Rheumatoid arthritis (RA) is a systemic disorder that affects the body's synovial tissues. Approximately 1 per cent of the global population suffers from RA, and women are three times more likely to suffer from the disease than men. Symptoms typically include stiffness, pain and swelling. In rare instances, individuals diagnosed with RA may also develop secondary conditions.
RA can cause low lymphocytes. Lymphocytes, sometimes referred to as "fighter cells," attack infection-causing microorganisms. Lymphocytopenia, the medical term for the condition arising from a low white-blood-cell count, can be a complication of RA. Referred to as Felty's syndrome, the uncommon condition affects less than 1 per cent of individuals diagnosed with RA. Patients who develop Felty's are more susceptible to infection due to decreased production of leukocytes, which play an important role in combating infection. A lowered number of white blood cells can also be caused by certain medications prescribed to ameliorate the symptoms of RA.
A Quick Look at Lymphocytes
Lymphocytes are white blood cells whose function is to fight off infection. There are three major categories of lymphocytes: B-cells, T-cells and NK-cells. T-cells, named for the thymus, where they grow, attack harmful microorganisms directly. B-cells, so named because they originate in the bone marrow, work by secreting antibodies into bodily fluid. NK, or natural killer cells, also destruct anomalies such as viral or cancer cells. Lymphocytes are a vital component of the body's immune system. Medical intervention may be necessary if the number of lymphocytes circulating in the blood becomes depressed.
Felty's Syndrome as a Cause of Low Lymphocytes
Felty's syndrome, an uncommon complication of RA, is diagnosed by the presence of three factors: RA, an enlarged spleen and a low white-blood-cell count. Although the specific cause of Felty's is not fully understood, researchers have posited that an abnormal number of white blood cells are stored in the spleens of Felty's sufferers, where they are unable to do their job. Lymphocytopenia, the medical term for a low number of lymphocytes circulating in the blood, places individuals at a high risk for infection. Not all patients diagnosed with Felty's require treatment, but those who do may be treated with a granulocyte stimulating factor (GSF), which increases the amount of white blood cells circulating in the body.
Medicinal Therapy May Result in Low Lymphocytes
Although the spontaneous appearance of lymphocytopenia in individuals diagnosed with RA is uncommon, medicinal therapy is sometimes responsible for the presence of a low white-blood-cell count. Methotrexate, an antimetabolite commonly prescribed to treat RA symptoms, slows the production of folic acid necessary for newly forming cells and can lead to a low white blood cell count. Individuals who have been prescribed methotrexate are routinely checked for lymphocytopenia, because available therapies can rectify this immunological imbalance.
B-Cell Depletion Therapy: A Deliberate Lowering of Lymphocytes
A relatively new treatment for RA has been developed by Dr. Johnathan C. Edwards, a researcher from University College in London. The treatment, known as B-cell depletion therapy, involves removing B-cells. These white blood cells can create abnormal antibodies that cause RA symptoms. Dr. Edwards posits that the removal of B-cells triggers formation of normal cells that in turn produce normal antibodies. According to Dr. Edwards, removal of B-cells causes the body's immune system to "forget" it has RA and thereby breaks the cycle of abnormal antibody creation responsible for RA symptoms. A combination of drugs are used to accomplish B-cell depletion. These are rituximab, prednisoline and cyclophoshamide. The drugs are administered intravenously. Results of B-cell depletion therapy have been promising.
Significance of Low Lymphocytes Acquired from RA or Its Treatment
Abnormally low lymphocytes, or lymphocytopenia, presents with a wide variety of symptoms. Mild lymphocytopenia is generally asymptomatic and only detected when a complete blood count (CBC), a routine procedure, is ordered by a health care provider. A drastic reduction of lymphocytes can lead to persistent infections from fungi, bacteria and viruses. Individuals at risk should consult with their doctor if symptoms of viral and/or bacterial infections persist for an inordinate period. Beneficial treatments are readily available.