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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Medicine+(Baltimore)
2014 ; 93
(1
): 1-10
Nephropedia Template TP
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Inflammatory arthritis in patients with myelodysplastic syndromes: a multicenter
retrospective study and literature review of 68 cases
#MMPMID24378738
Mekinian A
; Braun T
; Decaux O
; Falgarone G
; Toussirot E
; Raffray L
; Omouri M
; Gombert B
; De Wazieres B
; Buchdaul AL
; Ziza JM
; Launay D
; Denis G
; Madaule S
; Rose C
; Grignano E
; Fenaux P
; Fain O
Medicine (Baltimore)
2014[Jan]; 93
(1
): 1-10
PMID24378738
show ga
We describe the characteristics and outcome of inflammatory arthritis in patients
with myelodysplastic syndrome (MDS) in a French multicenter retrospective study.
Twenty-two patients with MDS (median age, 77.5 yr [interquartile range, 69-81];
10 women) were included. Inflammatory arthritis presented as polyarthritis in 17
cases (77%) and with symmetric involvement in 15 cases (68%). At diagnosis, the
median disease activity score 28 based on C-reactive protein (DAS28-CRP) was 4.5
[2-6.5]. Two patients had anti-citrullinated protein antibodies (ACPAs), and 1
had radiologic erosions. The median time between the diagnoses of arthritis and
MDS was 10 months [6-42], with a median articular symptom duration of 3 months
[2-8]. The diagnosis of both diseases was concomitant in 6 cases (27%); arthritis
preceded MDS in 12 cases (55%), and occurred after MDS in 4 (18%). While the
number of swollen and tender joints significantly decreased during follow-up, as
did the median DAS28-CRP (from 4.3 [3.8-4.6] at baseline to 2.9 [1.75-3.3]; p <
0.05), CRP remained elevated (CRP >20 mg/L) in 8 patients (42%). Nevertheless,
radiographic progression and new ACPA positivity were not observed during a
median follow-up of 29 months [9-76]. While most of the patients were treated
with steroids (n = 16) for arthritis, additional treatment was administered in
only 4 patients (hydroxychloroquine, n = 2; sulfasalazine [Salazopyrin] and
etanercept, n = 1, respectively). Eleven patients died during follow-up from
acute myeloid leukemia (n = 5); infections (n = 3); or cerebral bleeding,
cardiorespiratory failure, or undetermined cause (n = 1, respectively).
Inflammatory arthritis associated with MDS can have various presentations and is
often seronegative and nonerosive. Steroids alone are the most common treatment
in MDS-associated arthritis, but that treatment is insufficient to control
arthritis. Steroid-sparing strategies need to be identified.