Journal Article

POS0881 INFLAMMATORY RHEUMATISMS UPON TARGETED THERAPIES FOR ASTHMA, THE RITA STUDY

De Maleprade, B., Gandiolle, A., Forien, M., Sibilia, J., Gottenberg, J. E., Claudine, W., Salliot, C., Taille, C., Devouassoux, G., Khayath, N., Terrier, J., Mahrous, B., Meyer, A., Sebbag, E.

2024

Overview

Background:Targeted therapies for asthma, such as mepolizumab, benralizumab, dupilumab, tezepelumab, and omalizumab, represent a significant advancement in the management of severe asthma, as well as other diseases, including atopic dermatitis and nasal-sinus polyposis. New onsets of inflammatory rheumatism have been reported in the literature under these treatments, although the number of cases is currently limited (the largest series being n=11).Objectives:The aim of this study was to describe the characteristics and management of inflammatory rheumatism resulting from targeted therapies for asthma.Methods:A retrospective multicenter observational study was conducted. The study included patients who met the following criteria: (i) inflammatory rheumatism, (ii) occurring de novo, and (iii) under biologic therapy for asthma (given for either asthma or a related disease). The cases were reported by multiple investigators from different hospitals to the main investigator who collected the data.Results:The results showed that out of 30 patients with suspected inflammatory rheumatism, 12 met the criteria for inflammatory rheumatism (7 female, 5 males, aged 52.5 years, range 25 – 84). Seven patients were treated with dupilumab and five with mepolizumab for asthma (n=10), nasal-sinus polyposis (n=6), and atopic dermatitis (n=1). The median time between the introduction of these treatments and the onset of joint symptoms was 9.5 months (range 1-25). Only one patient was receiving corticosteroid therapy at the first articular symptoms (prednisone 20 mg/day).At the initial rheumatologic evaluation, all patients presented with peripheral joint involvement, while none had axial involvement. The median number of tender and swollen joints was 7 (range 3-26) and 3 (range 0-10), respectively. The median CRP level was 33 mg/L (range 3-66). Three patients (25%) tested positive for ACPA (median: 163.8 UI/L, range 13-293.2), 2 (16.5%) for rheumatoid factor, 3 (20%) had antinuclear antibodies (1/160 to 1/640), and 1 (8%) had anti-dsDNA (27,8 UI/L). Radiographs of hands and/or feet showed erosions in 2 out of 12 patients (17%). Extra-articular manifestations were present in 3 patients (25%), including cutaneous psoriasis (n=1, 8%), edema of the hands resembling RS3PE (n=1, 9%), and erythema nodosum (n=1, 8%). The diagnoses were rheumatoid arthritis (n=3), psoriatic arthritis (n=3), polymyalgia rheumatica (n=4), RS3PE syndrome (n=1), and sarcoidosis (n=1).Four out of twelve patients (33%) discontinued their targeted therapy for asthma, and two of them experienced an asthma relapse, which was treated with corticosteroids. Two patients switched to another targeted therapy for asthma (one received dupilumab and the other benralizumab), resulting in resolution of the rheumatism without rheumatological treatment. One patient resumed the same biologic therapy and one patient stopped treatment completely, both requiring rheumatologic treatment.Eight out of 12 patients (67%) continued targeted therapy for asthma.Rheumatic diseases were treated with corticosteroids (n=6, 50%; 5 mg/day range 5-20), methotrexate (n=7, 58%; 20 mg/week range 15-25) and/or targeted therapy for rheumatic diseases (n=2, 16.5%, including etanercept: n=1, tocilizumab: n=1, ixekizumab: n=1).No serious side effects were reported, including no infections, hospitalizations, or deaths related to side effects. After a follow-up of 2.5 months (range 0-26), 11 out of 12 patients achieved remission of their inflammatory rheumatism.Conclusion:In conclusion, inflammatory rheumatism may occur within the first few months of initiating targeted therapies for asthma. This series found that discontinuing targeted therapy for asthma resulted in asthma relapse in 50% of cases, while the rheumatism resolved in 50% of cases. In this series, the use of targeted therapy for asthma maintenance, in combination with methotrexate, and targeted therapy for inflammatory rheumatism (when methotrexate was ineffective), proved to be both effective and safe.REFERENCES: NIL. Acknowledgements:NIL.Disclosure of Interests:None declared.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Anti-DNA antibodies / Antinuclear antibodies / Arthritis / Asthma / Atopic dermatitis / Autoantibodies / biological DMARD / Corticosteroids / Dermatitis / Descriptive Studies / Edema / Erythema nodosum / Etanercept / Immunoglobulin E / Inflammation / Joint diseases / Methotrexate / Monoclonal antibodies / Patients / Polymyalgia rheumatica / Polyposis / Prednisone / Psoriasis / Psoriatic arthritis / Remission / Rheumatic diseases / Rheumatism / Rheumatoid arthritis / Rheumatoid factor / Sarcoidosis / Scientific Abstracts / Side effects / Steroids