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BackgroundNeuromyelitis Optica Spectrum disorders (NMOSD) is a rare autoimmune disease characterized by optic neuritis (ON) and/or longitudinal extensive transverse myelitis (LETM). It is commonly associated with other autoimmune diseases (OAD). Recent reports suggested racial differences in clinical phenotype and presentation of NMOSD. However, data on Black population is scarce.ObjectivesWe aim to characterize, in our largely Black population, the clinical, laboratory and radiologic features of patients with NMOSD and OAD. We also aim to ascertain differences in clinical presentation between NMOSD patients with and without OAD.MethodsIn a retrospective analysis, patients ≥ 18 years of age with a confirmed diagnosis of NMOSD as per the International Panel for NMOSD Diagnosis Criteria, seen at 2 NYC urban hospitals from 1/2005 to 4/2017 were identified. Demographic, clinical, and laboratory data were extracted together with expanded disability status scales (EDDS) and imaging studies. Brain magnetic resonance imaging (MRI) was reviewed by a neuro-radiologist who applied the NMOSD Radiological criteria to identify typical findings of the disease.ResultsForty-one patients fulfilled NMOSD criteria. 85.4% were women with a mean age of 44.7±2.03 years. 82.9% of the patients were Black and 34.1% (14/41) had an associated OAD. Systemic lupus erythematosus (SLE) was the most common OAD present prior to NMOSD diagnosis, followed by thyroid disease and Sjogren’s syndrome. Aquaporin 4 immunoglobulin G (AQP4IgG) was positive in 82.9% of the entire cohort and in 76.9% (10/13) of patients with NMOSD and OAD. Hypertension (33.3% vs. 15.3%), and cardiovascular disease (13.3% vs. 4%) were more frequent in NMOSD with OAD, compared with the NMOSD only group. On initial presentation of the NMOSD only group, visual changes (40% vs. 28.5%) and ON (38.4% vs. 20%)were predominant. In the intial presentation of NMOSD with OAD group, sensory loss (78.5% vs. 57.7%), acute myelitis (40% vs. 23.1%), and elevated C reactive protein (CRP) (20.85±11.2 vs. 3.2±1.85mg/d/L) were more freuent. Disability scores (EDDS) were 5.5 for each group. Brain MRI revealed lesions affecting corpus callosum in a marble pattern, (21.4% vs. 13.6%), the hemispheres in a spindle like pattern(33%vs 22.7%), the dorsal medulla (50% vs. 39.1%), the area postrema (38.5% vs. 27.3%) and the pons (21.4% vs. 13.4) for NMOSD with OAD and without respectively. LETM with predilection for the thoracic region was (66.7% vs 54.5%), cord edema (69.2% vs. 40.9%) and gadolinium enhancement (69.2% vs. 59.1%) for NMOSD with OAD and NMOSD only patients respectively.ConclusionAQP4IgG-positivity was observed in most of the cases in our predominantly Black NMOSD population. Over a third of the NMOSD patients had OAD. SLE was the most commonly reported. NMOSD with OAD patients tended to present with sensory loss, acute myelitis, and elevated CRP, while in NMOSD without OAD presented more with visual changes and ON. The NMOSD with OAD group had more MRI lesions involving corpus callosum, hem...

Background: Rheumatoid arthritis (RA) patients have an increased risk of malignancy with postulated risk factors that include chronic inflammation, smoking and the use of immunosuppressants have been postulated as drivers of higher malignancies rates. Our study aimed to describe the prevalence and type of malignancies encountered in an urban, predominantly Black RA patient population.Methods: Cross sectional analysis of 1142 patients with RA diagnosis by ICD-codes of which 501 cases met the inclusion criteria for the study. Blacks accounted for 88.4% of the study population. Fifty-six patients had cancer recorded in their medical records and these cases were further reviewed for tumor type, timing of diagnosis and patient clinical characteristics. Results:The cancer prevalence was 11.2% (56/501) in our Black RA population being studied. Mean age at cancer diagnosis was 59.9 ± 5.2 for the patients who developed cancer before RA diagnosis and 58.25 ± 16.02 for those who developed malignancy after RA diagnosis. There were 18 breast cancers, 4 colon and 4 cervical cancers; for lung, multiple myeloma, thyroid, squamous cell carcinoma and pancreas there were 3 cases each; for endometrial, Non-Hodgkin's lymphoma, meningioma and prostate, 2 cases each and 1 each for urinary bladder, esophageal adenocarcinoma, lymphoma, glioblastoma, liver, Hodgkin's lymphoma, sarcoma, ovary and renal cell carcinoma. No differences were found in years of RA duration, joint erosion, joint space narrowing or SENS score except for significantly higher ESR among the cancer group and RF seropositivity in the non-cancer group. Therapeutic modalities were not significantly different between the cancer and no cancer groups. Conclusion:Breast cancer was the most prevalent malignancy among our Black RA population. Further studies are needed to identify the contributing factors to the malignancy risk of breast cancer in our Black RA population and whether it is gender-related since RA is more prevalence in women Key points 1. First study to assess the prevalence of malignancy in predominantly Black RA patient population.2. The prevalence of malignancy was 11.2%, with breast cancer being the most frequent followed by colon and cervical cancer.3. No significant differences were found in patient comorbidities, smoking rates, clinical characteristics, medication patterns between the cancer and non-cancer groups.