Session Information
Session Type: Abstract Submissions (ACR)
Inflammatory arthritis in patients with myelodysplastic syndrome: French multicenter retrospective study.
For the Société Nationale Française de Médecine Interne (SNFMI), the CRI (Club Rhumatismes Inflammation) and Groupe Français d’étude des syndromes myélodysplasiques.
Background/Purpose :
To describe the characteristics and the outcome of inflammatory arthritis in patients with myelodysplastic syndrome (MDS).
Methods:
French multicenter retrospective study which included patients with MDS and inflammatory arthritis. Patient’s clinical, biological and radiological data at the diagnosis, during the follow-up were recorded, as well as treatment regimen. Patients with isolated arthritis were compared to MDS-associated vasculitis (n=22).
Results:
Twenty-two patients with myelodysplastic syndrome (77.5 years [69-81]; 10 women) were included. IPSS score of the myelodysplastic syndrome was 0.75 [0-1.4]. Inflammatory arthritis was present in all patients, with polyarthritis in 14 (64%) and symmetric involvement in 15 cases (68%). At the diagnosis of the arthritis, median DAS28-CRP was 4.5 [2-6.5], with the presence of anti-CCP antibodies in 2 cases (9%) and radiological erosions in 1 case. The median time between the diagnosis arthritis and MDS was of 9 [2-30] months, with median articular symptoms duration of 3 months [2-8]. The appearance of these 2 diseases was concomitant in 6 (27%) cases; arthritis preceded MDS in 12 (55%) and occurred after MDS in 4 (18%) cases. Characteristics of arthritis and of MDS, as well as treatments at the different points are in table 1. Whereas the number of swollen and tender joints significantly diminished during follow-up, as was the median DAS28-CRP (from 4.3 [3.8-4.6] at baseline to 2.9 [1.75-3.3]; p<0.05), C-reactive protein remained elevated (CRP>20 mg/l in 14 (64%) at baseline versus 8 (42%)). Nevertheless, no patients show any radiographic progression and new anti-CCP positivity during the follow-up of 29 [9-76] months. No correlation was found in concern the evolution of MDS and inflammatory arthritis. In concern the treatments, whereas almost all patients have corticosteroids, the associated treatment was present in only 4 cases (hydroxychloroquine in 2 cases, salazopyrine and etanercept, n=1; each). Eleven patients died during the follow-up from complications of MDS treatment or acutisation. In patients with MDS-associated vasculitis (n=22), death occurred in 17 cases (77%), but survival was not different from patients with only inflammatory arthritis.
Conclusion:
This study describes the characteristics of associated inflammatory arthritis in MDS. At the difference of other inflammatory arthritis, the use of other than steroids immunosuppressors is very poor, probably in relation with the underlying hemopathy. The use of biologics in this condition could be preferred to methotrexate, but need prospective studies.
|
Number of evaluable patients |
Baseline assessment N=22 |
First visit N=19 |
Second visit N=11 |
Third visit N=9 |
Last visit N=19 |
|
Arthritis characteristics |
|
|
|
|
|
|
Delay from the diagnosis (months) |
– |
6 [3-14] |
14 [8-32] |
19 [13-27] |
38 [17-61] |
|
Arthralgias |
22 (100%) |
13 (68%)** |
6 (55%)** |
3 (33%)** |
9 (47%)** |
|
Arthritis |
16 (73%) |
5 (26%)** |
2 (18%)** |
1 (11%)** |
3 (16%)** |
|
Number of swollen joints |
6 [4-8] |
2 [0-4]** |
4 [0-4]* |
0 [0-3]** |
0 [0-4.5]** |
|
Number of tender joints |
3 [0-4.5] |
0 [0-2]** |
0 [0-1]* |
0 [0]* |
0 [0]** |
|
Morning stiffness (hours) |
1 [0-1] |
0 [0-0.5]** |
0 [0-0.5]** |
0 [0-0.5]* |
0 [0]** |
|
Erosion present |
1 (5%) |
1 (5%) |
– |
– |
1 (5%) |
|
C-reactive protein (mg/l) |
30 [10-58] |
10 [5-30]* |
25 [3.5-56] |
25 [8-140] |
10 [3.5-55] |
|
CRP>20 mg/l |
14 (64%) |
7 (37%) |
5 (45%) |
4 (44%) |
8 (42%) |
|
DAS28-CRP |
4.3 [3.8-4.6] |
3 [1.8-3.7]** |
2.7 [2.2-4]* |
2.8 [1.6-3.3]** |
2.9 [1.75-3.3]** |
|
Efficacy (by physician) |
|
15 (79%) |
7 (64%) |
6 (67%) |
15 (79%) |
|
RA treatments |
|
|
|
|
|
|
Corticosteroids (prednisone) |
16 (73%) |
12 (63%) |
10 (91%) |
8 (89%) |
14 (74%) |
|
Corticosteroids (prednisone; mg/day |
27.5 [16-35] |
15 [10-25] |
10 [9.5-20] |
9.5 [5-17]* |
8 [5-15]** |
|
Steroid dependence |
– |
5 (26%) |
4 (36%) |
1 (11%) |
2 (11%) |
|
Other treatments |
4 (18%) hydroxychloroquine (n=2) etanercept salazopyrin |
4 (21%) hydroxychloroquine (n=2) etanercept salazopyrin |
3 (27%) hydroxychloroquine (n=2) salazopyrin |
2 (22%) hydroxychloroquine |
4 (21%) hydroxychloroquine (n=3) anakinra |
|
MDS characteristics |
|
|
|
|
|
|
Hemoglobin (g/dl) |
9 [8-11] |
11 [8.5-11.5] |
11 [8.7-13] |
10 [8-11] |
10 [8-12] |
|
Platelets (n/mm3) |
163 [62-657] |
114 [50-242] |
233 [75-250] |
150 [40-244] |
75 [12-146]* |
|
Neutrophils (n/mm3) |
260 [740-5070 |
1500 [1000-3000] |
1300 [1150-2500] |
1200 [1000-3105] |
2300 [1000-4550] |
|
Blastes (%) |
0 [0-8] |
0 [2] |
0 [0-0] |
0 [0-2.5] |
0 [0-1] |
|
MDS aggravation |
– |
3 (16%) |
2 (18%) |
4 (44%) |
4 (21%) |
|
MDS treatment |
4(18%) |
6 (32%) |
3 (27%) |
3 (33%) |
6 (32%) |
*p<0.05 versus baseline
*p<0.005 versus baseline
Disclosure:
A. Mekinian,
None;
O. Decaux,
None;
G. Falgarone,
None;
T. Braun Sr.,
None;
E. Toussirot,
None;
L. Raffray,
None;
B. Gombert,
None;
B. de Wazieres,
None;
A. L. Buchdaul,
None;
J. M. Ziza,
None;
D. Launay,
None;
G. Denis,
None;
S. Madaule,
None;
P. Fenaux,
None;
O. Fain,
None.
« Back to 2012 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/inflammatory-arthritis-in-patients-with-myelodysplastic-syndrome-french-multicenter-retrospective-study/