TCD4pos lymphocytosis in rheumatoid and psoriatic arthritis patients following TNFα blocking agents

Andrea Picchianti Diamanti, Bruno Laganà, Maria Christina Cox, Emanuela Pilozzi, Rachele Amodeo, Maurizio Bove, Milica Markovic, Roberta Di Rosa, Simonetta Salemi, Maria Laura Sorgi, Maria Manuela Rosado, Raffaele D’Amelio

Lymphocyte expansion and true lymphocytosis are commonly observed in the everyday clinical practice. The meaning of such phenomenon is often poorly understood so that discrimination between benign and malignant lymphocytosis remains difficult to establish. This is mainly true when lymphocytosis rises in patients affected by immune-mediated chronic inflammatory diseases under immunosuppressive treatment, conditions potentially associated with lymphomagenesis. In this brief report the development of mild T CD4(pos) lymphocytosis in a group of patients with chronic arthritis under anti-TNF-α treatment is described. Two hundred eight rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients have been evaluated longitudinally for at least 1-year before and 2-years after anti-TNF-α therapy introduction for the possible appearance of a lymphocyte expansion. In patients who developed lymphocyte expansion, T, B and NK cells were analysed. Twenty-five out of 208 (12%) subjects developed a mild T CD4(pos) lymphocytosis, during anti-TNF-α therapy, which reverted after its interruption. Higher lymphocyte count, more frequent use of steroids and shorter disease duration, before biological therapy start, have emerged as risk factors for lymphocytosis development. This is the first longitudinal cohort study evaluating the onset of lymphocytosis in RA and PsA patients under anti-TNF-α treatment and its possible clinical relevance. A mild T CD4(pos) lymphocytosis has been observed in 12% of RA and PsA patients probably related to anti-TNF-α treatment as previously reported by anecdotal cases. Patients with higher baseline lymphocyte count, use of steroids and shorter disease duration before the introduction of biologic therapy, seem to be prone to develop this laboratory reversible abnormality.