Association of rheumatoid arthritis and Castleman’s disease

Overview

Rheumatoid arthritis (RA), particularly its active forms, is associated with lymphadenopathy almost in 30% of cases. Simultaneously, increased incidence of lymphoproliferative as well as prelymphoproliferative disorders including Castleman’s disease is found in RA patients. Few case reports of Castleman’s disease association with RA have been published so far. Diagnosis of RA always preceded manifestation of Castleman’s disease in all of above-mentioned case reports. We describe here a case report of 54-year-old patient with lymphadenopathy of inguinal and parailiacal lymph nodes. Hyaline vascular type of Castleman’s disease was diagnosed in 1998. At the same time elevated serum levels of rheumatoid factors (latex test 1:20480) were detected. When three series of cyclophosphamide 680 mg/m² + vincristine 2 mg/m² and three series of cyclophosphamide 680 mg/m² + vinblastine 11 mg/m² were administrated, 2 months remission of the disease has been achieved. Glucocorticoid administration was initiated to overcome a subsequent relapse of the disease which lead to a persistent remission. Four years after diagnosis of Castleman’s disease, polyarthritic syndrome appeared with RA criteria (ACR/ARA 1987) being fulfilled. Methotrexate in a dose of 15 mg per week, hydroxychloroquine and sulfasalazine were added to glucocorticoids (8 mg per day). Two years later, the activity of RA reappeared and threetime elevation of liver enzymes was detected. Treatment with cyclosporine, dose of 2.5 mg per kg and day, has been started. It is remarkable that Castleman’s disease preceded 4 years before manifestation of RA in this case report. Several authors emphasize that it is impossible to distinguish histological finding of lymph node between Castleman’s disease and RA. This problem begins to be actual and alarming in an increasing use of biological treatment, which may cause adverse effects such as malignant disease.

Key words:
Castleman’s disease, rheumatoid arthritis, rheumatoid factor, cyclosporine A