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Rheumatology International

, Volume 39, Issue 2, pp 245–253 | Cite as

Persistent eosinophilia in rheumatoid arthritis: a prospective observational study

  • Dantis Emmanuel
  • Subhash Chandra Parija
  • Ankit Jain
  • Durga Prasanna Misra
  • Rakhee Kar
  • Vir Singh NegiEmail author
Observational Research
  • 79 Downloads

Abstract

Eosinophilia is an uncommon manifestation in Rheumatoid arthritis (RA), and there is a paucity of data regarding the relationship of eosinophilia with disease-related factors. We prospectively evaluated the clinical and disease-specific characteristics of RA patients with eosinophilia. Consecutive patients with RA with an absolute eosinophil count ≥ 500/mm3 without an apparent cause for eosinophilia, were investigated for parasitic infestation. Patients with a definite parasitic infestation received targeted therapy, and the rest were treated with albendazole empirically. The RA disease-specific characteristics of the patients with persistent eosinophilia were compared with the patients without eosinophilia. Of the 160 patients with eosinophilia, 30 patients (19%) had allergic diseases, six patients had bronchiectasis, and one patient had hypereosinophilia of undetermined significance. Intestinal helminthiasis was found in 34 patients (21%). Eosinophilia was unexplained in 89 patients (56%) and it resolved after empirical albendazole therapy in about two-thirds (58 patients). Thirty-one patients had persistent eosinophilia. Nonsteroidal anti-inflammatory drug and disease-modifying antirheumatic drug modification did not show any effect on eosinophilia. The disease-related characteristics were similar between patients with persistent eosinophilia and those without eosinophilia. Eosinophilia is due to secondary causes in the majority of RA patients, and the most common cause in our setting is an intestinal helminthic infection. Persistent eosinophilia in our cohort of RA did not indicate a more severe disease phenotype.

Keywords

Rheumatoid arthritis Eosinophilia Intestinal helminthiasis Albendazole Disease activity 

Abbreviations

ACPA

Anti-citrullinated protein antibodies

AEC

Absolute eosinophil count

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

DAS28

Disease activity score in 28 joints

DMARDs

Disease-modifying antirheumatic drugs

DRESS

Drug rash with eosinophilia and systemic symptoms

ELISA

Enzyme-linked immunosorbent assay

ESPOIR

Etude et Suivi des POlyarthrites Indifférenciées Récentes

ESR

Erythrocyte sedimentation rate

FIP1L1-PDGFRA (F/P)

Fip1-like 1-platelet-derived growth factor receptor alpha fusion gene

HCQ

Hydroxychloroquine

HEus

Hypereosinophilia of undetermined significance

IHAQ

Indian version of the Health Assessment Questionnaire

ILD

Interstitial lung disease

LEF

Leflunomide

MTX

Methotrexate

NSAIDs

Nonsteroidal anti-inflammatory drugs

PDGFRB

Platelet-derived growth factor receptor beta

RA

Rheumatoid arthritis

RF

Rheumatoid factor

SJ

Swollen joint

SSZ

Sulfasalazine

TJ

Tender joint

VAS

Visual analog scale

Notes

Acknowledgements

The authors thank Dr. Nonika Rajkumari, Assistant Professor, Department of Microbiology, JIPMER, for her contributions in parasitic work up.

Author contributions

(1) The conception and design of the study—DE, SCP, RK, and VSN. Acquisition of data—DE, SCP, AJ, and DPM. Analysis and interpretation of data—DE, SCP, AJ, and DPM. (2) Drafting the article—DE, AJ, and DPM. Revising it critically for important intellectual content—SCP, RK, and VSN. (3) Final approval of the version to be submitted—DE, SCP, AJ, DPM, RK, and VSN. (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved—DE, SCP, AJ, DPM, RK, and VSN.

Funding

The research was funded by an intramural research grant, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. (Grant no.: JIP/Res/Intra-DM-M.Ch/01/2015-16 and JIP/Res/Intra-DM, M.Ch/phas1/grant2/01/2016-17).

Compliance with ethical standards

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approved by the Institute Ethics Committee of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India, held on 11th December 2014 (JIP/IEC/2014/10/480).

Conflict of interest

Dantis Emmanuel declares that he has no conflict of interest. Subhash Chandra Parija declares that he has no conflict of interest. Ankit Jain declares that he has no conflict of interest. Durga Prasanna Misra declares that he has no conflict of interest. Rakhee Kar declares that she has no conflict of interest. Vir Singh Negi declares that he has no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical ImmunologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia
  2. 2.Department of Clinical Immunology and RheumatologyRajagiri HospitalAluvaIndia
  3. 3.Department of MicrobiologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia
  4. 4.Sri Balaji VidyapeethPillaiyarkuppamIndia
  5. 5.Immunology and Rheumatology ClinicMeerutIndia
  6. 6.Department of Clinical ImmunologySanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS)LucknowIndia
  7. 7.Department of PathologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia

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