THU0233 ASSOCIATION BETWEEN DEMYELINATING DISEASE AND AUTOINMMUNE RHEUMATIC DISEASE. A MULTIDISCIPLINARY EVALUATION
Authors: Sonia Peña Montelongo, González Plata Montserrat, Alicia García Dorta, Hernández Díaz Marta, Sagrario Bustabad, Rodriguez Lozano Beatriz
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Multiple sclerosis (MS) and neuromyelitis optica (NMO) are autoimmune disease which target is the mielina of the white substance of CNS. Presents alterations of the white substance observed in MRI, like hyperintense injuries in T2, in brain and/or the spinal cord. These injuries are unspecific; they can appear as regards to arterial hypertension or diabetes, thus the MS diagnosis will be established according to criteria of location and course of these injuries. The systemic autoimmune rheumatic diseases (SARD) may be presented by demyelination areas in the white matter of the brain and spinal cord, which are difficult to differentiate from MS and other demyelinating processes; but although most of CNS pathologic of the SARD are small vessels disease. On the other hand, it has been described in the MS positividad for ANA, antiphospholiped antibodies (aPL) and Anti-Ro52 without SARD evidences that there might reflect a disrregulación of the immune system or a form fruste of associate SARD. <h3>Objectives:</h3> 1.To describe the SARD predominance in patients whose the guide sign is the presence of injuries desmielinizantes in CNS. 2 To describe the clinical profile of these patients. 3. To describe the frequency of reumatic antibody posivity in MS. <h3>Methods:</h3> Retrospective observational study of patients with CNS demyelinating lesions as a guide sign and clinical-analytical findings suggestive of SARD assessed jointly by the Demyelinating Diseases Unit and and by the Rheumatology Service. MS diagnosis according to McDonald 2010 criteria. Statistical analysis with SPSS 17.0. carried out in the conditions of the usual clinical practice in the Consultations of Rheumatology and Neurology. We analyzed the patients referred from Consultations of Rheumatology to Neurology by finding demyelinating lesions in imaging test or suggestive neurological symptoms. And patients referred fro Consultations of Neurology to Rheumatology by finding clinical or analytical signs of systemic autoimmune rheumatologic disease during the study of a demyelinating lesion. We included patients assessed in Consultations of both services from 1/1/2010 to 31/12/2017. <h3>Results:</h3> Of 561 patients evaluated in Demyelinating Diseases Unit, 89 were evaluated also in Rheumatology. 82% were women, with avarage age of start the neurological symptoms at 40.6 years (SD 13.15), the average age at the time of assessment by Rheumatology 42.9 years (SD 12.8). Only 17 (19%) had previous a rheumatology diagnosis: Fibromyalgia 5 (5.6%); SARD 9 (10%). A definitive diagnosis was made in 63 patients (71%), probable 14 (16%) and nonspecific 12 (13.5%). Definitive diagnoses include: MS 32 (35.9%), NMO 4 (4.5%) and SARD 32 (35.9%): Neurosarcoidosis 3, NeuroSjögren 6, NeuroBeçhet 2, Neurolupus 3, aPLS 7 and in the context of UCTD 11. First neurological symptom in the SARD was sensitive decifit 11 (22%). SARD was ruled out in 50 patients (fibromyalgia or degenerative pathology). Patients with definitive diagnosis of MS (32) and positivity for antibodies: ANA requested in 29 patients; positive 46.6%, Anti-Ro52 requested in 28 and all negative. <h3>Conclusion:</h3> 1.The multidisciplinary assessment allowed to establish a definitive diagnosis in 71% of the patients. It allowed the new diagnosis of SARD in 55% of patients. 2. The 22% of SARD presented a sensitive deficit as the first neurological symptom. The main symptom suggestive of SARD that manifested the patients with demyelinating lesions were the inflammatory arthralgias, second probable Raynuad phenomenon and third ocular dryness.3. The 46.6% of MS have ANA positive without another sign of SARD. Distinguishing between an MS and SARD with neurological manifestations is a diagnostic challenge. <h3>Disclosure of Interests:</h3> None declared