Persistent eosinophilia in rheumatoid arthritis: a prospective observational study
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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.
KeywordsRheumatoid arthritis Eosinophilia Intestinal helminthiasis Albendazole Disease activity
Anti-citrullinated protein antibodies
Absolute eosinophil count
Disease activity score in 28 joints
Disease-modifying antirheumatic drugs
Drug rash with eosinophilia and systemic symptoms
Enzyme-linked immunosorbent assay
Etude et Suivi des POlyarthrites Indifférenciées Récentes
Erythrocyte sedimentation rate
- FIP1L1-PDGFRA (F/P)
Fip1-like 1-platelet-derived growth factor receptor alpha fusion gene
Hypereosinophilia of undetermined significance
Indian version of the Health Assessment Questionnaire
Interstitial lung disease
Nonsteroidal anti-inflammatory drugs
Platelet-derived growth factor receptor beta
Visual analog scale
The authors thank Dr. Nonika Rajkumari, Assistant Professor, Department of Microbiology, JIPMER, for her contributions in parasitic work up.
(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.
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
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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