First Sign of Myelodysplastic Syndromes Is Often Arthritis


For more than half of patients with myelodysplastic syndrome, swollen and tender joints preceded diagnosis by nearly a year, according to a new study. Also last week in the nonspecialty journals: A shark genome shows early steps in immune system evolution.

New articles relevant to rheumatology in the top general-interest journals.Inflammatory Arthritis in Patients With Myelodysplastic Syndromes: A Multicenter Retrospective Study and Literature Review of 68 CasesMedicine, January 2014

Inflammatory arthritis associated with myelodysplastic syndromes (MDS)  is often seronegative and nonerosive, and often precedes the symptoms indicating MDS. In this report, a multicenter French study retrospectively assessed the course of 22 patients with MDS. Arthritis preceded the MDS in 12 cases (55%). Steroids alone are the most common treatment, but are insufficient to control the arthritis.


Elephant shark genome provides unique insights into gnathostome evolutionNature, January 8, 2014

During a slow week for rheumatology in the nonspecialty journals, Nature provides an interesting glimpse into the early evolution of the immune system with a genome study of the elephant shark, Callorhinchus milii.  A cartilagenous fish that has the slowest-growing genome of all known invertebrates, the gene sequence provides insights into the evolution of the bony skeleton and the adaptive immune system.

The primitive shark lacks the secreted calcium-binding phosphoprotein family, as well as the CD4 receptor and many interleukins. The genome study  suggests a close linkage of immunoglobulin and T-cell receptor genes, supporting the idea that antigen receptor genes evolved from a common ancestor, and even that the V region of immunoglobulins was originally part of a structure similar to a T-cell receptor. The presence of cytotoxic natural killer and CD8 T cells but the absence of cytokines and important receptors associated with helper function implies that these sharks evolved a “full-blown” cytotoxic system but only a primordial type of helper function. Their immune system does eliminate self-reactive lymphocytes.

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