Angioimmunoblastic lymphadenopathy associated with polyarthritis.

Rothwell, R S; Mant, Michael J.; Davis, Paul J.

doi:10.1136/ard.39.4.406

Cited by 12 publications

(8 citation statements)

References 13 publications

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“…From x-ray data that were available in 10 cases, bone erosions were reported only in one case by McHugh et al 8 In 3 cases (30%), there was soft tissue swelling, whereas in 6 cases (60%), the x-rays were normal. Subcutaneous nodules were reported in another case by Rothwell et al, 12 but similar to our case, there has not been any histologic analysis of these nodules. The arthritis most commonly involved the small joints of the hand (MCPs, PIPs), wrists, knees, and ankles ( Table 1).…”

Section: Discussionsupporting

confidence: 83%

“…2 A review of the English literature revealed 16 additional patients with well-described synovitis (see Table 1). [2][3][4][5][6][7][8][9][10][11][12][13][14] Although AITL affects equally men and women, AITL-associated arthritis seems to be slightly more common in women (59%, 10 of 17). The majority of patients were middle-aged (mean age, 57.4 years), and their arthritis typically appeared either concurrently with the onset (11 of 17) or during the course (2 of 17) of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…We also review 16 additional well-described cases of AITL-associated arthritis from the English literature. [2][3][4][5][6][7][8][9][10][11][12][13][14] …”

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confidence: 99%

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Angioimmunoblastic T-Cell Lymphoma-Associated Arthritis

Tsochatzis¹,

Vassilopoulos²,

Deutsch³

et al. 2005

JCR: Journal of Clinical Rheumatology

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Angioimmunoblastic T-cell lymphoma (AITL) is a rare type of non-Hodgkin lymphoma with systemic manifestations, including fever, lymphadenopathy, rash, and rarely arthritis. We report the case of a patient who presented with symmetric inflammatory polyarthritis and skin nodules resembling rheumatoid arthritis (RA). The patient responded initially to low-dose prednisolone, but 12 months later, he developed typical features of AITL. The characteristics of AITL-associated arthritis from 16 additional cases from the English literature are also reviewed. AITL-associated arthritis is an uncommon manifestation of angioimmunoblastic lymphoma that can mimic RA, especially when the typical systemic features of lymphoma are absent. This type of arthritis should be included in the differential diagnosis of patients presenting with an inflammatory polyarthritis.A ngioimmunoblastic T-cell lymphoma (AITL) is a nonHodgkin lymphoma (NHL) that was first described independently by Frizzera and Lukes in 1975. Initially, it was termed immunoblastic lymphadenopathy or angioimmunoblastic lymphadenopathy with dysproteinemia. In 1988, it was included in the Kiel Updated Classification for Lymphomas and it is currently classified as a peripheral T-cell non-Hodgkin lymphoma-nodal type in the World Health Organization classification of lymphomas. Currently, it accounts for 2% of all cases of NHLs. 1 Patients with AITL uncommonly develop an inflammatory arthritis with clinical features suggestive of rheumatoid arthritis (RA). 2 In the majority of cases, arthritis appears together or soon after the onset of lymphoma. Arthritis preceding the diagnosis of AITL for more than 6 months is extremely uncommon, having been reported only once in the literature. 3 We present the case of a male patient with symmetric inflammatory polyarthritis and skin nodules that preceded the onset of AITL by 12 months. We also review 16 additional well-described cases of AITL-associated arthritis from the English literature. 2-14 CASE REPORTA 50-year-old man presented to our department with a 1-month history of lymphadenopathy, fever, and rash. Twelve months before his admission, he had developed symmetric polyarthritis that involved the metacarpophalangeal (MCP), proximal interphalangeal (PIP), wrist, elbow, and ankle joints. Small, hard subcutaneous nodules less than 0.5 cm in size were also noted in the extensory surfaces of his elbows bilaterally. A full laboratory workup at that time, including antinuclear antibodies (ANA), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), was unremarkable. His medical history was significant only for Hashimoto thyroiditis.Six months before his admission, the patient reported a generalized erythematous nonpruritic skin rash. A skin biopsy revealed nonspecific perivascular inflammation of the dermis extending to the dermal-epidermal junction. The patient's rash and arthritis responded dramatically to lowdose prednisolone (10 mg/d orally). A month before his admission, while his prednisolon...

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Angioimmunoblastic T-Cell Lymphoma-Associated Arthritis

Tsochatzis¹,

Vassilopoulos²,

Deutsch³

et al. 2005

JCR: Journal of Clinical Rheumatology

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“…Seronegative, inflammatory polyarthritis is an unusual feature of immunoblastic lymphadenopathy (IL) (1)(2)(3). Synovianalyses in 2 patients (I ,2) showed inflammatory effusions with a polymorphonuclear cell predominance.…”

Section: To the Editormentioning

confidence: 99%

Synovial fluid lymphocyte subpopulations in the polyarthritis of immunoblastic lymphadenopathy

Gray

1985

Arthritis & Rheumatism

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7. Ishikawa K, Ohira T, Sakata H: Effects of intra-articular injection of halopredone diacetate on the articular cartilage of rabbit knees: a comparison with rnethylprednisolone acetate. Toxicol Appl Pharmacol (in press) 8. Dieppe P, Calvert P: Crystals and J o h t Disease. London, Chapman and Hall, 1983, pp 23-56 9. Ryan LM, Cheung HS, McCarty DJ: Release of pyrophosphate by normal mammalian articular hyaline and fibrocartilage in organ culture. Arthritis Rheum 24: [1522][1523][1524][1525][1526][1527] 1981 Synovial fluid lymphocyte subpopulations in the polyarthritis of immunoblastic lymphadenopathyTo the Editor: Seronegative, inflammatory polyarthritis is an unusual feature of immunoblastic lymphadenopathy (IL) (1-3). Synovianalyses in 2 patients (I ,2) showed inflammatory effusions with a polymorphonuclear cell predominance. In a patient with IL and associated polysynovitis, described here, synovial fluid (SF) revealed a marked mononuclear pleocytosis. Lymphocyte subpopulations in the SF were identified by monoclonal antibody testing.A 45-year-old black man presented in 1981 with a systemic illness ultimately characterized by fever, weight loss, generalized lymphadenopathy, and a polyclonal gammopathy. Findings of peripheral lymph node biopsies were consistent with IL, showing effacement of the normal nodal architecture and a polymorphic infiltration of immunoblasts, plasma cells, and histiocytes. With corticosteroids an initial remission was seen, but adenopathy recurred, waxing and waning with steroid therapy.In June 1983, at the time of a disease exacerbation, the patient exhibited fever, enlarging adenopathy , and an acute, symmetric, inflammatory polyarthritis involving the metacarpophalangeal, proximal interphalangeal, wrist, elbow, knee, and ankle joints. The following studies gave normal or negative results: complete blood count, urinalysis, serum rheumatoid factor (latex fixation), hepatitis B surface antigen, anti-HA antigen, serum glutamic oxaloacetic transaminase, Monospot test, circulating immune complexes (Raji cell assay), blood cultures, antinuclear antibody, C3, C4, and cryoglobulins. Knee roentgenograms showed no erosions or chondrocalcinosis. Arthrocentesis of the left knee yielded 20 ml of yellow, turbid, poorly viscous fluid with a poor mucin clot, total protein of 5.1 gm/dl, white blood cell count of 20,250 (93% mononuclear, 7% polymorphonuclear), and negative findings on crystal search; bacte- rial, mycobacterial, and fungal stains and cultures were negative. Lymphocytes were separated from heparinized aliquots of blood and SF by density gradient centrifugation. Lymphocyte subpopulations were identified by indirect immunofluoresence after reaction with monoclonal antibodies, and results are shown in Table 1.Polyarthritis and fever improved with oral indomethacin; corticosteroids were reinstituted shortly thereafter, due to the development of sterile pulmonary lymphoid infiltrates. The patient's disease progressed to a null cell lymphoma, and he died in late 1983.In contrast to ea...

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“…7 A paraneoplastic polyarthritis in association with AITL is uncommon. [8][9][10][11][12] It usually involves the proximal interphalangeal, metacarpophalangeal, wrist, ankle, foot, and knee joints.…”

Section: Case Reportmentioning

confidence: 99%