FRI0491 IS THERE A RELATIONSHIP BETWEEN VOGT-KOYANAGI-HARADA AND INFLAMMATORY RHEUMATOLOGICAL DISEASES
Authors: S. B. Kocaer, M. Kaya, S. Guven, Z. Ayhan, A. O. Saatci, F. Onen, İ. Sari
Journal: Annals of the Rheumatic Diseases (2020)

Background: Vogt-Koyanagi-Harada Disease (VKHD) is a systemic autoimmune disease characterized by bilateral granulomatous panuveitis associated with systemic symptoms, including neurological, dermatological and audiovestibular systems. Due to its systemic nature, it may accompany with other autoimmune conditions. However, there is a considerably limited number of reports on the association of VKHD and rheumatologic diseases. Objectives: To investigate the relationship between VKHD and inflammatory rheumatological diseases. Methods: Patients who had bilateral granulomatous uveitis and fulfilled the 2001 revised diagnostic criteria for VKHD were included in our study. All patients were systematically reviewed in terms of the presence of any rheumatological manifestations including connective tissue diseases, spondyloarthritis (SpA), vasculitis, Behcet’s disease and sarcoidosis. Results: Demographic findings: There were fifteen patients in the study (86,7%,female), the mean age at diagnosis was 31,2 ± 11,1 years. Comorbidities: Six patients (4 hashimoto thyroiditis, 2 diabetes mellitus) had comorbid diseases. Rheumatological findings: Mechanical back pain in 4 patients, 1 patient had morning stiffness without any other SpA related features; 2 patients had inflammatory arthralgias in small joints, 4 patients had sicca symptoms, 1 patient had arthritis in knee joint, 3 patients had oral aphthae and 1 patient had photosensitivity. Laboratory tests and autoantibodies: The acute phase reactants were within normal ranges. The mean CRP value at the time of diagnosis was 2,7 ± 3,2 mg/L and ESR was 14,4 ± 9,2 mm/h. Two (15,3%) out of 13 patients had high serum ACE levels. RF, anti-CCP and anti-dsDNA were negative in all patients. ANA was positive (&gt;1/160 titers) in 4 patients (28,6%) and 3 patients had a titer above 1/320. Anti-ENA profile was positive in 2 patients with anti-SS-B and anti-histone components. MPO-ANCA was positive in one patient. HLA test: HLA-B27 was negative in all patients. HLA-B51 and B18 were positive in 2 patients. Radiographic findings: One patient had heel enthesitis on X-ray, 4 patients had bilateral grade 1 and one patient had unilateral grade 2 sacroiliitis. None of them fulfilled the Modified New York criteria for radiographic sacroiliitis. Hand X-rays of all patients were normal. One patient had reticular density on chest X-ray. Pathergy: The pathergy test was negative in all patients. Capilleroscopy: Four patients had pathological capilleroscopy findings (3 patient tortuous loops, 1 patient tortuous loops and microhemorrhages). Conclusion: This study suggests that; 1) inflammatory arthralgias and sicca symptoms were the most common rheumatological findings, 2) the frequency of SpA related features were not increased in VKHD, 3) increased autoantibody frequency, particularly in high titers of ANA could be seen in VKHD possibly reflecting the autoimmune nature of the disease, 4) even though there were signs of rheumatic diseases, none of the patients were grouped into any rheumatologic diagnostic classification. Demographic findings and rheumatological manifestations in VKHD patients VKHD patients (n=15) Females,n (%) 13 (86,7) Age,yrs (mean ± std) 34,6 ± 12,6 Age of diagnosis, yrs (mean±std) 31,2 ± 11,1 CRP baseline (mean±std) 2,7 ± 3,2 mg/L ESR baseline (mean±std) 14,4 ± 9,2 mm/H High ACE levels,n(%) 2/13 (15,3) RF positivity,n(%) 0/14 (0) Anti-CCP positivity,n (%) 0/6 (0) ANA positivity,n(%) 4/14 (28,6) ANA pattern,(n) Homogeneous (2) Nuclear (1) Homogeneous speckled (1) Anti-dsDNA positivity,n(%) 0/11 (0) Anti-ENA profile positivity,n(%) 2/14 (14,2) ANCA positivity,n(%) 1/12 (8,3) Pelvis X-Ray abnormality,n(%) Sacroiliitis (n) 5/12 (41,7) Bilateral grade 1 (4) Unilateral grade 2 (1) Capilleroscopy abnormality,n(%) 4/9 (44,5) Pathergy,n (%) 0/12 (0) Disclosure of Interests: None declared