Ab1005 the Unusual Adverse Events Including Multiple Sclerosis Developed Under Abatacept Therapy in a Patient With Jia

Abstract

BackgroundBiological therapy in patients with pediatric rheumatology disease may be associated with adverse events up to demyelinative lesion of CNS including multiple sclerosis (MS). It is a rare condition in the pediatric practice.Objectivesto describe the clinical case of newly diagnosed psoriasis and subsequently developing of multiple sclerosis in pediatric patient revealed in JIA who has been followed-up in Pediatric department of V.A. Nasonova Research Institute of Rheumatology for 8 years.MethodsDescription of clinical case of 13 y.o. male Caucasian pts presented with polyarthritis variant of juvenile idiopathic arthritis (JIA) since 2006.ResultsThe first symptoms (at the age of 1,5) were polyarthritis with fever, morning stiffness and inflammatory activity in laboratory tests in chronological link of DTP – re-vaccination. The patient admitted to the regional hospital where JIA was diagnosed and he received traditional therapy including NSAIDS, methotrexate, numerous of intraarticular injections, methylprednisolone pulse therapy with initial response. By the 2012 the child deteriorated with progressive polyarthritis, deformation of wrist joints, bilateral camptodactylia with progressive destruction on X-ray. Under the administration of abatacept therapy in our clinic in 2012 the significant improvement (70-90% ACR response) was achieved. 2 years later the plaque psoriasis developed. The cutaneous changes were impaired by the regular local application of GC so infusions of abatacept were continued. In 4th years of regular therapy (in the age of 13) sudden neurological symptoms such as headache, loss of sensitivity, ataxia, visual field defect appeared. He was admitted to neurological clinic. Multiple sclerosis was diagnosed based on the presenting signs and symptoms supporting cranial MRI – multiple focal areas of demyelination.ConclusionWe presented a patient with JIA who developed two different immunological related adverse events under long-term abatacept using: psoriasis “de novo” appeared as a native origin of juvenile arthritis and CNS – multiple sclerosis. This is the first case of developing MS under the abatacept therapy among the 1118 pts (2002-2018) who receive biological therapy in our clinic.Disclosure of InterestsNone declared