title: Are monoclonal gammopathies in rheumatoid arthritis predictive for lymphoproliferative disorders?
abstract: There is limited evidence for the association of specific malignancies with rheumatoid arthritis (RA). Monoclonal gammopathies can occur in RA. Their predictive value for the development of a lymphoproliferative disorder remains unclear and disputed. We reviewed charts of 214 RA patients all of whom had at least one serum protein electrophoresis. We performed a retrospective study of 12 patients with RA and an M spike. We further characterized the M spike by serum immunofixation and bone marrow studies. The median age at which the M spike was identified was 69 years. IgG was the predominant gammopathy in 50% of patients, with no difference in the amount of kappa (kappa) and lambda (lambda) chains. One patient was diagnosed with multiple myeloma, one with an undefined primary lymphoproliferative disorder, one with T-cell leukemia, five with myelodysplastic syndrome, and four with monoclonal gammopathy of undetermined significance at most recent evaluation. Of our patients, 42% had a myelodysplastic syndrome, which has not been previously reported, and, in contrast to previous reports, no lymphomas were identified. The follow-up evaluation of patients with myelodysplastic syndrome and monoclonal gammopathy of undetermined significance is important because they may progress to an overt neoplasia.
authors.affiliation: San Juan Veterans Affairs Medical Center, San Juan, Puerto Rico 00921, USA.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Toro-Jiménez
authors.forename: William
authors.initials: W
authors.lastname: Cáceres
authors.forename: Edwin
authors.initials: E
authors.lastname: Mejías