THU0580 JOINT MANIFESTATIONS SECONDARY TO IMMUNOTHERAPY: CLINICAL CHARACTERISTICS AND EVOLUTION
Authors: Carolina Perez-Garcia, Fabiola Ojeda, Ana Pros Simón, Emma Beltrán, Tarek Carlos Salman Monte, Edurne Arriola Aperribay, Jordi Monfort
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Inhibitors of CTLA-4 and PD-1 have shown improvements in survival in multiple advanced cancers. Immune-mediated effects such as arthralgias and arthritis have been described, but their prevalence and characteristics have not been well defined. <h3>Objectives:</h3> The objective of the study is to describe the prevalence of immunomediated joint manifestations (IJM), its characteristics and evolution in patients who received immunotherapy (nivolumab (NV), pembrolizumab (PB)) from January 1, 2016 to December 31, 2018 in our center. <h3>Methods:</h3> Data collection was performed at through the RPT (Registre Pacients Tractats) database of the CatSalut, and the patients referred to the monographic medical office of inflammatory joint diseases of our center. In all cases, the variables: age, sex, neoplasia, drug, number of doses, were recorded. In patients with joint involvement: other autoimmune manifestations, joint affectation prior to treatment, delay rheumatology derivation, joint affectation type, swollen and tender joint counts, ESR, CRP, RF, ACPA, ANA, HLA B 27, Hb, leukocytes, neutrophils, lymphocytes, treatment and evolution, were recorded. The statistical analysis was carried out with the SPSS 15.0 computer package <h3>Results:</h3> 106 patients received treatment (TTO) with immunotherapy (71 NV, 35 BP) for neoplasia (81 lung, 10 renal, 8 melanoma, 2 oropharynx). The mean age was 67.93 ± 10.7 years (21.7% women, 78.3% men). There were 11 events cataloged as IJM. The overall prevalence was 10.3% (5.6% NV, 14.3% PB). Patients with IJM received a greater number of doses (17.67 ± 9.3 vs9.24 ± 10.1 p = 0.018). No patient with melanoma presented IJM. All IJM suspicions cases were assessed by a rheumatology. When studying their characteristics (Table 1), 3 patients were added from the database of the rheumatology service (14 cases). They received in a clinical trial BP29541 (rectal cancer), Atezolizumab (lung cancer) and Durvalumab (lung cancer). 42.9% of the patients presented inflammatory arthralgias (IAT) and 57.1% arthritis (AT). In reference to their previous history, 2 patients had a history of hyperuricemia and arthritis. One patient concomitantly presented lymphocytic colitis confirmed by biopsy. The delay time for assessment by rheumatology was 18.1 ± 22.1 days. Patients with AT were older (p = 0.014), had higher ESR (p = 0.047) than those with IAT. No differences were found in other variables (table1). With reference to the analytical study, 1 patient was RF +, 2 ANA + at mean titers (1/160-1/320), none ACPA or HLA B 27 +. After assessment by rheumatology, two patients with IAT were diagnosed with bone M1 and two AT were categorized as gouty arthritis. The rest of the IAT responded to NSAIDs, did not require corticosteroids and were resolved. 6 cases of AT received prednisone, 3 required treatment dose 1 mg/kg weight and subsequently MTX in 2 of them, with evolution to low disease activity at present. Only one patient met RA classification criteria. <h3>Conclusion:</h3> The prevalence of IJM was higher than 10%, depending on the number of doses. Patients with arthritis had higher age and higher ESR. No patient presented ACPA and HLA B 27 +, so to include them in the initial analytical could be not necessary. In these patients, it is important the assessment by a rheumatologist to make a correct differential diagnosis, as well as establish referral circuits to avoid delay of care <h3>Disclosure of Interests:</h3> Carolina Perez-Garcia: None declared, Fabiola Ojeda: None declared, Ana Pros Simón: None declared, Emma Beltrán: None declared, Tarek Carlos Salman Monte: None declared, Edurne Arriola Aperribay: None declared, Jordi Monfort Speakers bureau: Bioibérica Procare Health