Background:Inhibitors of CTLA-4 and PD-1 have shown improvements in survival in multiple advanced cancers. Immune-mediated effects such as arthralgias and arthritis have been described, but their prevalence and characteristics have not been well defined.Objectives:The objective of the study is to describe the prevalence of immunomediated joint manifestations (IJM), its characteristics and evolution in patients who received immunotherapy (nivolumab (NV), pembrolizumab (PB)) from January 1, 2016 to December 31, 2018 in our center.Methods:Data collection was performed at through the RPT (Registre Pacients Tractats) database of the CatSalut, and the patients referred to the monographic medical office of inflammatory joint diseases of our center. In all cases, the variables: age, sex, neoplasia, drug, number of doses, were recorded. In patients with joint involvement: other autoimmune manifestations, joint affectation prior to treatment, delay rheumatology derivation, joint affectation type, swollen and tender joint counts, ESR, CRP, RF, ACPA, ANA, HLA B 27, Hb, leukocytes, neutrophils, lymphocytes, treatment and evolution, were recorded. The statistical analysis was carried out with the SPSS 15.0 computer packageResults:106 patients received treatment (TTO) with immunotherapy (71 NV, 35 BP) for neoplasia (81 lung, 10 renal, 8 melanoma, 2 oropharynx). The mean age was 67.93 ± 10.7 years (21.7% women, 78.3% men). There were 11 events cataloged as IJM. The overall prevalence was 10.3% (5.6% NV, 14.3% PB). Patients with IJM received a greater number of doses (17.67 ± 9.3 vs9.24 ± 10.1 p = 0.018). No patient with melanoma presented IJM. All IJM suspicions cases were assessed by a rheumatology. When studying their characteristics (Table 1), 3 patients were added from the database of the rheumatology service (14 cases). They received in a clinical trial BP29541 (rectal cancer), Atezolizumab (lung cancer) and Durvalumab (lung cancer). 42.9% of the patients presented inflammatory arthralgias (IAT) and 57.1% arthritis (AT). In reference to their previous history, 2 patients had a history of hyperuricemia and arthritis. One patient concomitantly presented lymphocytic colitis confirmed by biopsy. The delay time for assessment by rheumatology was 18.1 ± 22.1 days. Patients with AT were older (p = 0.014), had higher ESR (p = 0.047) than those with IAT. No differences were found in other variables (table1). With reference to the analytical study, 1 patient was RF +, 2 ANA + at mean titers (1/160-1/320), none ACPA or HLA B 27 +. After assessment by rheumatology, two patients with IAT were diagnosed with bone M1 and two AT were categorized as gouty arthritis. The rest of the IAT responded to NSAIDs, did not require corticosteroids and were resolved. 6 cases of AT received prednisone, 3 required treatment dose 1 mg/kg weight and subsequently MTX in 2 of them, with evolution to low disease activity at present. Only one patient met RA classification criteria.Conclusion:The prevalence of IJM was higher than 10%, depending on the number of...
Background:Inflammatory myopathies (IM) are a group of rare diseases that involve muscle inflammation. Several types are defined with a wide range of different manifestations and prognosis.Objectives:Describe the characteristics of the cohort of patients with IM in a tertiary hospital, in order to identify their demographic and clinical characteristics and try to find a correlation between them.Methods:Retrospective observational study of patients with IM: dermatomyositis (DM), polymyositis, antisynthetase syndrome (ASS), necrotizing autoimmune myopathy and overlap syndrome (OS). Clinical, biological, neurophysio and histopathological data were collected. Statistical analysis was performed using SPSS 23 IBM®.Results:28 patients were included with a follow-up of 10.9 ± 9.8 years (y). According to the 2017 EULAR / ACR criteria for IM, 89.2% were classified as definitive MI, with an average score of 12.1 ± 3.2. Age at diagnosis 47.3 ± 17.7y; ratio 1.3; 78.6% Caucasian, 10.7% Asian and 10.7% Latino. 39.3% had DM, 3.6% hypomyopathic and 3.6% amyopathic DM, 28.6% OS and 17.9% ASS. Lung involvement was the most prevalent extramuscular manifestation (67.9%). Systemic sclerosis was the most frequent overlapping autoimmune disease (AD) (21.4%) and 2 patients (7.1%) overlapped more than 1 AD. In Table 1 are detailed the clinical characteristics of the patients, and in Figures 1 and 2, the autoantibody (aa) profile and treatments used. The incidence of neoplasm was 10.7% 10.3 ± 9.6y after the diagnosis of myopathy (3 breast neoplasms, 1 colon and 1 cutaneous lymphoma), and of them, 66.7% had two synchronous neoplasms. No neoplasms were observed in the 2 anti-TIF1-γ+ patients. The subtype of IM in these patients was 1 OS anti-RNP+, 1 DM anti-PL-12+ and 1 ASS anti-OJ+. 17.9% smoked and 21.4% had taken statins at some point, without it being related to the start of the myopathic clinic. A capillaroscopy was performed in 67.9%, being pathological in 63.1%The positivity of anti-RNP (p=0.01) and steroid bolus (p=0.039) were correlated with a more severe disease, defined as a summation index composed of a series of manifestations (pulmonary hypertension (PH), ischemic heart disease, venous/arterial thrombosis, myo/pericarditis, interstitial lung disease (ILD), severe infections, neoplasms or hospitalizations). Other statistically significant correlations between aa and clinical manifestations are detailed in Table 3, among which the anti-RNP+ with myopericarditis stands out. No correlation was found between the findings on capillaroscopy and the type of IM.Conclusion:The most frequent subtype of IM was DM. 10.3% of the patients presented a neoplasm, all with different subtypes of myopathy and aa. The presence of anti-RNP+ correlated with greater severity of the disease and myopericarditis. Likewise, significant differences were found between the subtypes of aa and certain clinical manifestations. There is no correlation between findings on capillaroscopy and the type of IM.Table 1.Clinical characteristics.Clinical manifestationsFrequency %PresentationAcute40.7Subacute22.2Insidious37Muscular Weakness82.1Muscle Enzymes Elevation85.7Muscle Pain67.9Joint Manifestations (Mf)67.9Systemic Mf67.9Digestive Mf46.4Raynaud’s Syndrome (RS)53.6Sclerodactyly32Digital ulcers (DU)25Calcinosis10.7ILD67.9Nonspecific Interstitial Pneumonia63.2Usual Interstitial Pneumonia15.8Organizing Pneumonia10.5Lymphocytic Interstitial Pneumonia5.3Undefined Pattern5.3PH10.7Serious Infections17.9Figure 1.Aa.Figure 2.Treatment.Table 2.Correlations between clinical manifestations and aa.ManifestationsAutoantibodiesp valueDUAnti-MDA50.005SclerodactylyAnti-RNP0.011PericarditisAnti-RNP0.000MyocarditisAnti-RNP0.005DiabetesAnti-RNP0.027RSAnti-PM/Scl0.033CalcinosisAnti-PM/Scl0.027Flexion ContracturesAnti-PM/Scl0.027ArrhythmiasAnti-PL-120.001Disclosure of Interests:Irene Carrión Barberà Grant/research support from: I received a grant from the Spanish Rheumatology Foundation (FER) and laboratories KERN PHARMA for a brief stay abroad., Ana Pros Simón: None declared, Tarek Carlos Salman Monte: None declared, Manel Ciria: None declared, Francisco Vílchez-Oya: None declared, Selene Labrada: None declared, Toni Meraz: None declared, Jordi Monfort: None declared
Background Changes associated with systemic sclerosis (SSc)can have a negative impact on sexuality and sexual functioning (1). In women, common problems reported include vaginal dryness and discomfort, painful intercourse, and reduced frequency and intensity of orgasms (3). Prevalence of erectile dysfunction in men with SSc appears to be substantial, however literature on sexual function in women with SSc is scarce (2) and prevalenceof sexual disorders in premenopausal women with this disease has not been studied. Objectives To estimate the prevalence of female sexual disorders in premenopausal women with SSc, and to compare it with healthy controls. Methods Descriptive observational study of the premenopausal women with SSc of our department of Rheumatology who agreed to participate. The questionnaires Female Sexual Function Index (FSFI) and Female Sexual Function Test were distributed among patients and healthy controls of similar demographics characteristics. Data were analyzed using SPSS v.15. Statistical tests applied were Mann-Whitney U test and Fischer test. Results 7SSc premenopausal women agreed to participate in the study and were compared with seven healthy controls. The mean age was similar in both groups (p 0.38), being 40.4 years (SD 3.5) in the scleroderma group and 37.8 (SD 6.7) among women in the control group. 57% of women with SSc showed a moderate sexual dysfunction, while in the control group this percentage was 0, however no significant differences were found (p = 0.07). The Sexual Function Index was lower in patients with SSc, being of 16.78 [95% CI 5.47-28.1] in this group, and 33.87 [95% CI 32.54-35.19] in the control group (p = 0.001). Conclusions Inour study, more than half of premenopausal women with SSc showed moderate sexual dysfunction, and Sexual Function Index was significantly higher in the group of healthy women. However, further studies with larger numbers of patients are needed to confirm these findings. References Ann Julie Impens and James R. Seibold, “Vascular Alterations and Sexual Function in Systemic Sclerosis,” International Journal of Rheumatology, vol. 2010, Article ID 139020, 5 pages, 2010. doi:10.1155/2010/139020 A. Schouffoer, J. van der Marel, M. M. Ter Kuile et al., “Impaired sexual function in women with systemic sclerosis: a cross-sectional study” Arthritis Care and Research, vol. 61, no. 11, pp. 1601–, 2009 Levis B, Burri A, Hudson M, Baron M, Thombs BD. “Rates and correlates of sexual activity and impairment among women with systemic sclerosis”, Arthritis Care & Research, Vol. 64, No. 3, March 2012, pp 340–350. DOI 10.1002/acr.20696 Acknowledgements We thankD.Osorio forthe statisticalanalysis. Disclosure of Interest: None Declared
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