AB1513 SIROLIMUS INDUCED INFLAMMATORY ARTHROPATHY

Background Sirolimus is a non-calcineurin immunosuppressant commonly used in patients with organ transplantation to prevent rejection. While various inflammatory syndromes have been described post-sirolimus use, it uncommon arthritis sirolimus 1 . We present patient who developed significant joint inflammation following use. Results Our 39 year old gentleman had heart transplant 1992 dilated cardiomyopathy. He was switched after concerns about chronic kidney disease and graft vascular disease. Six weeks later, he bilateral foot pain swelling which prevented him from weight bearing. an MRI showed bone marrow oedema the midfoot tarsal basal metatarsals. then nuclear scan highly increased symmetrical uptake both mid feet affecting cuneiform second, third fourth bases of The appearances osteoblastic activity vascularity more keeping inflammation/infection no osteonecrosis. His C-reactive protein elevated at 148. This improved 30 cessation sirolimus. Blood cultures were negative. Of significance his history, also suffers gout has previous monoarthritic flares involving wrist, elbow index finger. However, placed on febuxostat 80 mg 2018 excellent response. serology negative for anti-CCP Rheumatoid factor. urate levels controlled 374. found be HLA-B27 positive, but there evidence back pain. tapering course prednisolone coupled Sirolimus, resolved. In follow-up clinic appointments, remained remission did not require any additional treatment continued Mycophenolate Mofetil Ciclosporin cardiac transplant. Conclusion There are many studies investigating use as anti-inflammatory agent autoimmune conditions such rheumatoid 2 bowel 3 mechanisms include down regulation IL-17 IL-6 induction by can paradoxically occur causes reduction STAT cytokine IL-10 raised TNFα serum sequelae post therapy disequilibrium cascade related ability inhibit mammalian target rapamycin (mTOR) subsequently modulates these effects 4 general, pro-inflammatory mild tend resolve drug Although our severe arthritic manifestations required steroid therapy, symptoms transient removal Sirolimus. References [1]Buron F, Malvezzi P, Villar E, Chauvet C, Janbon B, et al. (2013) Profiling Sirolimus-Induced Inflammatory Syndrome: A Prospective Tricentric Observational Study. PLOS ONE 8(1): e53078 [2]Wang J, Zhang SX, Hu FY, Zheng XJ, Cheng T, Yu NN, Yang WX, Gao Wen HY, Li XF. Treatment Patients Refractory Arthritis: Double-Arm, Open-Label, phase 1/2 Trial. Arthritis Rheumatol, 2018:70 (suppl 10). [3]Yin H, X, ameliorates responses switching regulatory T/T helper type 17 profile murine colitis. Immunology. 2013;139(4):494-502. [4]T Weichhart, G. Costantino, M. Poglitsch, Rosner, Zeyda, KM. Stuhlmeier, T Kolbe, TM. Stulnig, WH. Horl, M Hengstschlager, Muller, MD. Saemann. TSC-mTOR Signaling Pathway Regulates Innate Response. Immunity Volume 29, Issue 4, October 2008, Pages 565-577 Disclosure Interests None declared