Rheumatic involvement and bone scan features in Schnitzler syndrome: initial and follow-up data from a single-center coh
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(2020) 22:272
RESEARCH ARTICLE
Open Access
Rheumatic involvement and bone scan features in Schnitzler syndrome: initial and follow-up data from a single-center cohort of 25 patients Christelle Darrieutort-Laffite1*† , Catherine Ansquer2†, Hélène Aubert3, Françoise Kraeber-Bodéré2, Agathe Masseau4, Christian Agard4, Mohamed Hamidou4, Claire Bernier3, Jean-Marie Berthelot1, Benoit Le Goff1, Sébastien Barbarot3 and Antoine Néel4
Abstract Objective: To report on the characteristics and long-term course of rheumatic manifestations in Schnitzler syndrome (SchS). Methods: A retrospective cohort study of patients with SchS followed between 2000 and 2020. Inclusion criteria included a diagnosis of SchS (Strasbourg criteria). All available bone scans were reviewed and scored according to the intensity and number of pathological sites. The scintigraphic score was compared with the clinical activity score, CRP level, and treatments. Results: Twenty-five patients were included. Median age at diagnosis was 68 years. Eighty patients (72%) had SchSrelated rheumatic pain. Most patients had a long-standing isolated rash before constitutional and/or rheumatic symptoms appeared. The monoclonal component level was usually very low (IgMκ in 22/25). Rheumatic pain predominated around the knees. Bone scans revealed abnormal tracer uptake in 15/18 (85%). The scintigraphic score correlated with clinical activity (r = 0.4, p < 0.02) and CRP level (r = 0.47, p < 0.01). The scintigraphic score was lower in patients receiving corticosteroids or IL1Ra (interleukin 1 receptor antagonist) than in untreated patients (median scores:2, 0, and 13, respectively; p < 0.05). Two patients developed Waldenström macroglobulinemia. Of the 22 surviving patients, median age at follow-up was 76 years. IL1Ra was used in 13 patients, with dramatic efficacy on both symptoms and bone scan features. Conclusions: Rheumatic manifestations are very prevalent in SchS. However, bone pain can be misleading and contribute to misdiagnosis. Bone scan abnormalities are very prevalent and correlate with disease activity and treatments. IL1-Ra has a dramatic and durable efficacy but may not be required in every patient early on. Keywords: Bone scan, Bone lesions, Interleukin 1 receptor antagonist, Schnitzler syndrome
* Correspondence: [email protected] † Christelle Darrieutort-Laffite and Catherine Ansquer contributed equally to this work. 1 Department of Rheumatology, CHU Nantes, 1 place Alexis Ricordeau, 44000 Nantes, France Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article
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