{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:28:38Z","timestamp":1792553318699,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,10,30]],"date-time":"2018-10-30T00:00:00Z","timestamp":1540857600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Up to one\u2010third of patients with T cell large granular lymphocyte (T\u2010<jats:styled-content style=\"fixed-case\">LGL<\/jats:styled-content>) leukemia display symptoms of rheumatoid arthritis (<jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>). In Crohn's disease and psoriasis, treatment with tumor necrosis factor (<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>) inhibitors is associated with hepatosplenic \u03b3\u03b4 T cell lymphoma and with clonal expansion of \u03b3\u03b4 T cells, respectively. This study was undertaken to determine the prevalence of clonal T\u2010<jats:styled-content style=\"fixed-case\">LGL<\/jats:styled-content> cells in patients with <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> and define risk factors for this rare hematologic malignancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 529 <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> patients were recruited between November 2013 and August 2015. Eight\u2010color flow cytometry (fluorescence\u2010activated cell sorting [<jats:styled-content style=\"fixed-case\">FACS<\/jats:styled-content>]) was performed to screen for aberrant T cell populations of <jats:styled-content style=\"fixed-case\">LGL<\/jats:styled-content>s. Molecular analysis of the T cell receptor was used to confirm the diagnosis in patients with suggestive <jats:styled-content style=\"fixed-case\">FACS<\/jats:styled-content> findings. Electronic patient files were used to determine risk factors. Patients with clonal populations were monitored prospectively for up to 4 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median patient age was 61 years, and 74% were female. The median duration of <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> was 12 years. The median Disease Activity Score in 28 joints was 2.8, and 69.9% of patients had ever been treated with biologic disease\u2010modifying antirheumatic drugs. We identified clonal T\u2010<jats:styled-content style=\"fixed-case\">LGL<\/jats:styled-content> expansions in 19 patients, equaling a prevalence of 3.6%. The T\u2010<jats:styled-content style=\"fixed-case\">LGL<\/jats:styled-content> cell clone was constant over time in most patients and was significantly associated with the duration of the exposure to <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010blocking agents (<jats:italic>P =<\/jats:italic> 0.01). No other risk factors could be detected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> patients with long\u2010term exposure to <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010blocking agents were at a greater risk of developing clonal expansions of <jats:styled-content style=\"fixed-case\">LGL<\/jats:styled-content>s. This finding may prompt clinicians to refrain from using these substances in <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> patients with known T cell aberrations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.40654","type":"journal-article","created":{"date-parts":[[2018,6,25]],"date-time":"2018-06-25T08:17:03Z","timestamp":1529914623000},"page":"1914-1922","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Prevalence and Characteristics of Persistent Clonal T Cell Large Granular Lymphocyte Expansions in Rheumatoid Arthritis"],"prefix":"10.1002","volume":"70","author":[{"given":"Eva C.","family":"Schwaneck","sequence":"first","affiliation":[{"name":"Julius\u2010Maximilians\u2010Universit\u00e4t W\u00fcrzburg W\u00fcrzburg 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