Pathological assessment of the lymph node biopsies for lymphadenopathy in rheumatoid arthritis

Abstract

Objectives: To assess the incidence of reactive lymph node hyperplasia (RLH) and the diagnostic characteristics that can help differentiate it from lymphoproliferative disorders (LPD) in patients with rheumatoid arthritis (RA).

Methods: Data on patient characteristic from 32 consecutive RA patients with lymphadenopathy at a single medical center over a 6-year period were collected and analyzed to determine whether any of these characteristics can differentiated RLH from LPD.

Results: LPD including methotrexate (MTX) - associated LPD (MTX-LPD) and RLH were diagnosed in 19 and 10 patients, respectively. Conclusive diagnosis was not reached in the remaining three cases and they were regarded as grey-zone cases. Age, levels of lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R), as well as maximum standardized uptake value (SUV_max), were significantly higher in LPD than in RLH patients. The diagnosis cut-off values for these parameters were 66 year, 169 U/L, 899 U/mL and 8.18, respectively, based on the receiver operating characteristics curve analysis for both RLH and LPD.

Conclusions: About one-third of patients with RA who presented with lymphadenopathy had reactive lymph node enlargement. Older age and higher levels of LDH, sIL-2R, and SUV_max are more associated with LPD than should be considered when deciding to perform a biopsy.

Keywords:

• Immunosuppression
• lymphoproliferative disorders
• methotrexate
• pathology
• rheumatoid arthritis

Conflict of interest

None.

Additional information

Funding

This study was supported by the JSPS KAKENHI Grant [Number 17K0873C] and Grant-in-Aid for Clinical research from the National Hospital Organization.