THU0609 Clinical characteristics and outcome of spanish patients with acute myelitis associated with autoimmune diseases

Abstract

Background: Acute myelitis (AM) is a focal inflammatory disorder of the spinal cord characterised by motor, sensory, and autonomic dysfunctions that usually develop during a short period (several hours to days) and may resolve over several weeks to months. Acute has been reported as an unusual complication of autoimmune diseases (AD), mainly in systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS). Objectives: To analyse the frequency of concomitant AD in patients with patients with AM seen in a Spanish tertiary centre and to compare their clinical characteristics and outcome with those of AM patients without other AD. Methods: We performed a retrospective study including all the patients diagnosed with AM in our centre between January 1989 and December 2017. Patients with previous history of spinal disease (multiple sclerosis [MS], compression, trauma, arteriovenous malformation, radiotherapy) and children were excluded. Demographics, clinical, laboratory, imagenology, therapeutic and outcome data were obtained from their medical records. Results: During the study period 144 cases of AM were identified, 76 of them had complete data and were analysed. Most of the patient were women (47, 62%), with a mean age at diagnosis 42±17 years. The main causes of AM in our series were MS (35%), AD (18%), postviral myelitis (9%) and idiopathic (34%). The AD diagnosed in these patients were: SLE,4 SS,3 undifferentiated connective tissue disease,2 Graves' disease,1 ulcerative colitis,1 polymyalgia rheumatic,1 cryoglobulinemic vasculitis1 and sarcoidosis.1 A patient with MS had concomitantly another AD (inflammatory myopathy). Most of the patients with AD (12, 80%) were diagnosed of these disorders before the AM episode (median 48 months, range: 24-120). No differences regarding to sex, age and anatomical extension of AM were detected between AD and non-AD patients. The recurrence of AM was more frequent in non-AD patients (7% vs 54%, p<0.001) and a tendency to less severe clinical course was found in AD patients (67% vs 41%, p=0.08). Conclusions: AD were an important cause of AM in our series and this usually occurred after diagnose of AD, so it is important to consider AM when these patients develop neurological dysfunctions that suggest spinal cord damage. The outcome of AM seem to be better in patients with concomitant AD.