Lymphopenia in early arthritis: Impact on diagnosis and 3-year outcomes (ESPOIR cohort)

Autor: Sandrine Jousse-Joulin, Divi Cornec, Alain Saraux, Carole Duquenne, Stephan Pavy, Valérie Devauchelle-Pensec, Thierry Marhadour, Alain Cantagrel
Přispěvatelé: CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de rhumatologie, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre d'Investigation Clinique (CIC - Brest)
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Male
medicine.medical_specialty
Early inflammatory joint disease
[SDV]Life Sciences [q-bio]
Arthritis
Azathioprine
MESH: Arthritis
MESH: Lymphopenia
Rheumatology
immune system diseases
Internal medicine
Lymphopenia
Diagnosis
medicine
Prevalence
Rheumatoid factor
Humans
Longitudinal Studies
Prospective Studies
Rheumatoid arthritis
MESH: Longitudinal Studies
MESH: Prevalence
2. Zero hunger
Cytopenia
Systemic lupus erythematosus
MESH: Humans
MESH: Middle Aged
business.industry
Middle Aged
medicine.disease
Prognosis
MESH: Male
MESH: Prospective Studies
3. Good health
MESH: France
Hematologic disease
[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system
Cohort
Immunology
Female
France
business
MESH: Female
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
medicine.drug
Zdroj: Joint Bone Spine
Joint Bone Spine, Elsevier Masson, 2015, 82 (6), pp.417-22. ⟨10.1016/j.jbspin.2015.02.012⟩
ISSN: 1297-319X
DOI: 10.1016/j.jbspin.2015.02.012⟩
Popis: Objectives In patients with early arthritis naive to disease-modifying antirheumatic drugs, we evaluated the prevalence of initial and persistent lymphopenia, underlying diagnoses, and risk of infection or malignancy. Methods Eight hundred and thirteen patients with early arthritis included in the ESPOIR cohort had a clinical examination, laboratory tests (viral serology, immunological tests, and cytokine profile), and radiographs. We determined the prevalence of lymphopenia at baseline and after 3 years, associated factors, diagnoses, and risk of infection or malignancy. Results At baseline, 50/813 (6.2%) patients had lymphopenia. Lymphopenia was associated with positive rheumatoid factor (P = 0.02), cytopenia (P ≤ 0.05), hepatitis C (P = 0.05), higher C-reactive protein and DAS28 (P ≤ 0.05 for both). Cytokine profile and radiological progression were not significantly different between patients with and without lymphopenia. Suspected diagnoses at inclusion were rheumatoid arthritis (RA, n = 27), unclassified arthritis (n = 15), systemic lupus erythematosus (SLE, n = 3), spondyloarthritis (n = 2), Sjogren's syndrome (n = 1), hematologic disease (n = 1), and fibromyalgia (n = 1). Fifteen patients out of 42 (35.7%) with initial lymphopenia had persistent lymphopenia after 3 years, including 5 with documented causes (lupus, hepatitis C, undernutrition, azathioprine, and tamoxifen); none had PVB19, HIV, or HBV infection and none experienced infections, solid or hematologic malignancies during follow-up. Final diagnoses in these 15 patients were RA (n = 6), unclassified arthritis (n = 6), SLE (n = 1), spondyloarthritis (n = 1), and fibromyalgia (n = 1). Conclusions Lymphopenia is rare in early arthritis. The most common rheumatic cause is RA, in which marked inflammation and other cytopenias are common. Lymphopenia in early arthritis is often short-lived, even when methotrexate is prescribed.
Databáze: OpenAIRE
Externí odkaz: