Hyperviscosity Syndrome in Rheumatoid Arthritis

To the Editor: Hyperviscosity syndrome (HVS) is a life-threatening condition often occurring as complication of Waldenström macroglobulinemia (WM) but rarely in context rheumatic disease. Given its rarity, diagnosis can be delayed, leading to greater morbidity. Our interest was sparked by recent experience with patient rheumatoid arthritis (RA) who developed epistaxis progressively worsening dyspnea, confusion, and visual deficits culminating hospitalization due HVS1. As HVS uncommon era biologic medications, we conducted systematic review (Supplementary Figure 1, available from authors on request) define factors that predispose describe outcomes previous treatment approaches. We identified 25 cases hyperviscosity attributed RA. The most common presenting features for included bleeding diathesis (e.g., epistaxis, gastrointestinal hemorrhage, gingival bleeding), heart failure (dyspnea and/or pedal edema), neurologic symptoms (dizziness, syncope, confusion), constitutional (Table 1). RA years before (7.9 ± 7.4 yrs) manifestation 3 cases. Synovitis active … Address correspondence Dr. J.B. Miller, Instructor Medicine, 5200 Eastern Ave., Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD 21224, USA. Email: JMill237{at}jhmi.edu.