title: Synovitis in angioimmunoblastic lymphadenopathy with dysproteinemia simulating rheumatoid arthritis.
abstract: We describe a patient with angioimmunoblastic lymphadenopathy with dysproteinemia who developed a symmetric, rheumatoid-like, peripheral polyarthritis. Radiographs of the involved joints revealed soft tissue swelling without erosions or cartilage loss. Rheumatoid factor and fluorescent antinuclear antibodies were negative, and C-reactive protein and erythrocyte sedimentation rate were normal. Synovial fluid analysis showed an inflammatory effusion (white blood cell count of 3,500/mm3, with 76% polymorphonuclear leukocytes). A closed synovial biopsy of the wrist revealed a mononuclear infiltrate consistent with angioimmunoblastic lymphadenopathy with dysproteinemia. Monthly parenteral chemotherapy treatment with high-dose methyl-prednisolone and cyclophosphamide resulted in remission of all manifestations of disease, including arthritis.
authors.affiliation: Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892.
authors.forename: D T
authors.initials: DT
authors.lastname: Boumpas
authors.forename: M S
authors.initials: MS
authors.lastname: Wheby
authors.forename: E S
authors.initials: ES
authors.lastname: Jaffe
authors.forename: A D
authors.initials: AD
authors.lastname: Steinberg
authors.forename: J H
authors.initials: JH
authors.lastname: Klippel
authors.forename: J E
authors.initials: JE
authors.lastname: Balow
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D002648:Child; D003937:Diagnosis, Differential; D006801:Humans; D006942:Hypergammaglobulinemia / Q000150:complications*; D007119:Immunoblastic Lymphadenopathy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D012867:Skin / Q000473:pathology; D013583:Synovial Membrane / Q000473:pathology; D013585:Synovitis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M