Ageing may be defined as the deteriorative changes with time during post maturational life that underlie an increasing vulnerability to challenges and thereby decrease the ability to survive. Theories of ageing are multiple and can be divided into two major groups according to whether ageing is viewed as genetically predetermined (the biological clock), or as a response to random events over time; genetic ageing models are either adaptive or non-adaptive, while random event models focus on DNA, molecular, system or whole body approaches. A number of attempts have been made to distinguish structural and functional ageing changes from specific system based age related disease. Most longitudinal studies suggest a clustering of system based dysfunction, in individuals. Musculoskeletal ageing is a key contributor to the development of physical frailty, disability and dependency in later life. The three major musculoskeletal disorders associated with advancing age are osteoporosis, OA and sarcopenia. Lifecourse epidemiological studies have addressed age related change in bone density; cartilage structure and function; and muscle mass and strength. Environmental influences operating throughout life including nutrition and physical activity, are implicated in the pathogenesis of each of these three disorders. Contrasts can be made between the delineation of biomarkers; risk stratification approaches; and the availability of interventions; all of which have been developed for osteoporosis, but which are currently in evolution for OA and sarcopenia. These intermediary markers of disease risk, and approaches to alteration of risk, will be discussed in detail. Disclosures: C.C., Servier, MSD, Amgen, GSK/Roche, Alliance, Novartis, Eli Lilly, Medtronic—Consultancy/Lecture Fees. Disclosures: The authors have declared no conflicts of interest.

Background The utility of ultrasound in combination with the clinical examination (CE) for the evaluation of inflammatory arthritis is used in routine clinical practice. The assessment of hand osteoarthritis (HOA) is known to be challenging and clinical examination alone may underestimate co-existing soft-tissue pathologies. Corticosteroids (CS) injections are used for symptom modification in OA, however their efficacy in HOA is unknown.Furthermore the response to CS injections in patients may vary due to the clinician injecting an unaffected site or failing to inject all affected sites. Objectives To determine if the knowledge of an US scan influences clinical decision making in the planning of sites for targeted CS injections in HOA involving the carpometacarpal joint with other co-existing pathologies. Methods 34 consecutive HOA patients (31 female, 3 male) with a mean ± SD age of 61.2±9.4 years were recruited. These patients were initially diagnosed with symptomatic HOA involving the CMC joint and agreed to targeted CS injections. All patients had 2 independent assessments of their symptomatic hand, an US scan undertaken by a principal physiotherapist (MB) trained in sonography and a routine CE by an advanced physiotherapy practitioner (LF). Subsequently the patients were randomised into two groups GA and GB for targeted interventions. In GA, the physiotherapy practitioner (LF) performed a CE and was then given the US scan results prior to treatment. In GB US scans were made available after treatment had been initiated. The sites identified for CS injections were recorded along with rate of treatment decision changes based on US results before and after treatment. Results A possible 65 CS injection sites were identified by US (GA=42 sites and GB=23 sites) and 45 sites by CE (GA=24 sites and GB=21 sites).The clinician reported at least one change in the anticipated treatment plan of CS injections in 25 (74%) of 34 patients with only complete agreement in 9 patients.In GA 9 (45%) patient’s treatment plan was changed due to the influence of the US scan results. There were 11 sites changed in total with 5 sites added (1 joint, 1 median nerve, 3 De Quervains). In GB 9 (64%) patient’s treatment plan would have changed if the scan results were available. This would have involved 17 sites comprising of 10 additional sites identified (3 joints, 4 nerves, 3 soft tissue structures), 7 sites would have been removed (4 joints, 3 soft tissue). The actual injections to be performed were/would have been changed by the clinician in a total of 28/45 sites. Conclusions This study shows that findings from the US scan did influence the clinical decision making in the management of symptomatic HOA using targeted CS injections hand. US assessment did identify additional pathologies undetected by routine clinical examination relating to soft tissue structures especially De Quervains tenosynovitis and carpal tunnel syndrome. Disclosure of Interest M. Brandon: None Declared, L. Friel: None Declared, S. Budai: None Declared, R. Madhok: None Declared, D. Turner Grant/Research support from: ARUK 17832, J. Woodburn: None Declared

Background: Children and young adults with JIA have increased levels of poor oral hygiene and dental decay [1].Periodontitis and types of arthritis are linked by similar components of blood cytokine profiles.Good dental health can be directly affected in JIA patients due to physical limitations in upper limb movements making brushing and flossing teeth difficult.An important factor in oral care is good dental hygiene and access to dental health practitioners.NHS advice is that all children should be reviewed by a dentist annually and be offered both sealant of their teeth and fluoride varnish at the appropriate time.Our aim was to establish if our patients had any barriers to accessing dental care.Methods: All patients (age 18 and under) diagnosed with JIA in the paediatric rheumatology clinic over a period of 3 months were asked to complete a dental care questionnaire.Parents completed the questionnaire for their children if necessary.Data were analysed using Excel.Results: 30 questionnaires were completed.Demographics were M:F 1:1.3, all children were diagnosed with JIA, average age 10.5 years with range 2-18.27 children were registered with an NHS dentist with the exception of one child with a private dentist.26 children had seen a dentist at least annually and one child in the past 2 years. 2 children, one aged 16, were not registered with a dentist because their parents didn't think it was important.11 children had 25 fillings in total, 9 of these children were not supervised during dental hygiene.13 children admitted to drinking sugary drinks daily and had 16 dental fillings.None of the children admitted to smoking.Conclusions: Whilst our audit showed that most children were registered with a dentist and were reviewed annually, only 1 child had been offered sealant and fluoride varnish.The NHS advises that children with chronic medical conditions can be seen either by their NHS dentist or by the local Community specialist dental service which can be accessed by referral from their rheumatology department or NHS dentist.None of the children were seen by the specialist dental service.We have developed an information leaflet informing parents and children with JIA of the importance of dental health explaining the benefits of both sealant and fluoride for teeth.

Background: Cases series suggest joint hypermobility (JH) is a risk factor for musculoskeletal pain in childhood, but this has not been supported by epidemiological studies. However, the latter have largely comprised small samples, and prospective data based on large cohorts are lacking. We aimed to exploit the Avon Longitudinal Study of Parents and Children (ALSPAC), a unique birth cohort, to determine whether joint hypermobility (JH) in childhood is a risk factor for the subsequent development of musculoskeletal pain. Methods: JH was determined by Beighton score at age 13.8 years in ALSPAC, using a cut-off of >6. Musculoskeletal pain was evaluated by questionnaire at age 17.8 years. Logistic regression analysis was performed in 2901 participants (1267 boys and 1634 girls) with complete data. Results: 4.6% of participants were hypermobile at age 13.8 years. Moderately troublesome musculoskeletal pain at age 17.8 was reported most commonly at the lower back (16.1%), upper back (8.9%), neck (8.6%), shoulder (9.5%), knee (8.8%) and ankle/foot (6.8%). JH was associated with an increased risk of at least moderately troublesome musculoskeletal pain at the shoulder (1.68; 1.04, 2.72), knee (1.83; 1.10, 3.02) and ankle/foot (1.82; 1.05, 3.16) (OR with 95% CI, adjusted for gender, maternal education and BMI). An equivalent relationship was not observed at other sites including the spine, elbows, hands and hips. In analyses examining interactions with obesity, associations between JH and knee pain showed higher ORs in obese participants (1.6 and 11.0 in non-obese and obese participants, respectively, P = 0.04 for obesity interaction). Conclusions: JH represents a risk factor for musculoskeletal pain in adolescence, comprising a specific distribution namely the shoulder, knee and ankle/foot. These relationships were strongest in the presence of obesity, consistent with a causal pathway whereby JH leads to pain at sites exposed to the greatest mechanical forces. Disclosures: The authors have declared no conflicts of interest.