POS1365 ANNALYSIS OF PRO-INFLAMMATORY BIOMARKERS IN A POLYMYALGIA RHEUMATICA COHORT DURING THE ACUTE ONSET OF THE DISEASE
Authors: F. M. Ortiz Sanjuan, E. Grau García, C. Riesco Barcena, A. V. Huaylla Quispe, C. Pávez Perales, S. Leal Rodriguez, M. De la Rubia Navarro, I. Martínez Cordellat, C. Nájera Herranz, R. Negueroles Albuixech, J. E. Oller Rodríguez, E. Vicens Bernabeu, C. Alcañiz Escandell, I. Cánovas Olmos, I. Chalmeta Verdejo, J. J. Fragío Gil, L. Gonzalez Puig, J. Ivorra Cortés, J. A. Román Ivorra
Journal: Annals of the Rheumatic Diseases (2021)

Background: Polymyalgia Rheumatica (PMR) is a common inflammatory disease found in elderly patients and results in a high burden of long-term CS-based therapies. Most patients diagnosed with PMR have a good evolution following the introduction of medium-dose glucocorticoid treatment. However, the need to maintain corticosteroid treatment for an extended period (around 12-15 months) is often the norm in standard clinical practice. Activation of Th-17 lymphocytes with the consequent action of pro-inflammatory cytokines such as IL-1, IL-6, IL-17, or IL-23 is well known in the acute phase of this disease and treated by glucocorticoids or IL-6 blockers satisfactorily. However, activation of Th-1 lymphocytes appears to play a leading role in a chronic phase of the disease through the activation of INF-gamma and IL-12. Objectives: Our aim was to assess proinflammatory biomarkers in a cohort of patients with PMR during the acute onset of the disease and its possibly relationship with corticosteroid dose. Methods: Prospective study of a wide and unselected series of patients classified as PMR following 2012 ACR/EULAR classification criteria for PMR. Patient evaluations were performed at baseline and at 3 and 6 months after initiation of corticosteroid therapy. Serum levels of the proinflammatory biomarkers interleukin-6 (IL-6), interleukin-8 (IL-8), CXC motif ligand 10 chemokine (CXCL10), CXC motif ligand 9 chemokine (CXCL9), CXC motif ligand 2 chemokine (CXCL2) and CC motif ligand 2 chemokine (CCL2) were measured in PMR patients and in healthy controls. Results: A total of 25 patients with PMR were studied (32% men; 68% women). The mean age was 72.72 ±9.32 years (range 65-79). We also included 35 healthy controls. In reference to laboratory parameters and proinflammatory biomarkers at the onset of PMR, the mean values (± standard deviation) were as follows: C reactive protein (CRP): 28.4±26.6 mg/dL; erythrocyte sedimentation rate (ESR): 54.3±21.3 mm/h; haemoglobin: 12.6±1.6 g/dL; IL-6: 17.6±30.1 pg/mL; IL-8: 10.1±6.9 pg/mL; CXCL10: 259.4±290.7 pg/mL; CXCL9:5175±4396.8 pg/mL;, CXCL2: 25.9±12.5 pg/mL; CCL2: 471.3±152.9 pg/mL. IL-6, IL-8 and CXCL9 levels were significantly increased in PMR patients comparing with the healthy control group. The Health Assessment Questionnaire (HAQ) performed at the onset of the PMR yielded a mean value of 1.6±0.6. The mean dose of prednisone employed at the onset of PMR was 14.8±5.6 mg/day. After 6 months, the mean dose of prednisone employed was 6.7±3.9 mg/day, the median [range] value for CRP was 3.1 [1.75-7.2] mg/dl and the mean value for ESR was 22±14 mm/h. Regarding relationship between proinflammatory biomarkers studied and doses of prednisone employed, no differences were observed. Regarding pain perception and disability, we observed higher visual analogic scale values (VAS) in association with higher IL-6 levels (P=0.03) and higher HAQ values in association with higher IL-6 and CXCL2 values. After 6 months, our patients showed an excellent evolution, and no complications were observed. Conclusion: During the acute onset of PMR, IL-6, IL-8 and CXCL9 levels were significantly increased in our population of PMR patients. No differences were observed between proinflammatory biomarkers studied and doses of prednisone employed. Disclosure of Interests: None declared