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A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual-emission x-ray absorptiometry and scintigraphy. Experts applied research evidence obtained from systematic literature reviews using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendations (SOR) was assessed by taskforce members using a visual analogue scale. A total of 7550 references were identified in the search process, from which 158 studies were included in the systematic review. Ten recommendations were produced using research-based evidence and expert opinion encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis. The SOR for each recommendation was generally very high (range 8.9–9.5). These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities. We aimed to produce recommendations that are practical and valuable in daily practice for rheumatologists, radiologists and general practitioners.

Background:The ankle is a frequently affected joint in rheumatic & musculoskeletal diseases in both young and older populations, resulting in pain, limited mobility, and decreased quality of life[1]. UltraSound (US) is particularly suited for evaluating soft tissue structures, including the joint capsule, tendons and ligaments and is used for diagnosis and monitoring of patients with both inflammatory rheumatic diseases and degenerative joint disease[2].Objectives:To investigate and identify different pathologies of soft tissue lesions and synovitis of the ankle and foot in patients presenting with foot and ankle complaints using US and their functional impact.Methods:A cross-sectional, multicenter observational study on consecutive patients who are attending the rheumatology outpatient clinics of Medical Unviersity of Vienna and Benha University Hospitals due to ankle or foot pain or swelling. All patients were subjected to clinical and ultrasound examination of the ankle and foot. Sonographic evaluation was performed for the joints of both ankles, forefoot, mid foot and hind foot for the presence of synovitis on gray scale (GS), power Doppler (PD), erosions (GS) and osteophytes (GS). The tendons and ligaments of Anterior, medial, lateral and posterior compartments were evaluated for the presence of tenosynovitis and/or tendon damage on GS and PD. Ankle or foot pain and disability were assessed by Foot Function Index (FFI)[3].Results:A total of 200 ankles and feet were examined in 100 patients with mean age of 41 years. 65% of cases were females and 35% of cases were males. The majority of cases had a diagnosis of Rheumatoid Arthritis (RA) (34%), followed by SpondyloArthritis (SpA) (23%) and (16%) of cases were undiagnosed. Most of patients (25%) presented with swelling at right ankle joint while (80%) of patients presented with tenderness at the fore-foot area. US examination revealed that joints were more affected than tendons and ligaments of different compartments of ankle and foot. Metatarsophalangeal (MTPs) joints were the most common affected joints (83%) followed by talonavicular (TNJ) joint (63%), subtalar joint (46%) and tabiotalar joint (TTJ) (35%). Achilles tendon was the most commonly affected tendon followed by tibialis posterior tendon. Anterior-inferior tabio-fibular ligament (ATIFL) ligament was the most commonly affected ligament (28%). Among different cases, the most common involved joint by US in RA patients were MTPs, while in SpA patients; Achilles tendon was the most commonly involved tendon. There were significant association between clinical and US findings in tabiotalar (p<0.001), MTPs (p<0.001) joints and achillis tendon (p<0.001) whereas no significant association between clinical and US findings in the remaining joints, tendons and ligaments. Regarding functional assessment, We found a significant correlation between synovitis in US of most of MTPs joints and pain and disability in FFI (p<0.001).There were significant correlation between the presence of synovitis and erosions in naviculo-cuniform joint and pain and disability in FFI (p=0.004), also between the presence of synovitis in talonavicular joint and pain and disability in FFI (P=0.005).Conclusion:Ultrasound is an essential tool in identifying different pathologies of the ankle and foot as well as clinical examination due to their complicated anatomy. It clearly distinguish between synovitis, tenosynovitis, enthesitis and ligament injury. Ankle and foot pathologies have a significant impact on patients’ function and disability, and they should be evaluated accurately using US.REFERENCES:[1] Brockett CL, Chapman GJ. Biomechanics of the ankle. Orthopaedics and Trauma. 2016; 30:232–238.[2] De Maeseneer M, Marcelis S, Jager T, Shahabpour M, Van Roy P, Weaver J, et al. Sonography of the normal ankle: a target approach using skeletal reference points. AJR Am J Roentgenol 2009;192:487–495.[3] Carter K, Lahiri M, Cheung PP, Santosa A, Rome K. Prevalence of foot problems in people with inflammatory arthritis in Singapore. Journal of Foot and Ankle Research, 2016:9, 37.Acknowledgements:NIL.Disclosure of Interests:None declared.

Reflecting the perceived need for developing evidence-based recommendations on the use of imaging of the joints in the clinical management of spondyloarthritis (SpA) a European League Against Rheumatism (EULAR) convened a task force comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries. The objectives of the task force were to formulate key clinical research questions relating to the role of imaging in both axial and peripheral SpA, to identify and critically appraise the available evidence, and to generate recommendations based on both evidence and expert opinion. Evaluated imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed-, positron emission- and single photon emission computed tomography, dual-emission x-ray absorptiometry and scintigraphy. Twelve research questions were generated using a process of discussion and consensus and a total of three systematic literature searches of articles were performed using MEDLINE and EMBASE databases. In addition the abstract archives of relevant international rheumatology and radiology meetings as well as the bibliographies of included papers were hand searched for evidence of other studies for inclusion. Titles and abstracts of all citations identified were screened, and potentially relevant articles were reviewed in full text using predetermined inclusion and exclusion criteria. A total of 7550 references were identified in the search process, from which 158 studies were finally included in the systematic reviews. Quality assessment of the included studies was performed using the QUADAS-2 tool. The results were presented to the taskforce members who then developed 10 recommendations, encompassing the full spectrum of imaging in making a diagnosis of axial or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis. The strength of each recommendation (SOR) was assessed by the taskforce members using a visual analogue scale and was generally very high (mean 8.9-9.5). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6280

Imaging tools may help diagnose, monitor and treat diseases earlier. Imaging biomarkers have unique advantages and limitations compared to other biomarkers. They provide information on the exact site of the disease, are relatively non-invasive and allow follow-up. However unlike biospecimens or physiological measurements, the quality and validity of imaging measurements as biomarkers commonly depends on the use and technical characteristics of the diagnostic imaging device, and in some cases also on the expertise of the operator as well. Moreover, for many imaging biomarkers, standardisation of acquisition and analysis as well the identification of objectively measured characteristics poses additional concerns. Nonetheless imaging biomarkers have the potential to detect and monitor rheumatic diseases as well as predict response to treatment. In order to qualify, an imaging biomarker has to be accurate, reproducible, standardized and suitable for multicenter evaluation and needs to demonstrate correlation with either anatomy/pathology or with other imaging modalities. Furthermore, in order to be used as a predictive biomarker, it needs to be closely linked to the success or failure of the therapeutic effect and with the clinical outcome relevant to the disease. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6322

Background:A bidirectional relationship exists between rheumatoid arthritis (RA) and mood and anxiety disorders, which may influence outcomes in inflammatory arthritis. In addition, subjective illness perception was also reported to be associated with patient reported outcomes longitudinally independently of inflammation.Objectives:To assess the association of depression, anxiety and illness perception with subjective and objective signs of inflammation in patients with RA and assess a clustering of the patients according to these variables.Methods:Patients with RA fulfilling the 2010 classification criteria were recruited consecutively from the outpatient clinic and asked to complete questionnaires reporting symptoms of depression (9-question Patient Health Questionnaire, PHQ-9), anxiety (Beck Anxiety Inventory, BAI) as well as illness perception (brief Illness Perception Questionnaire, bIPQ). Patients underwent physical examination and musculoskeletal sonography of 22 hand- and finger joints. The clinical disease activity index (CDAI) was calculated and signs for sonographic inflammation were assessed using the EULAR-OMERACT grading system. Pearson correlations were calculated between the PHQ-9, BAI, bIPQ and PD and GS score as well es items of the CDAI. Clusters based on subjective and objective signs of the disease activity as well as depression, anxiety, illness perception and VAS pain were built via k-means clustering.Results:We included 55 patients with a mean CDAI of 17.0 ± 12.8. Symptoms of at least mild depression was recorded in 63.0% and symptoms of anxiety in 23.1%. The tender joint count (TJC) was significantly associated with depression and the bIPQ (r=0.48, r=0.45) but not with anxiety. PGA as well as EGA were associated with depression (r=0.50, p<0.001; r=0.46, p<0.001), anxiety (r=0.30, r=0.28) and illness perception (r=0.58, r=0.33). None of the assessed psychiatric symptom scales, nor illness perception was was associated with swollen joint count (SJC). The PD and GS scores were associated with SJC (r=0.42, r=0.63) but not with depression, anxiety or illness perception (Table 1). The cluster analyses revealed 3 clusters (1,2,3). No significant difference was found among the clusters regarding SJC (1: 2.0±1.4, 2: 2.8±3.1, 3: 3.5±4.5, p=0.76). Mean CDAI of the patients corresponded to moderate disease activity (1: 14.5±6.3, 2: 12.1±10.1) and high disease activity (3: 24.4±14.). While the difference between objective (SJC, EGA) and subjective (TJC; PGA) signs of disease activity in cluster 1 and 2 were small (tender-swollen joint count difference (TSJCD): 1.0±0.0 and 0.7±4.8, respectively), we did find a discrepancy between subjective and objective markers in cluster 3 (TSJCD: 7.7±6.1, PGA 6.6±2.8 vs. EGA 3.0±2.1). Cluster 1 and 2 differed regarding anxiety (1: 51.0±21.2, 2:5.4±5.3)), illness perception (1: 3.5±0.7, 2: 40.7±11.2) and pain (1: 8.0±0.0 vs. 2: 3.8±2.6). (Figure 1)Conclusion:Illness perception, anxiety and depression were associated with subjective signs of disease activity (TJC, PGA) but interestingly also with EGA. The identification of 3 clusters differing regarding the discrepancies in subjective and objective signs of disease activity as well as anxiety, depression and illness perception underscores the complexity to be taken into account in targeted patient care. These results serve as the basis for future studies exploring the association of baseline psychiatric comorbidities and illness perception with treatment response rates and outcome.Table 1. Correlation of symptoms of depression and anxiety, illness perception, power Doppler and grey scale score with tender joint count (TJC), swollen joint count (SJC), PGA (patient global assessment), EGA (evaluator global assessment) and power Doppler and grey scale score.Figure 1.A. Results of the cluster analyses. B. Graphical representation of the results of the cluster analyses. BAI: Beck’s anxiety index, BIPQ: brief Illness perception questionnaire, EGA: evaluator global assessment, PGA: patient global assessment, SJC: swollen joint count, TJC: tender joint count, TSJCD: tender-swollen joint difference.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Ultrasound is an imaging technique widely used in patients with rheumatic and musculoskeletal diseases (RMDs) to detect signs of inflammation and structural damage. Factors such as nomenclature, definitions of ultrasound-detected pathologies, scoring systems and technical issues may affect the validity and generalisability of results of ultrasound studies in RMDs. These aspects, along with critical design characteristics, are often suboptimally reported in current ultrasound studies. A few years ago, a European Alliance of Associations for Rheumatology (EULAR) taskforce published a 23-item recommendation checklist to ensure transparent and comprehensive reporting of ultrasound research [1].Objectives:To assess the implementation of the EULAR recommendation checklist since its development, and to compare ultrasound studies before and after the publication of the checklist.Methods:Web of Science Core Collection und SCOPUS databases were screened by a medical information specialist for citations for the checklist. The identified articles were evaluated by two independent reviewers for appropriate study type (original research) and content (ultrasound). Based on the identified articles which cited the checklist, a second set of articles, published before the checklist became available, was generated. Articles in the second set were randomly selected from a list of articles matched for topic and journal to those in the first set. A pre-defined sheet containing 47 components based on the original checklist was used to extract data from both sets of articles (before and after). Paired Student´s T-test was utilized to compare the number of checklist components between the two groups of articles.Results:A total of 24 articles cited the EULAR recommendation checklist. Of these 14 were excluded due to inappropriate study type (n:13 comment, viewpoint or review) or lack of use of ultrasound (n:1). The finally included 10 articles were matched to topic (10/10) and journal (8/10). Among the checklist components, those most frequently mentioned included ultrasound broad domain (100%), conflict of interest related to ultrasound (100%), objective (95%), participation consent (95%) and selection criteria (95%), ultrasound machine (85%) and ultrasound transducer (85%), while ultrasound software (0%), reliability of existing scoring system (0%), training of existing scoring system (0%), ultrasound exam duration (5%) or reliability of new scoring system (5%) were the least likely to be included in the articles (Table 1). The median number of checklist components included in the articles citing the checklist was significantly higher as compared to the matched articles published before the checklist was developed (median, interquartile range 31; 9.25 vs. 23; 7.25; p<0.001).Conclusion:Our data suggests that the recently developed EULAR recommendation checklist facilitates the transparent and comprehensive reporting of ultrasound in studies utilising this imaging modality in RMDs.REFERENCES:[1] Costantino F, Carmona L, Boers M, et al EULAR recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis 2021;80:840-847.Acknowledgements:NIL.Disclosure of Interests:Peter Mandl AbbVie, Janssen, AbbVie, Novartis, Janssen, Enrico De Lorenzis: None declared, Federico Giuseppe Lazzaro: None declared, Brigitte Wildner: None declared, Maria Antonietta D’Agostino: None declared.

Background:Rheumatic disorders often affect women in their childbearing age and are associated with various preconceptional and obstetrics complications. Immunological adaptations during pregnancy affects the course of autoimmune diseases, infections and might alter immunological response upon vaccinations. In the context of the SARS-CoV-2- pandemic, the question of vaccine efficacy in pregnant women suffering from rheumatic disease in comparison to healthy individuals became evident.Objectives:In the present study the acquired passive immunity of newborn of women suffering from rheumatic disease compared to healthy controls was explored. As reference to the newly established mRNA vaccines against SARS-CoV-2, passively acquired immunity was determined against conventional vaccines such as Varicella-Zoster-Virus and RubellaMethods:We recruited 36 pregnant women in their 3rd trimester of pregnancy between November 2021 and March 2022. The case group consisted of 11 pregnant women suffering from rheumatic disease and 25 healthy controls. Venous blood sampling was performed at the inclusion visit. Additionally, umbilical cord blood samples were collected postpartum. Antibody-titers were determined with Roche SARS-CoV-2 RBD ECLIA for SARS-CoV-2, and Kits by DiaSorin for VZV and Rubella in maternal and umbilical cord serum for both groups.Results:Antibody-titers against SARS-CoV-2 did not differ statistically significant between case and control group for both, maternal and umbilical cord serum. This shows that the vaccine against SARS-CoV-2 is equally effective during pregnancy for women suffering from rheumatic disorders as in healthy controls. Also, this case-control study was able to show that children born to women with rheumatic disease have robust passive maternal immunity. For Rubella, there was also no statistically significant difference for neither children nor women from either group. However, women suffering from rheumatic disease had significantly higher antibody-titers against VZV, which might be due to better preconceptional counseling and re-vaccination. This was also the case for the children, which is congruent with the detected higher maternal antibody titers. Maternal and umbilical cord serum antibody titers correlated positively in case of all detected antibodies, which suggests that that the titer in umbilical cord sera is dependent on maternal antibody- titers and not altered by the presence of the rheumatic disease.Conclusion:Vaccines during pregnancy are effective for women suffering from rheumatic disorders and their children (passive maternal immunity).REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:Antonia Puchner: None declared, Helene Ramspeck: None declared, Elisabeth Simader: None declared, Veronica Falcone: None declared, Valentin Ritschl: None declared, Peter Mandl: None declared, Stephan Blüml: None declared, Daniel Aletaha Abbvie, Amgen, Galapagos, Lilly, Janssen, Merck, Novartis, Pfizer, and Sandoz, Abbvie, Amgen, Galapagos, Lilly, Janssen, Merck, Novartis, Pfizer, and Sandoz, Abbvie, Amgen, Galapagos, Lilly, and Sanofi, Klara Rosta: None declared.

Background:Musculoskeletal ultrasound (MSUS) is widely regarded as a valuable tool for assessing the full extent of synovitis in patients with rheumatoid arthritis (RA). In recent decades, numerous global ultrasound scores have been developed, however the number of joints, and choice of MSUS modality or elementary lesion (e.g. grey-scale [GS]and/or Doppler [D], synovial effusion [SE] and/or synovial hypertrophy [SH], etc.) to be included remained questionable. Following a systematic literature review (SLR) published in 2010 [1] which highlighted the heterogeneity of MSUS definitions, scoring systems and number of joints scanned to evaluate synovitis burden in RA, the OMERACT US Working Group (WG) developed a global synovitis scoring system (GLOESS) at joint and patient level (joint set), with standardized and validated definitions and grading of synovitis which advocates the use of a combined GS and D score, and synovial hypertrophy, but not synovial effusion as the elementary lesions denoting synovitis [2].Objectives:To analyze the implementation and metric properties of the proposed GLOESS as scoring system to evaluate synovitis burden in RA.Methods:A SLR of Central, Embase and Medline databases was performed (31.3.2010 to 15.9.2023) by two independent reviewers updating our previous SLR [2]. Original research reports written in English which assessed the reliability, validity and sensitivity of global MSUS scoring systems in RA were included and data extracted using a predefined extraction sheet.Results:Of 1564 reports identified, 99 articles were included in the final review. The majority of global scoring systems were composed of semiquantitative grades of individual joints, quantitative grades were utilized in only 6/99 (6%) of studies, while a global score based on joints graded in binary fashion was investigated in 28/99 (28%) The joint set most commonly used was the 7-joint (wrist, metacarpophalangeal [MCP]2, MCP3, proximal interphalangeal [PIP]2, PIP3, metatarsophalangeal [MTP]2, MTP5 of the clinically more affected side) (15/99, 15%), and 12-joint (bilateral elbow, wrist, MCP2, MCP3, knee, ankle) (15/99, 15%), 22-joint (bilateral wrist, MCP1-5, PIP 1-5) (12/99, 12%) and 28-joint (bilateral shoulder, elbow, wrist, MCP 1-5, IP1, PIP 2-5, knee) sets (9/99, 9%), while more extensive sets were investigated more rarely. Regarding the consideration of SE or SH as signs of synovitis 40/99 (40%) considered only SH as proposed by the GLOESS, while 38/99 (38%) articles considered both – studies in the latter group were generally older as compared to the former. Regarding the use of a composite score (GS+D) this was evaluated in 22/99 (22%) studies, with the majority of studies evaluating the domains separately. All included studies assessed face and content validity, while 73/99 (73%) also assessed construct validity by comparison to clinical examination, laboratory findings or other imaging modalities. 34/99 (37%) evaluated responsiveness and 42/99 (42%) evaluated reliability. With regard to feasibility, time of evaluation varied from 15 to 60 min and tended to increase with the number of joints involved in the examination.Conclusion:MSUS can be regarded as a valuable tool for globally examining the extent of synovitis in RA. The adoption of GLOESS has a validated scoring system was clearly denoted in the more recently published articles, as well as the use of SH solely to define synovitis. Reduced joint counts are utilized more frequently than more extensive joint sets, especially for evaluating responsiveness.REFERENCES:[1] 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(9):2055-62.[2] D’Agostino MA et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardised, consensus-based scoring system. RMD Open. 2017;3(1):e000428.Acknowledgements:NIL.Disclosure of Interests:Peter Mandl Abbvie, Janssen, Abbvie, Janssen, Novartis, Clara Watschinger: None declared, Irina Gessl: None declared, Lene Terslev Janssen, Novartis and GE, Helen Keen: None declared, Carlos Pineda: None declared, Brigitte Wildner: None declared, Maria-Antonietta D’Agostino: None declared.

Background:Musculoskeletal ultrasound (MSUS) has established itself as a disease outcome measurement instrument over the last two decades and is now widely used in clinical practice and research. MSUS target domains, including consensual theoretical definitions of pathological processes (e.g. synovitis or structural damage), operational definitions of elementary lesions (e.g. synovial hypertrophy or bone erosions), acquisition standards and scoring systems developed as part of the Outcome Measures in Rheumatology (OMERACT) methodology, have been validated via a step-wise approach consisting of Delphi process to produce theoretical and operational definitions, and intra- and interobserver reliability exercises based either on still images or videos, or on live acquisition using patients or healthy subjects to test such theoretical agreement.Objectives:Evaluate factors influencing Delphi- and reliability exercises in MSUS for developing recommendations to standardize consensus and validation studies aiming at producing new scoring systems.Methods:A systematic search of the Central, Embase, and Medline databases was performed by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Original articles published in English up to September 2023, reporting on Delphi consensus studies and intra- and interobserver reliability exercises performed on adult patients or healthy subjects according to the OMERACT Ultrasound Working Group (US WG) methodology were included. Attributes of the consensus studies and reliability exercises were extracted from the included studies using a predefined sheet.Results:A total of 2744 articles were screened, and 25 were included in the final review. Of these, 15 reported on Delphi studies, while 25 reported on 33 reliability exercises (16 image-based and 17 patient-based). The majority of the Delphi studies included the target domains “elementary lesions” (87%) and scoring systems (73%) (Table 1). 86% of these studies consisted of up to 3 rounds, and 86% utilized ≥75% as a cut-off for reaching agreement among participants. The number of participants ranged from 13 to 49, with response rates between 68-100%. With respect to reliability exercises, the number of images used ranged from 23 to 152, the number of patients from 6 to 13 and the number of expert participants from 12-35 (image-based) and 9-19 (patient-based) (Figure 1). All but one exercise featured two rounds, and all of them assessed both intra- and interobserver reliability. A single exercise used various forms of kappa statistics, while another single exercise utilised an intraclass correlation coefficient to measure reliability. All but a single (97%) of reliability studies evaluated either elementary lesions and/or scoring systems. While 59% of patient-based reliability exercises featured a pre-training exercise, this was the case only in 6% of image-based exercises.Conclusion:The included Delphi consensus and reliability exercise studies focused on either elementary lesions or scoring systems. Variation was observed in the number of included expert participants, of images/patients utilized, and the integration of pre-training exercises. These results represent the first step by the US WG for producing recommendations to harmonise consensus and reliability studies in MSUS, the results of which will aid OMERACT groups and other researchers to develop and validate new definitions or scoring systems for imaging outcome measures.REFERENCES:NIL.Table 1. Key attributes of Delphi consensus studies in musculoskeletal ultrasound according to the OMERACT Ultrasound Working Group methodology. AC: acquisition standard, EL: elementary lesion; GD: global definition; NA: not available; SS: scoring systemFigure 1. Key attributes of intra-/interobserver reliability exercises in musculoskeletal ultrasound according to the OMERACT Ultrasound Working Group methodology. EL: elementary lesion; GD: global definition; NA: not available; SS: scoring systemAcknowledgements:NIL.Disclosure of Interests:Peter Mandl AbbVie, Janssen, AbbVie, Novartis, Janssen, Stine Maya Dreier Carstensen: None declared, Lene Terslev Janssen, Novartis and GE, Helen Keen: None declared, Carlos Pineda: None declared, Maria-Antonietta D’Agostino: None declared.

BackgroundThe increased availability of imaging techniques has led to their more extensive use in rheumatological practice. In the context of crystal-induced arthritis (CiA), evidence-based recommendations for their use are lacking.ObjectivesTo systematically assess current literature regarding the use of imaging in CiA.MethodsAfter the identification of the areas of interest and 14 research questions for the application of imaging in CiA, we performed 4 separate systematic literature searches (per disease and per indication) in Embase, Medline, and Central regarding the use of imaging for the diagnosis, monitoring and prediction of outcome and treatment effects of gout, calcium pyrophosphate dihydrate crystal deposition disease (CPPD) and basic calcium phosphate/hydroxyapatite crystal deposition disease (BCPD), as well as for guiding intra-articular procedures and patient education. Titles and abstracts were screened, the full-text of the eligible articles were reviewed and data of the included studies were extracted. Risk of bias was assessed validated instruments based on study type.ResultsThe overview of the included studies for each research question and imaging modality is shown in Table 1. For gout, out of 2915 studies, 88 studies were finally included (table 1, figure 1). The majority of diagnostic studies reported good to excellent (≥80%) sensitivity and specificity of DECT and US for diagnosis. Conventional radiographs (CR) and computed tomography (CT) showed high specificity but lower sensitivity in most studies. The majority of the follow-up studies showed a significant change of crystal deposition by US and DECT and inflammatory signs by US. An increase of structural damage was shown in some studies by CR and CT, mainly after a follow-up of at least 2 years. For CPPD, out of 687 studies, 50 studies were included (table 1, figure 1). Diagnostic studies on CR and US generally showed high specificity in all joints, in particular wrists and knees, while sensitivity was more variable, but generally high. There was a single study on monitoring, while 9 studies assessed the prognostic role of CPPD on CR and MRI in patients with OA, with contradicting results. Evidence on the application of DECT was scarce. For BCPD/HADD, out of 1389 abstracts, 55 studies were included (table 1, figure 1). There were 2 diagnostic studies, one on CR, reporting good performance, and one on MRI, with suboptimal performance. The utility of imaging in monitoring was assessed in 43 studies, mostly on CR and US of the shoulder, the majority reporting a reduction in the size of deposits, while 12 studies with contrasting results assessed the role of CR, US and MRI for prediction of treatment response. The search on patient education retrieved 254 studies, of which 2 could be included, which suggest a potential role of DECT in patient education. No studies on the role of imaging to guide procedures in CiA could be included in the final review (table 1, figure 1).ConclusionThe present SLR has provided background evidence for the development of EULAR recommendations on the use of imaging in CiA in clinical practice.Table 1.Overview of the included studies for each research question and imaging modality.Number of included studiesCRUSMRIDECTCTOther*Total**GoutRQ1- diagnosis7230283145RQ2- monitoring7121113030RQ3- prediction of outcome2000002RQ4- prediction of treatment effect0301003CPPDRQ5- diagnosis2326236044RQ6- monitoring1000001RQ7- prediction of outcome9000009RQ8- prediction of treatment effect0000000BCPDRQ9- diagnosis1110003RQ10- monitoring387000045RQ11- prediction of outcome0000000RQ12- prediction of treatment effect95100015IMAGING-GUIDED PROCEDURESRQ13- guiding aspiration0000000PATIENT EDUCATIONRQ14- patient education0002002* Sheer wave elastography**Some studies assessed multiple imaging modalitiesFigure 1.Flow chartREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.