Lymphocyte subsets associated with T cell receptor β‐chain gene rearrangement in patients with rheumatoid arthritis and neutropenia

Abstract

Objective. To determine the incidence of a clonal lymphoid disease in patients with chronic rheumatoid arthritis (RA) and neutropenia.Methods. Lymphocytes from 23 RA patients with either current neutropenia or a history of this complication were studied.ResuUs. Eight patients had a clonal reaflgngement of the T cell receptor m h a h gene. Phenotypically, they showed a distinctive pattern characterized by an inverted CD4+:CD8+ cell ratio and an increased number and percentage of CD57+/CDS+ and CD3+/DR+ lymphocytes. None had evidence of a lymphoid malignancy.Conclusion. Among RA patients with neutropenia, there is a subset who have a subclinical disease resembling T y lymphoproliierative disease.

Large Granular Lymphocyte Leukemia

“…The advent of flow cytometry and progress in immunohistochemistry and molecular clonality studies has allowed the detection of much smaller populations of clonal LGLs in a background of normal polyclonal hematopoiesis [44]. Flow cytometry can also uncover rare cases of LGL leukemia with the absence of typical LGL morphology but with the typical immunophenotype [45]. Detection of a smaller clonal LGL population in patients with systemic symptoms or cytopenias does not require a waiting period of 6 months to establish the diagnosis [8,43].…”

T-Cell Large Granular Lymphocyte Leukemia and Related Disorders

“…T cells are thought to play an important role in joint destruction in RA [70]. Approximately one-third of patients with Felty's syndrome has clonal proliferations of T cells [62,71]-for example, 8 of 23 patients in a study by GonzalesChambers et al [72] and 4 of 12 patients in a series by Loughran et al [73]. In a study of 32 patients with RA, 50% had evidence of CD8 + oligoclonality as assessed by PCR, compared with 4% of 25 age-matched controls [74].…”

Constitutive expression of Fas ligand in large granular lymphocyte leukaemia

“…The Tcell type is a chronic leukaemia of LGL with a CD3 þ , CD8 þ , CD57 þ phenotype. Autoimmune manifestations, including rheumatoid arthritis, are prominent clinical features of this form of LGL leukaemia (Freimark et al, 1987;Loughran et al, 1988;Gonzales-Chambers et al, 1992).…”