pylori eradication therapy or placebo. Three months after randomization, gastric mucosal biopsies were taken for H. pylori culture and histological examination. At 3 and 12 months, blood samples were taken for repeated serological testing. The gold standard for H. pylori infection was based on a positive culture or both a positive histological examination and a positive serological test. Sensitivity, specificity and receiver operating curves (ROC) were calculated. H. pylori eradication therapy was successful in 91% of patients. Culture provided an overall sensitivity of 82%, and 73% after eradication, with a specificity of 100%. Histological examination with either H&E or IHC stains provided sensitivities and specificities between 93% and 100%. Adding IHC to H&E stains did not improve these results. The ROC curve for percent change in H. pylori IgG-antibody titers had good diagnostic power in identifying H. pylori negative patients, with an area under the ROC curve of 0.70 (95 % CI 0.59 to 0.79, P = 0.085) at 3 months and 0.83 (95% CI 0.76 to 0.89, P < 0.0001) at 12 months. A cut-off point of at least 21% decrease in H. pylori IgG-antibody titers at 3 months and 58% at 12 months provided a sensitivity of 64% and 87% and a specificity of 81% and 74% respectively, for successful eradication of H. pylori. In NSAID using patients, following H. pylori eradication therapy or placebo, histological examination of gastric mucosal tissue biopsies provided good sensitivity and specificity ratios for evaluating success of H. pylori eradication therapy. A percentual H. pylori IgG-antibody titer change has better sensitivity and specificity than an absolute titer change or a predefined H. pylori IgG-antibody titer cut-off point for evaluating success of H. pylori eradication therapy.