Synovitis in angioimmunoblastic lymphadenopathy with dysproteinemia simulating rheumatoid arthritis

Angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) is an uncommon disorder of the lymph glands that is characterized by an increase in the blood levels of proteins called gammaglobulins. Symptoms of AILD include fever, anemia (decreased red blood cell production), abnormal white blood cell production, and the presence of autoantibodies (antibodies that attack the body's own tissues). AILD can affect the liver, spleen, bone marrow and skin. A diagnosis of AILD is usually made by examining samples of lymph node tissue (biopsy). Early in the disease, immune cells (B cells) in the lymph tissue increase in number and make large quantities of antibodies. In some cases this results in the development of malignant (cancerous) lymph node tumors. Most treatments are not effective in treating AILD, and roughly 70 percent of those diagnosed as having AILD die within two years. Most of the patients die as a result of infections. In most cases of AILD the joints are not affected. This article describes the case report of a 61-year-old male patient who developed arthritis several months prior to the onset of AILD. Radiographs (x-rays) of the joints showed signs of swelling, but no cartilage damage or loss. Joint fluid and blood tests for the presence of rheumatoid arthritis were negative. Joint fluid from the wrist contained elevated levels of white blood cells characteristic of AILD. The patient was treated successfully with methylprednisolone and cyclophosphamide. This finding indicates that AILD may affect the joints, and that joint biopsies provide a better method for diagnosing joint involvement than joint fluid sampling. (Consumer Summary produced by Reliance Medical Information, Inc.)