OP0213 MYOFASCIA-DOMINANT: INFLAMMATION DETECTED ON WHOLE BODY MRI PREDICTS RAPIDLY PROGRESSIVE INTERSTITIAL LUNG DISEASE IN PATIENTS WITH DERMATOMYOSITIS
Authors: Kohei Karino, Michihiro Kono, Michihito Kono, Yuichiro Fujieda, Masaru Kato, Toshiyuki Bohgaki, Olga Amengual, Kenji Oku, Shinsuke Yasuda, Tatsuya Atsumi
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rapidly progressive interstitial lung disease (RPILD) is a major cause of death in patients with dermatomyositis (DM). Early diagnosis and aggressive immunosuppressive therapy are required in RPILD to improve the prognosis. Clinically amyopathic dermatomyositis (CADM) and anti-melanoma differentiation-associated gene 5 antibody are known as the risk factors for RPILD. However, 70% of the patients with CADM do not develop RPILD<sup>1</sup>. Whole-body magnetic resonance imaging (WB-MRI) can detect inflammation of whole muscle and myofascia. Although recent studies have indicated that MRI could be useful for assessing disease activity<sup>2</sup>, the relation between MRI findings and RPILD has not been investigated. <h3>Objectives</h3> In this study, we assessed whether WB-MRI findings are related with RPILD in patients with DM. <h3>Methods</h3> This retrospective study comprised 33 patients with DM who underwent WB-MRI in our hospital before the initiation of treatment for myositis. Muscular and myofascial signal abnormalities were scored on 42 muscular groups. The ratio of myofascial score to muscular score (myofascia/muscle ratio) was calculated and used to evaluate myofascia-dominant inflammation. RPILD was defined as the acute onset and rapid worsening of dyspnea, hypoxemia and radiographic ILD/fibrosis within 1 month. <h3>Results</h3> Of 33 patients, 16 were CADM, and 24 had ILD, including 8 patients with RPILD. All patients including CADM showed abnormal signal intensity in muscle and myofascia (scores median: 15 and 21, respectively). Muscle scores positively correlated with serum level of creatine kinase (r=0.672, p&lt;0.001). The patients with RPILD showed a significantly higher myofascia/muscle ratio compared with that in the non-RPILD patients (2.167 vs 1.000; p=0.018). Logistic regression analysis identified myofascia/muscle ratio &gt;1.53 (odds ratio: 141.90, p=0.042) and older age (odds ratio: 1.15, p=0.041) as independent risk factors for RPILD. <h3>Conclusion</h3> We newly defined myofascia-dominant inflammation using WB-MRI as a predictor to develop RPILD in patients with dermatomyositis. <h3>References</h3> [1] Moghadam-Kia S, et al. Anti-Melanoma Differentiation-Associated Gene 5 Is Associated With Rapidly Progressive Lung Disease and Poor Survival in US Patients With Amyopathic and Myopathic Dermatomyositis. Arthritis Care Res. 2016. [2] Malattia C, et al. Whole-body MRI in the assessment of disease activity in juvenile dermatomyositis. Ann Rheum Dis. 2014. <h3>Disclosure of Interests</h3> Kohei Karino: None declared, Michihiro Kono: None declared, Michihito Kono Grant/research support from: GlaxoSmithKline, Yuichiro Fujieda: None declared, Masaru Kato Grant/research support from: GSK, Actelion, Speakers bureau: GSK, Actelion, Bayer, Nippon Shinyaku, Eli Lilly, Chugai, Pfizer, Ayumi, Eisai, Asahi Kasei, Toshiyuki Bohgaki: None declared, Olga Amengual: None declared, Kenji Oku: None declared, Shinsuke Yasuda Grant/research support from: Bristol-Myers Squibb Co., Paid instructor for: GlaxoSmithKline, Speakers bureau: Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Tatsuya Atsumi Grant/research support from: Astellas Pharma Inc., Takeda Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co. Ltd., Otsuka Pharmaceutical Co., Ltd. and Pfizer Inc. Alexion Inc., Bayer Yakuhin, Ltd,Otsuka Pharmaceutical Co., Ltd. Chugai Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Eisai Co., Ltd., Bristol-Myers Squibb Co., Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma Co., Asahi Kasei Pharma Co., Consultant for: ONO PHARMACEUTICAL CO., LTD Sanofi K.K. Daiichi Sankyo Co., Ltd. Pfizer Inc., Speakers bureau: Mitsubishi Tanabe Pharma Co., Chugai Pharmaceutical Co., Ltd., Astellas Pharma Inc., Takeda Pharmaceutical Co., Ltd., Pfizer Inc.,Daiichi Sankyo Co. Ltd., Bristol-Myers Squibb Co., Eli Lilly Japan K.K.