Erosive Rheumatoid Arthritis After Bilateral Hand Transplantation
Authors: Brittany L. Adler, Jemima Albayda, Jamie T. Shores, W.P. Andrew Lee, Gerald Brandacher, Clifton O. Bingham
Journal: Annals of Internal Medicine (2017)

Letters1 August 2017Erosive Rheumatoid Arthritis After Bilateral Hand TransplantationBrittany L. Adler, MD, Jemima Albayda, MD, Jamie T. Shores, MD, W.P. Andrew Lee, MD, Gerald Brandacher, MD, and Clifton O. Bingham III, MDBrittany L. Adler, MDFrom Johns Hopkins University School of Medicine, Baltimore, Maryland., Jemima Albayda, MDFrom Johns Hopkins University School of Medicine, Baltimore, Maryland., Jamie T. Shores, MDFrom Johns Hopkins University School of Medicine, Baltimore, Maryland., W.P. Andrew Lee, MDFrom Johns Hopkins University School of Medicine, Baltimore, Maryland., Gerald Brandacher, MDFrom Johns Hopkins University School of Medicine, Baltimore, Maryland., and Clifton O. Bingham III, MDFrom Johns Hopkins University School of Medicine, Baltimore, Maryland.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0588 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Rheumatoid arthritis is a systemic autoimmune disease that primarily affects joints. The pathogenesis is unknown but probably involves environmental and genetic factors.Objective: To describe a patient whose rheumatoid arthritis seems to be a combination of environmental and genetic factors.Case Report: A previously healthy 26-year-old woman of Filipino descent developed digital gangrene from meningococcemia, resulting in bilateral midforearm and below-knee amputations. At age 33 years, the patient received allogeneic bilateral hand and forearm transplants. Neither the patient nor the donor had a personal or family history of rheumatoid arthritis. The immunotherapy regimen consisted of a bone marrow cell ...References1. Neogi T, Aletaha D, Silman AJ, Naden RL, Felson DT, Aggarwal R, et al; American College of Rheumatology. The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: phase 2 methodological report. Arthritis Rheum. 2010;62:2582-91. [PMID: 20872596] doi:10.1002/art.27580 CrossrefMedlineGoogle Scholar2. Gregersen PK, Silver J, Winchester RJ. The shared epitope hypothesis. An approach to understanding the molecular genetics of susceptibility to rheumatoid arthritis. Arthritis Rheum. 1987;30:1205-13. [PMID: 2446635] CrossrefMedlineGoogle Scholar3. Ali AA, Moatter T, Baig JA, Iqbal A, Hussain A, Iqbal MP. Polymorphism of HLA-DR and HLA-DQ in rheumatoid arthritis patients and clinical response to methotrexate—a hospital-based study. J Pak Med Assoc. 2006;56:452-6. [PMID: 17144392] MedlineGoogle Scholar4. Mariaselvam CM, Fortier C, Charron D, Krishnamoorthy R, Tamouza R, Negi VS. HLA class II alleles influence rheumatoid arthritis susceptibility and autoantibody status in South Indian Tamil population. HLA. 2016;88:253-8. [PMID: 27753285] doi:10.1111/tan.12910 CrossrefMedlineGoogle Scholar5. Shores JT, Brandacher G, Lee WP. Hand and upper extremity transplantation: an update of outcomes in the worldwide experience. Plast Reconstr Surg. 2015;135:351. [PMID: 25401735] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Johns Hopkins University School of Medicine, Baltimore, Maryland.Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Financial Support: By grant P30-AR053503 and T32-AR048522 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, award W81XWH-08-2-0032 from the Department of Defense and Armed Forces Institute of Regenerative Medicine, and the University of Pittsburgh Medical Center and Johns Hopkins University School of Medicine.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L16-0588.This article was published at Annals.org on 27 June 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTwo Decades of Hand TransplantationA review on the effect of prolyl isomerization on immune response aberration and hypersensitivity reactions: A unifying hypothesis 1 August 2017Volume 167, Issue 3Page: 216-218KeywordsAllelesAntibodiesAntigensDisclosureGeneticsHuman leukocyte antigenPathogenesisRheumatoid arthritisTransplantationUltrasound imaging ePublished: 27 June 2017 Issue Published: 1 August 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...