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Rheumatology International

, Volume 38, Issue 6, pp 1017–1022 | Cite as

CT assessment of axillary lymphadenopathy in patients with rheumatoid arthritis: association with disease activity and severity

  • Mizue Hasegawa
  • Fumikazu Sakai
  • Naoko Konda
  • Asako Okabayashi
  • Hideki Katsura
  • Yohei Seto
Imaging
  • 82 Downloads

Abstract

Background

Axillary lymph nodes (ALNs) are often seen on chest computed tomography (CT) in rheumatoid arthritis (RA) patients. Early reports described lymphadenopathy as one of the systemic manifestations rather than regional lymphadenopathy secondary to drainage from the affected joints. Subsequently, the importance of the immunological events occurring in draining lymph nodes in the development of arthritis was documented.

Objective

To identify the relationships of local disease activity and background characteristics, including systemic disease activity, systemic disease activity, with axillary lymphadenopathy (AL) in RA using CT.

Methods

RA patients who had undergone chest CT were retrospectively analyzed. The maximum short axis of the ALNs was measured, and the number of positive ALNs ≥ 5 mm was counted. Tender and swollen joints in the upper limbs were counted as indicators of local disease activity. Background characteristics and systemic disease activity were assessed based on the selected RA indicators. Correlations between AL and both local disease activity and background characteristics including systemic disease activity were analyzed.

Results

Of 135 patients, 58 had positive ALNs (average size 7.97 mm, range up to 15 mm). The presence of positive unilateral ALNs was correlated with the severity of ipsilateral upper limb arthritis. Multivariate analysis showed correlations between AL and both local disease activity and serological findings such as serum C-reactive protein (CRP) and immunoglobulin (Ig) G.

Conclusion

AL in patients with RA was correlated with local arthritis activity, as well as background characteristics and systemic disease activity.

Keywords

Arthritis Axillary lymphadenopathy Lymph node Lymphadenopathy Rheumatoid arthritis 

Notes

Acknowledgements

The authors would like to thank Dr. Tomoyuki Akita for his valuable advice and assistance with the statistical analysis of this study.

Author contributions

MH: conception and design of the study, analysis and interpretation of the data, collection and assembly of data, drafting of the article, and critical revision of the article for important intellectual content. FS: conception and design of the study, analysis and interpretation of the data, drafting of the article, and critical revision of the article for important intellectual content. NK: collection and assembly of data. AO: collection and assembly of data. HK: collection and assembly of data. YS: conception and design of the study, analysis and interpretation of the data collection and assembly of data, drafting of the article, and critical revision of the article for important intellectual content.

Funding

None.

Compliance with ethical standards

Conflict of interest

Mizue Hasegawa, Fumikazu Sakai, Naoko Konda, Asako Okabayashi, Hideki Katsura, and Yohei Seto declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Protocol number: 3903. Date of approval: 25 Apr 2016. Approving institution: Tokyo Women’s Medical University, Tokyo, Japan.

Informed consent

For this type of study formal consent is not required.

External editing support

FORTE (http://www.forte-science.co.jp/).

References

  1. 1.
    Motulsky AG, Weinburg S, Saphir O, Rosenberg E (1952) Lymph nodes in rheumatoid arthritis. Arch Intern Med 90:660–676CrossRefGoogle Scholar
  2. 2.
    Newbould BB (1964) Role of lymph nodes in adjuvant induced arthritis in rats. Ann Rheum Dis 23:392–396CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kamel OW, van de Rijin M, Weiss LM, Del Zoppo GJ, Kahler Hench P, Robbins BA et al (1993) Reversible lymphomas associated with Epstein–Barr virus occurring during methotrexate therapy for rheumatoid arthritis and dermatomyositis. N Engl J Med 328:1317–1321CrossRefPubMedGoogle Scholar
  4. 4.
    Kamel OW, van de Rijin M, Lebrun DP, Weiss LM, Warnke RA, Dorfman RF (1994) Lymphoid neoplasms in patients with rheumatoid arthritis and dermatomyositis: frequency of Epstein–Barr virus and other features associated with immunosuppression. Hum Pathol 25:638–643CrossRefPubMedGoogle Scholar
  5. 5.
    Amett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324CrossRefGoogle Scholar
  6. 6.
    Aletaha D, Neogi T, Silman AJ, Funovitis J, Felson DT, Bingham CO 3rd et al (2010) Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against. Rheum Collab Initiat 62:2569–2581Google Scholar
  7. 7.
    Xing L, Ji RC (2008) Lymphangiogenesis, myeloid cells and inflammation. Expert Rev Clin Immunol 4(5):599–613CrossRefPubMedGoogle Scholar
  8. 8.
    Liersch R, Detmar M (2007) Lymphangiogenesis in development and disease. Thromb Haemost 98:304–310CrossRefPubMedGoogle Scholar
  9. 9.
    Lee SH, Suh JS, Kim HS, Lee JD, Song J, Lee SK (2003) MR evaluation of radiation synovectomy of the knee by means of intra-articular injection of holmium-166-chitosan complex in patients with rheumatoid arthritis: results at 4-month follow up. Korean J Radiol 4(3):170–178CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Olszewski WL, Pazdur J, Kubasiewicz E, Zaleska M, Cooke CJ, Miller NE (2001) Lymph draining from foot joints in rheumatoid arthritis provides insights into local cytokine and chemokine production and transport to lymph nodes. Arthritis Rheum 44(3):541–549CrossRefPubMedGoogle Scholar
  11. 11.
    Young A, Koduri G (2007) Extra-articular manifestations and complications of rheumatoid arthritis. Best Pract Res Clin Rheumatol 21(5):907–927CrossRefPubMedGoogle Scholar
  12. 12.
    Calgüneri M, Öztürk MA, Özbalkan Z, Akdogan A, Üreten K, Kiraz S et al (2003) Frequency of lymphadenopathy in rheumatoid arthritis and systemic lupus erythematosus. J Int Med Res 31:345–349CrossRefPubMedGoogle Scholar
  13. 13.
    Fleming A, Dodman S, Crown JM, Corbett M (1976) Extra-articular features in early rheumatoid arthritis. Br Med J 1:1241–1243CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Kondratowicz GM, Symmons DP, Bacon PA, Mageed RAK, Jones EL (1990) Rheumatoid lymphadenopathy: a morphological and immunohistochemical study. J Clin Pathol 53:106–113CrossRefGoogle Scholar
  15. 15.
    Hart FD (1987) Lymphadenopathy in rheumatoid patients. Ann Rheum Dis 46:645–646CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Robertson MDJ, Hart FD, White WF, Nuki G, Boardman PL (1968) Rheumatoid lymphadenopathy. Ann Rheum Dis 27:253–260CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Nosanchuk JS, Schnitzer B (1969) Follicular hyperplasia in lymph nodes from patients with rheumatoid arthritis: a clinicopathological study. Cancer 24:343–354CrossRefGoogle Scholar
  18. 18.
    van Baarsen LGM, de Hair MLH, Ramwadhdoebe TH, Zijlstra IJAJ., Maars M, Gerlag DM, Tak PP (2013) The cellular composition of lymph nodes in the earliest phase of inflammatory arthritis. Ann Rheum Dis 72:1420–1424CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Li J, Kuzin I, Moshkani S, Proulx ST, Xing L, Skrombolas D et al (2010) Expanded CD23(+)/CD21(hi) B cells in inflamed lymph nodes are associated with the onset of inflammatory-erosive arthritis in TNF-transgenic mice and are targets of anti-CD20 therapy. J Immunol 184:6142–6150CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Bouta EM, Li J, Brown EB, Ritchlin CT, Xing L, Schwarz EM (2015) The role of the lymphatic system in inflammatory-erosive arthritis. Semin Cell Dev Biol 38:90–97CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ahmed MA, Fouda N, Elashry AEAA. (2013) Axillary lymph node in rheumatoid arthritis: Does it associate disease activity? Egypt Rheumatol 35:37–43CrossRefGoogle Scholar
  22. 22.
    Manzo A, Caporali R, Vitolo B, Alessi S, Banaglio F, Todoerti M et al (2011) Subclinical remodeling of draining lymph node structure in early and established rheumatoid arthritis assessed by power Doppler ultrasonography. Rheumatology 50:1395–1400CrossRefPubMedGoogle Scholar
  23. 23.
    Huh Y, Kim S, Suh J, Song H, Song K, Shin K (2005) The role of popliteal lymph nodes in differentiating rheumatoid arthritis from osteoarthritis by using CE 3D-FSPGR MR Imaging: Relationship of the inflamed synovial volume. Korean J Radiol 6:117–124CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kelly CA, Malcolm AJ, Griffiths I (1987) Lymphadenopathy in rheumatic patients. Ann Rheum Dis 46:224–227CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Respiratory medicine, Yachiyo Medical CenterTokyo Women’s Medical UniversityYachiyoJapan
  2. 2.Department of Diagnostic Radiology, Saitama International Medical CenterSaitama Medical UniversitySaitamaJapan
  3. 3.Department of Rheumatology, Yachiyo Medical CenterTokyo Women’s Medical UniversityYachiyoJapan

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