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Persistent eosinophilia in rheumatoid arthritis: a prospective observational study

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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.

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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

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Acknowledgements

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

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).

Author information

Author notes

  1. Dantis Emmanuel

    Present address: Department of Clinical Immunology and Rheumatology, Rajagiri Hospital, Aluva, Kerala, 683112, India

  2. Subhash Chandra Parija

    Present address: Sri Balaji Vidyapeeth, Pillaiyarkuppam, Puducherry, 607402, India

  3. Ankit Jain

    Present address: Immunology and Rheumatology Clinic, Meerut, UP, 250001, India

  4. Durga Prasanna Misra

    Present address: Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India

Authors and Affiliations

  1. Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Dantis Emmanuel, Ankit Jain, Durga Prasanna Misra & Vir Singh Negi

  2. Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Subhash Chandra Parija

  3. Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Rakhee Kar

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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.

Corresponding author

Correspondence to Vir Singh Negi.

Ethics declarations

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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Emmanuel, D., Parija, S.C., Jain, A. et al. Persistent eosinophilia in rheumatoid arthritis: a prospective observational study. Rheumatol Int 39, 245–253 (2019). https://doi.org/10.1007/s00296-018-4191-1

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