OBJECTIVES:This study aimed to develop consensual definitions and semiquantitative scoring for structural damage on ultrasound and to test the reliability of individual components of a global Outcome Measures in Rheumatology ultrasound joint damage score (GLODS) in rheumatoid arthritis (RA). METHODS:A Delphi survey including statements on normal ultrasound appearance of joint features, scanning technique, new definitions, and scoring systems for 3 components of structural damage (bone erosions, cartilage change, and joint malalignment) was circulated among task force members. After agreement (≥75% of grades 4-5 on a 1-5 Likert scale) was achieved on the statements, datasets of ultrasound images representing various grades of the above-mentioned structural damage components were created and used in 2 web-based exercises. Finally, the metacarpophalangeal joints 1 to 5 of 7 patients with RA were scanned with ultrasound, twice on the same day by 7 task force members for detecting and scoring the 3 components using the consensus-based semiquantitative GLODS. Intraobserver and interobserver reliability of the new scoring system was measured by weighted kappa. RESULTS:Agreement on a total of 9 statements was reached in 4 Delphi rounds. Intraobserver and interobserver reliability for the individual components ranged from good to excellent in both the web-based (0.72-0.97) and the live exercises (0.68-0.89). Intraobserver and interobserver reliability of the total GLODS was shown to be excellent (0.92) and good (0.69), respectively. CONCLUSIONS:Ultrasound is a reliable tool for evaluating bone erosions, cartilage change, and joint malalignment in the hand joints of patients with RA. These features can be reliably integrated into a global ultrasound score.

Musculoskeletal ultrasound (MSUS) is a well-established and reliable tool for the evaluation of entheses and enthesitis, particularly at larger and accessible sites. Recent technological advances, including high- and ultra-high-frequency transducers, have expanded its potential, enabling detailed assessment of distal extremity entheses. This narrative review provides a focused and updated perspective on this evolving field, highlighting three key advances. First, the identification and characterization of previously underrecognized entheseal sites in the distal extremities, such as pulley systems, retinacula, novel tendon insertions, and collateral ligaments, broadening the morphological spectrum of entheseal imaging. This is complemented by improved evaluation of vascularization through microvascular imaging and contrast-enhanced US (CEUS). Second, the emergence of interventional approaches, particularly US-guided entheseal biopsy, offers a novel means to investigate entheseal tissue in vivo and may establish a link between imaging and histopathology. Third, the integration of advanced functional imaging modalities, including elastography and multispectral optoacoustic tomography (MSOT), provides preliminary additional insights into the biomechanical and molecular properties of the enthesis beyond conventional structural assessment. Collectively, these developments support new investigational perspectives, positioning MSUS as a dynamic and integrative modality capable of exploring new anatomical territories and biological dimensions, with the potential to reshape the understanding and evaluation of entheseal involvement in rheumatology.

Interstitial lung disease (ILD) is one of the most important extra-articular manifestations of rheumatoid arthritis (RA) due to its associated significant mortality. The availability of pharmacological treatments capable of slowing its progression, especially when initiated early, makes early diagnosis an essential part of its management. The low sensitivity of chest X-ray or lung function tests to identify RA-ILD in the early stages of the disease, together with the cost, accessibility, and ionizing radiation limitations of high-resolution computed tomography (HRCT), especially when serial screening or follow-up studies are required, has prompted the study of lung ultrasound (LUS) as an additional aid for the screening, diagnosis, and/or follow-up of RA-ILD. Based on the safety, low cost, and accessibility of LUS, and the encouraging results of research into this technique in ILD associated with systemic sclerosis, progress has been made in its validation process with research addressing aspects such as its accuracy, feasibility, and reliability. Negative predictive value and sensitivity values exceeding 80–90% have been reported, suggesting its potential utility. Feasibility has been suggested since LUS scan can be performed in less than 10 minutes, and intra- and inter-observer or examiner reliability shows values in the good to excellent range. However, there are still aspects that require further investigation, such as the standardization of the LUS scanning protocol or the requirements to ensure an effective learning curve before applying the technique in clinical practice. It is necessary to recognize the inherent limitations of LUS and understand that it should be considered a tool to aid in the early identification of patients who require HRCT, which is currently the diagnostic gold standard.

Objectives To provide a comprehensive description of a standardised, landmark-based ultrasound (US) technique for evaluating the lateral costotransverse (LCTL), supraspinous (SSL) and iliolumbar (ILL) ligaments of the thoracolumbar spine and to assess its reliability, feasibility and its potential applicability in spondyloarthritis (SpA).Methods LCTL, SSL and ILL were examined using US in specimens, followed by dissection to confirm structure location and validate US findings using a standardised anatomic-based and sonoanatomic-based landmark approach. The US technique was subsequently applied in 20 healthy controls (HC), in whom feasibility and inter-rater and intra-rater reliability among four operators with different expertise were assessed. Ligament visualisation was scored as: 0, not visualised; 1, incompletely visualised; 2, perfectly visualised. The technique was tested in three patients with SpA to evaluate its applicability.Results Anatomical study confirmed location and landmarks for all three ligaments. 120 ligaments were assessed in two rounds in HC. Visualisation scores ranged from 1 to 2 in 100% LCTL, 99.1% SSL and 85.9% ILL, with score 2 obtained in 69.6% of 960 assessments. Mean examination time decreased from 12′17″ to 10′56″ between rounds, with no significant differences between operators. Intra-rater and inter-rater agreement ranged from moderate to high. In patients with SpA, US detected both inflammatory and structural lesions in the three ligament entheses.Conclusion The proposed standardised US approach allows reliable assessment of LCTL, SSL and ILL. This technique provides a robust and reproducible method for evaluating the ligaments of the thoracolumbar spine and opens a new approach to the US assessment of patients with spinal inflammatory diseases, including SpA.

Background/Objectives: The objective of this study is to investigate the intra- and inter-explorer reliability of different lung ultrasound (LUS) scores in patients with suspected rheumatoid arthritis with associated interstitial lung disease (RA-ILD). Methods: Fourteen consecutive patients with suspected RA-ILD based on the presence of respiratory symptoms, lung function tests (LFTs) or imaging alterations were recruited. The screening protocol consisted of an LFT, a chest X-ray, and HRCT. LUS examinations of different B-line and pleural line scores including 14 intercostal spaces were performed by three experienced sonographers, guaranteeing blinding. Intra- and inter-explorer reliability were calculated for all LUS scores and at the intercostal space level by weighted Cohen’s kappa and Fleiss’ kappa, respectively, relying on absolute differences using Stata/IC 14.2 software® (StataCorp, College Station, TX, USA). Results: Both global (ĸ = 0.73–0.82) and binary (ĸ = 0.80–0.90) scores of B lines showed substantial to excellent intra-explorer reliability, with slightly better results for the binary score. The inter-explorer reliability was equally excellent for the global score (ĸ = 0.93) and the binary score (ĸ = 0.90) of B lines. The intra-explorer reliability of the semiquantitative pleural score was excellent for all the sonographers (ĸ = 0.88–0.91), and the binary pleural score had slightly lower intra-explorer reliability (ĸ = 0.77–0.84). Regarding inter-explorer reliability, both semiquantitative and binary pleural scores were equally excellent (ĸ = 0.84). Good to excellent inter-explorer reliability was found in all the scanned areas. Conclusions: Substantial to excellent intra- and inter-explorer reliability of different feasible B-line and pleural LUS scores were found, adding evidence in favor of the potential implementation of LUS for RA-ILD diagnosis in clinical practice.

Objectives To develop an EULAR training model for education in synovial tissue biopsy (STB) under ultrasound guidance (UG) following a stepwise approach: (1) development of educational material on UGSTB in large and small joints; (2) assessment of the validity, reliability and feasibility of the UGSTB educational procedure on cadaveric specimens; (3) validation of this procedure in live patients.Methods Using a nominal group (NG) and a DELPHI consensus methodology, educational audio-visual (AV) material and minimal requirements for education in UGSTB were developed by an expert panel. Then the experts performed an UGSTB on cadaveric joints using the developed approach. The samples retrieved from the cadaveric joints were confirmed histologically and the procedure was then tested by a group of ultrasonographers with different expertise for feasibility and face validity. The AV material and the practical procedures’ phases were subsequently ranked by the experts to finalise the training model for performing UGSTB in patients. The ST retrieved in patients was assessed for tissue quality.Results Based on NG and DELPHI processes, educational material and a stepwise standardised cadaver-based training model were developed. The knee was the cadaveric joint with the highest yield of histologically good quality of ST. 90% of the UGSTB from patients showed synovial membrane and 77% intact lining layer.Conclusions This EULAR endeavour provided a consensus-based comprehensive educational material and a practical cadaver-based model for training in UGSTB, which has shown feasibility and validity in tissue acquisition in specimens and patients.

We read with great interest the article titled "A Proposal for a New Lung Ultrasound Score in Rheumatoid Arthritis: The Reliability of Lung Ultrasound for Rheumatoid Arthritis-Associated Interstitial Lung Disease Diagnosis" [...].

To examine the effect of discovery learning on musculoskeletal ultrasound (MSUS) performance and to explore how expert learners engage in a collaborative learning environment. Experts in MSUS participated in a discovery learning session where they were divided into groups. Each participant had one attempt to solve the same MSUS case and could seek assistance from other group members or learning resources. The video-recorded sessions were analyzed using both quantitative and qualitative methods. Performance was assessed using the validated Objective Structured Assessment of Ultrasound Skills (OSAUS) tool (1–5 points per item), and an outcome score was calculated based on the number of correct MSUS images (0–4). Participants’ comfort and perception of discovery learning were evaluated using a 5-point Likert scale questionnaire. 28 MSUS experts from 13 different countries completed the study. The mean OSAUS score (standard deviation) was 3.96 (0.5), and the mean outcome score was 1.89 (0.9). Using Pearson’s correlation coefficient, we found a significant correlation between the OSAUS score and the outcome score (0.72, p < .001). The qualitative analysis revealed that the experts used actions associated with adaptive expertise and that social hierarchy persisted in the collaborative learning environment. Finally, we found high comfort with and acceptance of the discovery learning approach. Discovery learning may be an effective teaching strategy for future advanced MSUS courses, including international Teach-the-Teachers courses. Since social hierarchy was present, a facilitator is necessary during collaborative training.

The interpretation of lung ultrasound (US) is the result of the analysis of artifacts, rather than exact representations of anatomical structures, which appear when changes in the physical properties of the lung occur. Its application to the study of interstitial lung disease (ILD) associated with autoimmune diseases has aroused great interest in the last 10 years, as evidenced by a growing number of publications studying its usefulness in the diagnostic process, as a prognostic marker, and as an aid in monitoring of patients. The main elements in lung US interpretation in ILD are the B lines and the changes in the pleural line. B lines are vertical artifacts that are generated when there is a partial decrease in the air content of the lung parenchyma and/or the volume of the interstitial area expands. Pleural line alterations that can be seen are irregularities, thickening, fragmentation, or subpleural nodules. Both the B lines and the changes in the pleural line have shown a significant positive correlation with the evidence on chest computed tomography (high-resolution computed tomography [HRCT]) of ILD associated with autoimmune diseases, with sensitivity and negative predictive values of up to 100%. These results, together with the safety, accessibility, and low cost of lung US, support this imaging technique as a promising screening method for optimizing the indication for HRCT. The role of lung US regarding sensitivity to change needs further investigation with multicenter prospective studies.

Novel mechanisms of COVID-19 vaccines raised concern about their potential immunogenicity in patients with rheumatoid arthritis (RA) undergoing immunomodulatory treatments. We designed a retrospective single-center study to investigate their effectiveness and safety in this population, analyzing data from the first vaccination program (December 2020–October 2021). Inclusion criteria were availability of post-vaccination serology and a minimum subsequent follow-up of 6 months. Binding antibody units (BAU/mL) ≥ 7.1 defined an adequate serological response. Post-vaccine COVID-19 incidence and its timing since vaccination, adverse events (AEs), and RA flares were recorded. Adjusted logistic and linear multivariate regression analyses were carried out to identify factors associated with vaccine response. We included 118 patients (87.2% women, age 65.4 ± 11.6 years, evolution 12.0 ± 9.6 years), of whom 95.8% had a complete vaccination schedule. Adequate humoral immunogenicity was achieved in 88.1% of patients and was associated with previous COVID-19 and mRNA vaccines, whereas smoking, aCCP, age, and DMARDs exerted a negative impact. Post-vaccine COVID-19 occurred in 18.6% of patients, a median of 6.5 months after vaccination. Vaccine AE (19.5%) and RA flares (1.7%) were mostly mild and inversely associated with age. Our results suggest that COVID-19 vaccines induce adequate humoral immunogenicity, with an acceptable safety profile in RA patients.

Background Point-of-care musculoskeletal (MSK) ultrasound (US) courses are typically held in-person. The COVID-19 pandemic guidelines forced courses to switch to online delivery. To determine this impact, we conducted an observational cohort study, comparing homework completion and image quality between an Online and a historical In-person cohort. Methods The In-person (n = 27) and Online (n = 24) cohorts attended two learning sessions spaced six months apart. The course content was the same, while the process of delivery differed. As homework, participants submitted US images biweekly for up to five months after each session. Expert faculty provided written feedback to all participants, and two independent reviewers rated the image quality for a subset of participants in each group who had completed at least 70% of their homework (In-person, n = 9; Online, n = 9). Participants self-reported their satisfaction through post-course evaluation. Results 63% of In-Person and 71% of Online cohort participants submitted their homework images. We observed no differences in the mean amount of homework images submitted for In-person (M = 37.3%, SD = 42.6%) and Online cohorts (M = 48.1%, SD = 38.8%; p > 0.05, Mann-Whitney U Test). At course end, the cohorts did not differ in overall image quality (p > 0.05, Wilcoxon Signed-rank Test). All participants reported high levels of satisfaction. Conclusions A convenience sample of participants attending a basic MSK US course in-person and online did not differ statistically in homework completion, quality of submitted US images, or course satisfaction. We add to literature suggesting online learning remains a viable option post-pandemic.

Objectives Digital annular pulleys (DAPs) are important anatomical structures for finger function. The anatomy, histology and imaging assessment of DAPs, particularly at the level of their entheses, are still not clearly defined. The advent of high-frequency US transducers opened new perspectives in evaluating submillimetre-scale structures, such as pulleys, paving the way for their global assessment. The study aimed to characterize DAPs from an anatomical, histological and US perspective, focusing on the detection and complete description of pulley entheses.Methods US assessment and gross anatomy dissection were conducted on 20 cadaveric hands to study DAP thickness and structure, including enthesis identification. The results of the US and anatomical measurements were correlated. DAP entheses identified by US were characterized via histological analysis. DAPs in 20 healthy controls (HCs) were detected and measured by US. The A1, A2 and A4 DAP entheses were assessed using a new dynamic manoeuvre to better evaluate those structures.Results A total of 1200 DAPs (400 cadaveric, 800 HCs) were analysed. The cadaveric study demonstrated strong correlation between anatomical and US measurement of DAPs (r = 0.96). At the histological level, DAP entheses at the volar plate, sesamoid bones or phalangeal ridges contained fibrous and fibrocartilaginous tissue. US assessment of A1, A2 and A4 DAPs in HCs allowed the identification of 718/720 (99.73%) entheses.Conclusion US is an effective tool to detect and study DAPs. DAP entheses reveal both fibrous and fibrocartilaginous characteristics. A newly described manoeuvre to optimize DAP enthesis visualization enhances their detection by US.

Arthritis & RheumatologyVolume 75, Issue 4 p. 639-640 Letter The ultrasonographic pseudo–double contour sign in calcium pyrophosphate deposition disease: an anatomic explanation and how to distinguish it from gout Georgios Filippou, Georgios Filippou [email protected] orcid.org/0000-0002-1647-2083 Department of Rheumatology, IRCCS Istituto Ortopedico Galeazzi, Milan, ItalySearch for more papers by this authorMaribel Miguel-Pérez, Maribel Miguel-Pérez Unit of Human Anatomy and Embryology Department of Pathology and Experimental Therapeutics Faculty of Medicine and Health Sciences, University of Barcelona Bellvitge Campus, Barcelona, SpainSearch for more papers by this authorLuis Coronel, Luis Coronel Instituto Poal de Reumatologia, University of Barcelona and Vall d'Hebron Hospital, Barcelona, SpainSearch for more papers by this authorSilvia Sirotti, Silvia Sirotti orcid.org/0000-0001-9795-131X Department of Clinical Science and Community Health, Università Degli Studi di Milano, Milan, ItalySearch for more papers by this authorGiovanni Pacini, Giovanni Pacini orcid.org/0000-0001-5355-0071 Division of RheumatologyDepartment of Experimental and Clinical Medicine Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, ItalySearch for more papers by this authorAnna Scanu, Anna Scanu Department of Women's and Children's Health, University of Padova, Padova, ItalySearch for more papers by this authorDavid Bong, David Bong Faculty of Medicine and Health Sciences, University of Barcelona Bellvitge Campus and Instituto Poal de Reumatologia University of Barcelona, Barcelona, SpainSearch for more papers by this authorIngrid Möller, Ingrid Möller Faculty of Medicine and Health Sciences, University of Barcelona Bellvitge Campus and Instituto Poal de Reumatologia University of Barcelona, Barcelona, SpainSearch for more papers by this authoron behalf of the EULAR Study Group on Anatomy for the Image, the EULAR Study Group on Anatomy for the ImageSearch for more papers by this author Georgios Filippou, Georgios Filippou [email protected] orcid.org/0000-0002-1647-2083 Department of Rheumatology, IRCCS Istituto Ortopedico Galeazzi, Milan, ItalySearch for more papers by this authorMaribel Miguel-Pérez, Maribel Miguel-Pérez Unit of Human Anatomy and Embryology Department of Pathology and Experimental Therapeutics Faculty of Medicine and Health Sciences, University of Barcelona Bellvitge Campus, Barcelona, SpainSearch for more papers by this authorLuis Coronel, Luis Coronel Instituto Poal de Reumatologia, University of Barcelona and Vall d'Hebron Hospital, Barcelona, SpainSearch for more papers by this authorSilvia Sirotti, Silvia Sirotti orcid.org/0000-0001-9795-131X Department of Clinical Science and Community Health, Università Degli Studi di Milano, Milan, ItalySearch for more papers by this authorGiovanni Pacini, Giovanni Pacini orcid.org/0000-0001-5355-0071 Division of RheumatologyDepartment of Experimental and Clinical Medicine Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, ItalySearch for more papers by this authorAnna Scanu, Anna Scanu Department of Women's and Children's Health, University of Padova, Padova, ItalySearch for more papers by this authorDavid Bong, David Bong Faculty of Medicine and Health Sciences, University of Barcelona Bellvitge Campus and Instituto Poal de Reumatologia University of Barcelona, Barcelona, SpainSearch for more papers by this authorIngrid Möller, Ingrid Möller Faculty of Medicine and Health Sciences, University of Barcelona Bellvitge Campus and Instituto Poal de Reumatologia University of Barcelona, Barcelona, SpainSearch for more papers by this authoron behalf of the EULAR Study Group on Anatomy for the Image, the EULAR Study Group on Anatomy for the ImageSearch for more papers by this author First published: 25 October 2022 https://doi.org/10.1002/art.42397Citations: 1 Supported and funded by the Italian Ministry of Health: Ricerca Corrente. Author disclosures are available at https://onlinelibrary.wiley.com/action/downloadSupplement?doi=10.1002%2Fart.42397&file=art42397-sup-0001-Disclosureform.pdf. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Supporting Information Filename Description art42397-sup-0001-Disclosureform.pdfPDF document, 2.2 MB Disclosure Form art42397-sup-0002-Video.movQuickTime video, 11.4 MB Video S1: Supplementary Video Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Reference 1Gutierrez M, Schmidt WA, Thiele RG, et al. International consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise. Rheumatology 2015; 54: 1797–805. 2Zhang Q, Gao F, Sun W, et al. The diagnostic performance of musculoskeletal ultrasound in gout: a systematic review and meta-analysis. PLoS One 2018; 13:e0199672. 3Neogi T, Jansen TL, Dalbeth N, et al. 2015 gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 2015; 67: 2557–68. 4Filippucci E, Gutierrez Riveros M, Georgescu D, et al. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease: an ultrasound study. Osteoarthritis Cartilage 2009; 17: 178–81. 5Adinolfi A, Picerno V, Di Sabatino V, et al. Inquiry is fatal to certainty–is the ultrasonography double contour sign specific for uric acid-induced arthritis? Arthritis Rheum 2013; 65: 1952. 6Ogdie A, Taylor WJ, Neogi T, et al. Performance of ultrasound in the diagnosis of gout in a multicenter study: comparison with monosodium urate monohydrate crystal analysis as the gold standard. Arthritis Rheumatol 2017; 69: 429–38. 7Löffler C, Sattler H, Peters L, et al. Distinguishing gouty arthritis from calcium pyrophosphate disease and other arthritides. J Rheumatol 2015; 42: 513–20. 8Filippou 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 Dis 2018; 77: 1194–9. 9Filippou G, Scanu A, Adinolfi A, et al. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann Rheum Dis 2021; 80: 261–7. Citing Literature Volume75, Issue4April 2023Pages 639-640 ReferencesRelatedInformation

BackgroundStructural damage in rheumatoid arthritis (RA) includes bone erosion, cartilage change, and joint malalignment; historically evaluated with conventional radiography. Ultrasound (US) has been shown to be a valid tool for evaluating both cartilage change and bone erosion.ObjectivesTo obtain agreement on definitions and develop semiquantitative scoring systems for assessing structural damage by US and to validate these in a web-based reliability exercise.MethodsA Delphi survey of statements was prepared by an OMERACT US Working Group task force (USWG) based on a previously published systematic literature review (1) and circulated between group members, including definitions on normal US appearance of joint components, definitions of elementary lesions and scoring systems for bone erosions and joint malalignment. Definitions and a US scoring system for scoring cartilage change were recently developed and validated by the USWG (2) After agreement was achieved (≥75% of grades 4-5 on 1-5 Likert scale) on the statements, still images of metacarpophalangeal and proximal interphalangeal joints 2-5 in healthy controls and in RA patients with varying degrees of pathology were acquired by the USWG members. A dataset of 100 anonymized images, representing various grades of the 3 components of structural damage was created and utilized in 2 rounds of a web-based exercise. Intra- and inter-reader reliability of the scoring systems was assessed by kappa statistics.Results19 USWG members needed 4 Delphi rounds to reach agreement on a total of 9 statements. 4/12 statements were approved in the first, 2/6 in the second, 1/5 in the third and 2/2 in the fourth round. Final scoring systems and representative images are shown in Table 1 & Figure 1. 22 members participated in the web-based reliability exercise. The intra-reader reliability was almost perfect for bone erosion (kappa: 0.87) and cartilage change (kappa: 0.83) and substantial for malalignment (kappa of 0.72). The inter-reader reliability was almost perfect for bone erosion (kappa: 0.85), and substantial for cartilage change (kappa: 0.79) and malalignment (0.62).Table 1.Final definitions of scoring systems of elementary lesions of structural damage in rheumatoid arthritisAgreementBone erosionA 4-grade semiquantitative scoring system can be used to score erosions as follows: grade 0. intact cortical bone; grade 1. single small erosion (diameter: ≤2mm); grade 2. single large erosion (diameter: >2mm) or 2 small erosions; grade 3. 2 large erosions or ≥3 erosions, regardless of size. Both longitudinal and transverse scans should be considered, and the largest measure chosen for each erosion.100%Cartilage changeA 3-grade semiquantitative scoring system can be used to grade hyaline cartilage change as follows: grade 0. normal cartilage; grade 1. minimal change: focal thinning or incomplete loss of cartilage; grade 2. severe change: diffuse thinning or complete loss of cartilage.80% (2)MalalignmentA 3-grade semiquantitative scoring system can be used to grade malalignment as follows: 0. normal alignment; 1. subluxation or partial dislocation, where the two bone endings are malaligned so that one bone ending is dislocated from its normal position, but still within the articulation; 2. luxation or total dislocation, where the luxated bone ending moves beyond the articulation and the opposing bone ending. Bone position may be compared with a contralateral or similar intact joint if available.94%Figure 1.Representative images of the scoring systems for bone erosion (A), cartilage change (B) and malalignment (C)ConclusionThis first attempt to create a composite US instrument based on scoring systems encompassing all aspects of structural damage, demonstrates that US is a reliable tool for evaluating and scoring bone erosion, cartilage change and malalignment in the finger joints of RA patients.References[1]Gessl I, et al. Semin Arthritis Rheum. 2021 Jun;51(3):627-39.[2]Mandl P, et al. Rheumatology (Oxford). 2019 Oct 1;58(10):1802-11.Disclosure of InterestsPeter Mandl Speakers bureau: AbbVie, Janssen, Lilly, Novartis, Consultant of: AbbVie, Janssen, Lilly, Novartis, Grant/research support from: AbbVie, BMS, Novartis, Janssen, Lilly, MSD, UCB, Irina Gessl: None declared, Georgios Filippou: None declared, Silvia Sirotti: None declared, Lene Terslev Speakers bureau: Novartis, Pfizer, UCB, Janssen, GE, Carlos Pineda: None declared, Helen Keen Speakers bureau: Roche, AbbVie, Janssen, Consultant of: Sanofi, Marina Backhaus: None declared, David Andrew Bong: None declared, Edoardo Cipolletta: None declared, PAZ COLLADO: None declared, Christian Dejaco Speakers bureau: Roche, AbbVie, Sanofi, Lilly, Pfizer, Novartis, Janssen, Galapagos, Consultant of: Roche, AbbVie, Sanofi, Lilly, Pfizer, Novartis, Janssen, Galapagos, Andrea Delle Sedie Speakers bureau: Abbvie, Amgen, Lilly, MSD, Novartis, UCB, Paid instructor for: Abbvie, Amgen, Lilly, MSD, Novartis, UCB, Consultant of: Abbvie, Amgen, Lilly, MSD, Novartis, UCB, Christina Duftner: None declared, Hilde Berner Hammer: None declared, Annamaria Iagnocco: None declared, Zunaid Karim: None declared, Ingrid Möller Speakers bureau: Bristol-Myers Squibb, Ibsa, Pfizer, Galapagos, Esperanza Naredo Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Janssen, Celgene GmbH, Paid instructor for: Novartis, Consultant of: Novartis, Lilly, Grant/research support from: Lilly, Pfizer, Wolfgang A. Schmidt: None declared, Marcin Szkudlarek: None declared, Giorgio Tamborrini: None declared, Priscilla C Wong: None declared, Emilio Filippucci Speakers bureau: AbbVie, Amgen, Bristol -Myers Squibb, Janssen-Cilag, Lilly, Novartis, Pfizer, Roche, Union Chimique Belge Pharma, Peter Balint Speakers bureau: Abbvie, Janssen, Lilly, Novartis, Maria-Antonietta D’Agostino: None declared

El propósito de esta revisión es presentar los principales aspectos del componente genético de las enfermedades reumatológicas autoinmunes, incluyendo las características del modelo de herencia multifactorial o poligénico y sus formas monogénicas, así como los principales genes asociados en ambos casos. De igual manera, los cambios epigenéticos implicados, además de la influencia del ambiente y el sexo para conferir mayor riesgo a las mujeres de padecer alguna de estas enfermedades. Finalmente, se comenta acerca de los avances logrados por el estudio de las ciencias ómicas, abriendo camino a una nueva clasificación molecular de estas enfermedades, y así dirigirlo a una medicina personalizada. Se revisó la literatura de los últimos 5 años de publicaciones en lengua inglesa mediante la base de datos PubMed, se incluyeron 28 artículos de revisión y 19 artículos originales. Se discutió el papel de los factores genéticos que participan en la etiología de las enfermedades reumatológicas autoinmunes, gracias a la disponibilidad de estudios moleculares, lo que permite mayor comprensión de la fisiopatología y la posibilidad de realizar en un futuro cercano un diagnóstico y tratamiento basado en marcadores moleculares.The purpose of this review is to present the main aspects of the genetic component of autoimmune rheumatic diseases, including the characteristics of the multifactorial or polygenic inheritance model, and its monogenic forms, as well as the main associated genes in both cases. The epigenetic changes involved, and the influence of the environment and sex that confer greater risk to women suffering from any of these diseases. Finally, to make known the advances that the study of omic sciences has allowed, opening the way to a new molecular classification of these diseases, aimed at personalized medicine. A review of the literature of the last 5 years, of English-language publications, in the PubMed database was performed and 28 review articles, and 19 original articles were included. Knowledge of the genetic factors involved in the aetiology of autoimmune rheumatic diseases, thanks to the availability of molecular studies, allows a better understanding of their pathophysiology and the possibility of diagnosis and treatment based on molecular markers in the future.

Abstract The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.

The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.

The hamstring muscle complex (HMC) are the “brakes” of human bipedal ambulation and are susceptible to injury during concentric contraction. Although common in sports medicine practice, a recent systematic review of severe hamstring injuries (grade II-III) suggests that greater than 10% of these severe injuries are non-sports related and disproportionately affect older women. Musculoskeletal ultrasound (MSKUS) is one of the basic imaging techniques utilized to detect and define these injuries and eliminate other potential causes of posterior thigh pain. This presentation will discuss the clinical application of MSKUS of the HMC in rheumatology/musculoskeletal medicine and offer a systematic anatomically-based method of examining this important non-articular region. Disclosure of Interests: None declared