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Citation:
Gaillard F, Rasuli B, Sharma R, et al. Multicentric reticulohistiocytosis. Reference article, Radiopaedia.org (Accessed on 11 May 2024) https://doi.org/10.53347/rID-1694
Multicentric reticulohistiocytosis (MRH), also known as lipoid dermatoarthritis, is a rare systemic disorder.
The exact prevalence is not known, but the condition is considered to be very rare 11. It has a slight female preponderance 11.
Associations
There is a recognised association with various malignancies (up to 25% of cases 9,11).
The two most common and characteristic manifestations are 11:
- symmetric, erosive, deforming polyarthritis, typically affecting the hands but can also involve other small joints and also larger joints
- papulonodular skin lesions, particularly periungual lesions
Multicentric reticulohistiocytosis is considered a form of granulomatous disease 10 characterised by infiltration of multinucleated histiocytes into various tissues, primarily affecting skin and synovium, which results in an erosive, deforming polyarthritis.
Skeletal
It can have similar plain film findings as gout and rheumatoid arthritis, although it is, unlike these two other conditions, associated with joint space widening.
Features are bilateral and symmetric and include:
- sharply demarcated marginal erosions: can have a strikingly bilateral symmetrical distribution and is often sharply circumscribed and rapidly progressive
- nodular soft tissue swelling: may be appreciated as prominent, non-calcified nodules of the skin, subcutaneous tissue, and tendon sheaths
- predisposition for interphalangeal joints
- there can be a tendency toward early and severe atlantoaxial involvement
- no or mild periarticular osteopenia (unlike rheumatoid arthritis)
- often a disproportion between severity of joint destruction and mildness of symptoms regardless of therapy
- absent or minimal periosteal reaction
Treatment and prognosis
Management is typically challenging and successful treatment regimens are only guided by case reports and series given the rarity of the condition 11. Various DMARDs have been used with varying degrees of success 11.
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4. Brodey, Philip A. Radiology. doi:10.1148/114.2.327
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5. Fiumicelli A, Bruni L. [Multicentric reticulohistiocytosis (lipoid dermato-arthritis). A radiologic study of 3 cases]. Radiol Med. 1990;80 (3): 277-85. - Pubmed citation
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6. Gold RH, Bassett LW, Seeger LL. The other arthritides. Roentgenologic features of osteoarthritis, erosive osteoarthritis, ankylosing spondylitis, psoriatic arthritis, Reiter's disease, multicentric reticulohistiocytosis, and progressive systemic sclerosis. Radiol. Clin. North Am. 1988;26 (6): 1195-212. - Pubmed citation
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7. Kamata Y, Minota S. Progressive multicentric reticulohistiocytosis. Intern. Med. 2012;51 (6): 687-8. Pubmed citation
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8. Kishikawa T, Miyashita T, Fujiwara E et-al. Multicentric reticulohistiocytosis associated with ovarian cancer. Mod Rheumatol. 2007;17 (5): 422-5. Mod Rheumatol (abstract) - doi:10.1007/s10165-007-0600-0 - Pubmed citation
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9. El-Haddad B, Hammoud D, Shaver T et-al. Malignancy-associated multicentric reticulohistiocytosis. Rheumatol. Int. 2011;31 (9): 1235-8. Rheumatol. Int. (full text) - doi:10.1007/s00296-009-1287-7 - Pubmed citation
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10. Tajirian AL, Malik MK, Robinson-Bostom L et-al. Multicentric reticulohistiocytosis. Clin. Dermatol. 2006;24 (6): 486-92. doi:10.1016/j.clindermatol.2006.07.010 - Pubmed citation
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11. Sanchez-Alvarez C, Sandhu AS, Crowson CS, Wetter DA, McKenzie GA, Lehman JS, Makol A. Multicentric reticulohistiocytosis: the Mayo Clinic experience (1980-2017). (2020) Rheumatology (Oxford, England). doi:10.1093/rheumatology/kez555 - Pubmed
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