title: Inflammatory arthritis in patients with myelodysplastic syndromes: a multicenter retrospective study and literature review of 68 cases.
abstract: 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.
authors.affiliation: From the Service de médecine interne (AM, EG, OF), Université Paris 13, AP-HP, Hôpital Jean Verdier, Bondy; Service d'hématologie clinique (TB, PF), Université Paris 13, AP-HP, Avicenne, Bobigny; Service de médecine interne (OD), Université Rennes 1, Hôpital Universitaire de Rennes, Rennes; Service de rhumatologie (GF), Université Sorbonne Paris Cité, Université Paris 13, Li2P, EA4222, Hôpital Avicenne, Bobigny; Centre Investigation Clinique Biothérapie CBT-506 & Service de rhumatologie (ET), CHU Besançon, Besançon; Service de médecine interne (LR), CHU de Bordeaux, Bordeaux; Service de rhumatologie (MO), CH Romilly/Seine; Service de médecine interne (BG), Hôpital de La Rochelle, La Rochelle; Service de médecine interne et gériatrique (BDW), CHU Nîmes, Nîmes; Service de médecine interne (A-LB), CH Douai, Douai; Service de rhumatologie (J-MZ), CH Croix Saint Simon, Paris; Service de médecine interne (DL), CHU Lille, Université Lille II, Lille; Service de médecine interne (GD), Hôpital de Rochefort, Rochefort; Service de médecine interne (SM), CHG Albi, Albi; and Service d'hématologie clinique (CR), Hôpital Saint-Vincent de Paul, UC Lille, Univ Nord de France, Lille; France.
authors.forename: Arsène
authors.initials: A
authors.lastname: Mekinian
authors.forename: Thorsten
authors.initials: T
authors.lastname: Braun
authors.forename: Olivier
authors.initials: O
authors.lastname: Decaux
authors.forename: Géraldine
authors.initials: G
authors.lastname: Falgarone
authors.forename: Eric
authors.initials: E
authors.lastname: Toussirot
authors.forename: Loic
authors.initials: L
authors.lastname: Raffray
authors.forename: Mohamed
authors.initials: M
authors.lastname: Omouri
authors.forename: Bruno
authors.initials: B
authors.lastname: Gombert
authors.forename: Benoit
authors.initials: B
authors.lastname: De Wazieres
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Buchdaul
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Ziza
authors.forename: David
authors.initials: D
authors.lastname: Launay
authors.forename: Guillaume
authors.initials: G
authors.lastname: Denis
authors.forename: Serge
authors.initials: S
authors.lastname: Madaule
authors.forename: Christian
authors.initials: C
authors.lastname: Rose
authors.forename: Eric
authors.initials: E
authors.lastname: Grignano
authors.forename: Pierre
authors.initials: P
authors.lastname: Fenaux
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000453:epidemiology; D011111:Polymyalgia Rheumatica / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids