| Diagnostic strategy for patients with hypogammaglobulinemia in rheumatology. | |
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MedLine Citation:
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PMID: 21036646 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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The discovery of hypogammaglobulinemia, which is defined as a plasmatic level of immunoglobulin (Ig) under 5g/L is rare in clinical practice. However, the management of immunodepressed patients in rheumatology, sometimes due to the use of immunosuppressive treatments such as anti-CD20 in chronic inflammatory rheumatisms, increases the risk of being confronted to this situation. The discovery of hypogammaglobulinemia in clinical practice, sometimes by chance, must never be neglected and requires a rigorous diagnosis approach. First of all, in adults, secondary causes, in particular lymphoid hemopathies or drug-related causes (immunosuppressors, antiepileptics) must be eliminated. A renal (nephrotic syndrome) or digestive (protein-losing enteropathy) leakage of Ig is also possible. More rarely, it is due to an authentic primary immunodeficiency (PID) discovered in adulthood: common variable immunodeficiency (CVID) which is the most frequent form of PID, affects young adults between 20 and 30 years and can sometimes trigger joint symptoms similar to those in rheumatoid arthritis; or Good syndrome, which associates hypogammaglobulinemia, thymoma and recurrent infections around the age of 40 years. In most cases, after confirming hypogammaglobulinemia on a second test, biological examinations and thoracic-abdominal-pelvic CT scan will guide the diagnosis, after which the opinion of a specialist can be sought depending on the findings of the above examinations. At the end of this review, we provide a decision tree to guide the clinician confronted to an adult-onset hypogammaglobulinemia. |
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Authors:
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Maxime Samson; Sylvain Audia; Daniela Lakomy; Bernard Bonnotte; Christian Tavernier; Paul Ornetti |
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Publication Detail:
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Type: Journal Article Date: 2010-10-30 |
Journal Detail:
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Title: Joint, bone, spine : revue du rhumatisme Volume: 78 ISSN: 1778-7254 ISO Abbreviation: Joint Bone Spine Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-05-06 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100938016 Medline TA: Joint Bone Spine Country: France |
Other Details:
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Languages: eng Pagination: 241-5 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved. |
Affiliation:
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Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; CR Inserm U866, Lipids Nutrition Cancer, 21000 Dijon, France. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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