Rheumatoid factor positivity in ANCA-negative eosinophilic granulomatosis with polyangiitis: cardiac mimicry, mononeuritis multiplex, and long-term outcome in a case-based systematic review.

What was studied

This report starts with one woman aged 42 years. She had asthma and a high rheumatoid factor. She came with heart problems that looked like a heart attack. Her coronary arteries were not blocked. Later she developed more eosinophils, sinus disease with nasal polyps and nerve damage. She was diagnosed with ANCA-negative EGPA. The authors then reviewed published cases that were ANCA-negative and rheumatoid factor-positive.

What they found

The woman was treated with prednisolone and azathioprine. She later stayed off drugs that calm the immune system, with no reported relapse. On review she was stable, apart from mild nerve symptoms. The review found 38 published cases. 36 had no earlier rheumatoid arthritis. Their median age was 53 years. Nerve damage and heart involvement were often reported. Reports were often incomplete. No published case reported a long remission without treatment. Follow-up was incompletely reported in several.

What it means for patients

The authors say a positive rheumatoid factor should not stop doctors from thinking of EGPA. This holds even if it is high. They say it applies when asthma, eosinophilia, ENT disease or nerve problems are present. They propose a reporting checklist for future case reports.

Why it is not certain yet

The case report covers one patient, who cannot show what usually happens. Published cases were often incomplete. Follow-up and treatment details were missing in several cases. Case reports have no comparison group.

Source

Rheumatoid factor positivity in ANCA-negative eosinophilic granulomatosis with polyangiitis: cardiac mimicry, mononeuritis multiplex, and long-term outcome in a case-based systematic review.

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