title: The Schnitzler syndrome.
abstract: The Schnitzler syndrome is a rare and underdiagnosed entity which is considered today as being a paradigm of an acquired/late onset auto-inflammatory disease. It associates a chronic urticarial skin rash, corresponding from the clinico-pathological viewpoint to a neutrophilic urticarial dermatosis, a monoclonal IgM component and at least 2 of the following signs: fever, joint and/or bone pain, enlarged lymph nodes, spleen and/or liver, increased ESR, increased neutrophil count, abnormal bone imaging findings. It is a chronic disease with only one known case of spontaneous remission. Except of the severe alteration of quality of life related mainly to the rash, fever and pain, complications include severe inflammatory anemia and AA amyloidosis. About 20% of patients will develop a lymphoproliferative disorder, mainly Waldenström disease and lymphoma, a percentage close to other patients with IgM MGUS. It was exceedingly difficult to treat patients with this syndrome until the IL-1 receptor antagonist anakinra became available. Anakinra allows a complete control of all signs within hours after the first injection, but patients need continuous treatment with daily injections.In many aspects, the Schnitzler syndrome resembles the genetically determined auto-inflammatory syndromes involving activating mutations of the NLRP3 inflammasome. This latter point and its consequences will be addressed.
authors.affiliation: Clinique Dermatologique, Faculté de Médecine, Université de Strasbourg and Hôpitaux Universitaires, 1, place de l'hôpital, F-67091 Strasbourg cedex, France. dlipsker@gmail.com
authors.forename: Dan
authors.initials: D
authors.lastname: Lipsker
mesh_terms: D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002352:Carrier Proteins / Q000235:genetics; D005076:Exanthema / Q000473:pathology; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000009:adverse effects / Q000627:therapeutic use*; D008232:Lymphoproliferative Disorders / Q000209:etiology; D008875:Middle Aged; D000071199:NLR Family, Pyrin Domain-Containing 3 Protein; D019873:Schnitzler Syndrome / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000503:physiopathology; D012867:Skin / Q000473:pathology
chemical_list: D018501:Antirheumatic Agents; D002352:Carrier Proteins; D053590:Interleukin 1 Receptor Antagonist Protein; D000071199:NLR Family, Pyrin Domain-Containing 3 Protein; C453881:NLRP3 protein, human