title: TCD4poslymphocytosis in rheumatoid and psoriatic arthritis patients following TNFα blocking agents.
abstract: Lymphocyte expansion and true lymphocytosis are commonly observed in the everyday clinical practice. The meaning of such phenomenon is often poorly understood so that discrimination between benign and malignant lymphocytosis remains difficult to establish. This is mainly true when lymphocytosis rises in patients affected by immune-mediated chronic inflammatory diseases under immunosuppressive treatment, conditions potentially associated with lymphomagenesis. In this brief report the development of mild T CD4poslymphocytosis in a group of patients with chronic arthritis under anti-TNF-α treatment is described.
  
  
  
  Two hundred eight rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients have been evaluated longitudinally for at least 1-year before and 2-years after anti-TNF-α therapy introduction for the possible appearance of a lymphocyte expansion. In patients who developed lymphocyte expansion, T, B and NK cells were analysed.
  
  
  
  Twenty-five out of 208 (12%) subjects developed a mild T CD4poslymphocytosis, during anti-TNF-α therapy, which reverted after its interruption. Higher lymphocyte count, more frequent use of steroids and shorter disease duration, before biological therapy start, have emerged as risk factors for lymphocytosis development.
  
  
  
  This is the first longitudinal cohort study evaluating the onset of lymphocytosis in RA and PsA patients under anti-TNF-α treatment and its possible clinical relevance. A mild T CD4poslymphocytosis has been observed in 12% of RA and PsA patients probably related to anti-TNF-α treatment as previously reported by anecdotal cases. Patients with higher baseline lymphocyte count, use of steroids and shorter disease duration before the introduction of biologic therapy, seem to be prone to develop this laboratory reversible abnormality.
authors.affiliation: Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, "Sapienza" University, Via di Grottarossa 1039, 00189, Rome, Italy. andrea.picchiantidiamanti@uniroma1.it.
authors.forename: Andrea
authors.identifier: 0000-0002-8552-4641
authors.initials: A
authors.lastname: Picchianti Diamanti
authors.affiliation: Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, "Sapienza" University, Via di Grottarossa 1039, 00189, Rome, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Laganà
authors.affiliation: Haematology Unit, Rome, Italy.
authors.forename: Maria Christina
authors.initials: MC
authors.lastname: Cox
authors.affiliation: UOC Anatomic Pathology, Rome, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Pilozzi
authors.affiliation: UOC Laboratory Diagnostic, Rome, Italy.
authors.forename: Rachele
authors.initials: R
authors.lastname: Amodeo
authors.affiliation: UOC Laboratory Diagnostic, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bove
authors.affiliation: Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, "Sapienza" University, Via di Grottarossa 1039, 00189, Rome, Italy.
authors.forename: Milica
authors.initials: M
authors.lastname: Markovic
authors.affiliation: Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, "Sapienza" University, Via di Grottarossa 1039, 00189, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Di Rosa
authors.affiliation: Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, "Sapienza" University, Via di Grottarossa 1039, 00189, Rome, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Salemi
authors.affiliation: Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, "Sapienza" University, Via di Grottarossa 1039, 00189, Rome, Italy.
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Sorgi
authors.affiliation: Menarini Group, Research Toxicology Center (R.T.C), Pomezia, Italy.
authors.forename: Maria Manuela
authors.initials: MM
authors.lastname: Rosado
authors.affiliation: Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, "Sapienza" University, Via di Grottarossa 1039, 00189, Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: D'Amelio
mesh_terms: D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D015704:CD4 Antigens / Q000378:metabolism*; D003710:Demography; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008218:Lymphocytosis / Q000150:complications* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D018501:Antirheumatic Agents; D015704:CD4 Antigens; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF-α agent; Lymphocytosis; Psoriatic arthritis; Rheumatoid arthritis; TCR