AB1137 Inflammatory and erosive arthritis, a common unknown manifestation of vogt-koyanagi-harada disease (VKHD)
Authors: D. Ramos-Bello, A.J. Pedro-Martínez, G. Aguilera Barragán-Pickens, E.S. Acevedo-Castañeda, H. López-Ferretis, G. Martínez-Flores, T.A. Luna-Zúñiga, E. Santillán-Guerrero, R. Moreno-Valdés, M. Saldaña-Baarnard, E. Cuevas-Orta, C. Abud-Mendoza
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> VKHD is a rare cause of bilateral granulomatous panuveitis leading to significant visual loss in patients who present it. VKHD is a multisystemic, autoimmune, inflammatory disease that usually displays extraocular manifestations that include meningismus, vitiligo, poliosis, and hearing loss. Arthritis is an unknown manifestation of the disease. In Mexico, VKHD affect mainly young women and is responsible for 13% to 27% of all uveitis. <h3>Objectives</h3> To describe the presence of inflammatory and erosive arthritis in patients with VKHD. <h3>Methods</h3> Observational study of patients with established VKHD that fulfilled the 2001 revised diagnostic criteria for VKHD was rolled out. Articular ultrasonography was performed to all patients by a trained rheumatologist in carpal, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints evaluating presence of sinovitys, power Doppler (PD) signal, bone erosions, and cartilage changes; serology and hand x-ray were requested and evaluated. <h3>Results</h3> We included 5 women and 1 man, mean age was 36.2±10.3 years, and they all had characteristics of acute (4 patients) or chronic (2 patients) VKHD. They received treatment with intravenous methylprednisolone 1 g/day for 3 days combined with cyclophosphamide and thereafter methotrexate (12.5–17.5 mg/week) for maintenance therapy, scheme with which no ocular recurrences have been presented. Two patients had synovitis on physical examination. All patients had PD signal on the ultrasound and they had involvement of both wrists, MCPs and PIPs joints consistent with polyarthritis pattern; additionally bone erosions were detected in 2 patients. Rheumatoid factor and anti citrullinated peptide antibody were negative in all patients <h3>Conclusions</h3> The presence of inflammatory and erosive arthritis in patients with VKHD has only been described in one case recently. We propose that polyarthritis is common manifestation of this rare disease, including erosive arthritis, representing part of the spectrum of the disease, processes that share some features of the genetic susceptibility with rheumatoid arthritis as HLA-DR4, CTLA-4 and STAT4. <h3>References</h3> [1] Voorduin S, et al. Frecuencia y causa de las uveítis en el Instituto de Oftalmología Conde de Valenciana. Rev Mex Oftalmol 2005; 79 (4): 193–196 [2] Read RW, et al. Revised diagnostic criteria for Vogt- Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol2001; 131:647–652. [3] Aydin T, et al. Association of Vogt Koyanagi Harada Syndrome and Seronegative Rheumatoid Arthritis. Ethiopian Journal of Health Sciences. 2016;26(2):193–196 [4] Baltmr A, et al. Vogt–Koyanagi–Harada syndrome – current perspectives. Clin Ophthalmol. 2016; 10: 2345–2361. <h3>Disclosure of Interest</h3> None declared