RHEUMATOID HYPERVISCOSITY - ANALYSIS OF A PATIENT WITH INTERMEDIATE COMPLEXES THAT BLOCK OTHER AUTOANTIBODIES AND A REVIEW OF THE LITERATURE

Objectives: To report a patient whose rheumatoid arthritis presented w ith hyperviscosity syndrome, analyze this patient's rheumatoid factor and review the previously reported patients. Methods: Immunofluorescen ce for antinuclear antibodies, double immunodiffusion, enzyme-linked i mmunosorbent assay, and size exclusion chromatography were used before and after plasmapheresis to study the patient's rheumatoid hypervisco sity. A systematic Medline search of rheumatic illnesses, hyperviscosi ty, and polyclonal gammopathy and references in identified papers was used to identify previously reported patients, Results: Similar to sev eral previous patients, this patient's sera contained both IgG and IgM rheumatoid factor and abundant intermediate complexes. Other autoanti bodies, either from the patient or from, other patients, were masked b y rheumatoid factor or intermediate complexes from the reported patien t's sera. Rheumatic hyperviscosity is seen uncommonly, being reported in only 18 patients with rheumatoid arthritis and nine with other rheu matic illnesses. Conclusions: There are two mechanisms by which rheuma toid factor can lead to hyperviscosity, both of which require large am ounts of rheumatoid factor Rheumatoid hyperviscosity must be recognize d because this rife-threatening syndrome usually can be successfully t reated with plasmapheresis acutely and immunosuppressives for long-ter m control. Copyright (C) 1998 by W.B. Saunders Company.