title: Hypereosinophilia and seroconversion of rheumatoid arthritis.
abstract: At the intersection of atopy and autoimmunity, we present a patient with seronegative rheumatoid arthritis (RA) who developed hypereosinophilia, without evidence of other etiologies, as she became rheumatoid factor (RF) positive. Although the magnitude of eosinophilia in patients with RA has been thought to reflect the severity or activity of the RA, in our patient, eosinophilia developed at a time when the patient's synovitis was well controlled. Although eosinophilia may reflect associated drug hypersensitivity, discontinuation of the medications utilized to control our patient's disease, adalimumab and methotrexate, did not promote clinical improvement. Probably the most curious aspect of our patient was the concomitant development of rheumatoid factor seropositivity in the setting of previously seronegative RA. The temporal relationship between the development of peripheral eosinophilia and seroconversion suggests a possible connection between these events. We speculate that the T cell cytokine production that can induce eosinophilia may simultaneously activate RF production.
authors.affiliation: Department of Dermatology, Langone School of Medicine at New York University, New York, NY, USA.
authors.forename: Rachel K
authors.initials: RK
authors.lastname: Rosenstein
authors.forename: Richard S
authors.initials: RS
authors.lastname: Panush
authors.forename: Neil
authors.initials: N
authors.lastname: Kramer
authors.forename: Elliot D
authors.initials: ED
authors.lastname: Rosenstein
mesh_terms: D000068879:Adalimumab; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D015551:Autoimmunity / Q000276:immunology*; D005260:Female; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000150:complications* / Q000276:immunology; D008727:Methotrexate / Q000627:therapeutic use; D012217:Rheumatoid Factor / Q000276:immunology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D012217:Rheumatoid Factor; D000068879:Adalimumab; D008727:Methotrexate