Spondyloarthritis with monoclonal garmmopathy of undetermined significance: a report of five cases with literature review
10.3760/cma.j.cn141217-20250220-00047
- VernacularTitle:脊柱关节炎合并意义未明的单克隆丙种球蛋白病5例并文献复习
- Author:
Hongling ZENG
1
;
Jinyan GUO
1
;
Dongbin JIANG
1
;
Xin ZHANG
1
;
Yujie HE
1
;
Guanmin GAO
1
;
Shengyun LIU
1
Author Information
1. 郑州大学第一附属医院风湿免疫科，郑州 450052
- Publication Type:Journal Article
- Keywords:
Monoclonal gammopathy of undetermined significance;
Spondyloarthritis;
Tumor necrosis factor inhibitors;
Janus kinase inhibitors;
Prognosis
- From:
Chinese Journal of Rheumatology
2025;29(11):951-955
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics, treatment, and prognosis of patients with spondyloarthritis (SpA) and clinically insignificant monoclonal garmmopathy of undetermined significance (MGUS).Methods:A retrospective study was performed to analyze the clinical characteristics of patients simultaneously diagnosed with both SpA and MGUS at the First Affiliated Hospital to Zhengzhou University between January 2020 and December 2024, supplemented by a literature review.Results:Among the 5 patients (2 males, 3 females; age range 33~65 years), 4 presented with peripheral arthritis and 2 with extra-articular manifestations. All patients demonstrated elevated globulin and IgG levels, with 4 being HLA-B27 positive. M-protein typing revealed IgG/κ in 3 cases and IgA/λ in 2. All five patients underwent both X-ray and MRI examinations, with sacroiliitis being detected in 4 cases. Three patients with long disease duration showed poor response to conventional therapy (NSAIDs/DMARDs). Targeted therapies yielded variable outcomes: one patient achieved normalized globulin/IgG levels with etanercept (3-year follow-up without MGUS progression); another showed marked clinical improvement and significant globulin/IgG reduction with JAK inhibitor (tofacitinib, treated for 7 years); while a third demonstrated no symptom relief then switching from TNF-α inhibitor to IL-17 inhibitor.Conclusion:Persistent hyperglobulinemia in SpA patients warrants MGUS screening. Those with SpA-MGUS may require targeted therapies, where JAK inhibitors and monoclonal TNF-α inhibitors appear to be the preferred options, though long-term monitoring for MGUS progression remains essential.
