Bone and joint tuberculosis in paediatrics: a 13-year retrospective study.

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Abstract

[Indexed for MEDLINE] 6. Joint Bone Spine. 2015 Dec;82(6):417-22. doi: 10.1016/j.jbspin.2015.02.012. Epub 2015 Jul 14. Lymphopenia in early arthritis: Impact on diagnosis and 3-year outcomes (ESPOIR cohort). Duquenne C(1), Cornec D(1), Marhadour T(1), Jousse-Joulin S(1), Cantagrel A(2), Pavy S(3), Devauchelle-Pensec V(1), Saraux A(4). Author information: (1)Rheumatology unit and immunology department (EA 2216), hôpital de la Cavale-Blanche, CHU de Brest, université Bretagne occidentale, BP 824, 29609 Brest cedex, France. (2)Rheumatology unit, Toulouse university hospital, 31059 Toulouse cedex 9, France. (3)Rheumatology unit, Bicêtre hospital, 94275 Le-Kremlin-Bicêtre, France. (4)Rheumatology unit and immunology department (EA 2216), hôpital de la Cavale-Blanche, CHU de Brest, université Bretagne occidentale, BP 824, 29609 Brest cedex, France. Electronic address: Alain.Saraux@chu-brest.fr. OBJECTIVES: In patients with early arthritis naive to disease-modifying antirheumatic drugs, we evaluated the prevalence of initial and persistent lymphopenia, underlying diagnoses, and risk of infection or malignancy. METHODS: Eight hundred and thirteen patients with early arthritis included in the ESPOIR cohort had a clinical examination, laboratory tests (viral serology, immunological tests, and cytokine profile), and radiographs. We determined the prevalence of lymphopenia at baseline and after 3 years, associated factors, diagnoses, and risk of infection or malignancy. RESULTS: At baseline, 50/813 (6.2%) patients had lymphopenia. Lymphopenia was associated with positive rheumatoid factor (P=0.02), cytopenia (P≤0.05), hepatitis C (P=0.05), higher C-reactive protein and DAS28 (P≤0.05 for both). Cytokine profile and radiological progression were not significantly different between patients with and without lymphopenia. Suspected diagnoses at inclusion were rheumatoid arthritis (RA, n=27), unclassified arthritis (n=15), systemic lupus erythematosus (SLE, n=3), spondyloarthritis (n=2), Sjögren's syndrome (n=1), hematologic disease (n=1), and fibromyalgia (n=1). Fifteen patients out of 42 (35.7%) with initial lymphopenia had persistent lymphopenia after 3 years, including 5 with documented causes (lupus, hepatitis C, undernutrition, azathioprine, and tamoxifen); none had PVB19, HIV, or HBV infection and none experienced infections, solid or hematologic malignancies during follow-up. Final diagnoses in these 15 patients were RA (n=6), unclassified arthritis (n=6), SLE (n=1), spondyloarthritis (n=1), and fibromyalgia (n=1). CONCLUSIONS: Lymphopenia is rare in early arthritis. The most common rheumatic cause is RA, in which marked inflammation and other cytopenias are common. Lymphopenia in early arthritis is often short-lived, even when methotrexate is prescribed. Copyright © 2015. Published by Elsevier SAS. DOI: 10.1016/j.jbspin.2015.02.012