eMedicine Specialties > Dermatology > Benign Neoplasms

Multicentric Reticulohistiocytosis: Treatment & Medication

Author: Ronald P Rapini, MD, Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School, MD Anderson Cancer Center
Contributor Information and Disclosures

Updated: Mar 10, 2008

Treatment

Medical Care

No therapy consistently improves MRH. After an average course of 8 years, patients often go into remission, but considerable joint destruction may have already occurred. Many different drugs have been used. (A common quip is that those diseases for which many treatment options exist often have no particular useful therapy.) None of these is covered in great detail here because of the lack of uniformly accepted therapy. The response to therapy is difficult to determine because of the rarity of the disease, lack of controlled studies, and tendency for the remission to complicate evaluation of efficacy. Most of the previously reported therapies include the following:

  • First-line therapies
    • Systemic corticosteroids (eg, prednisone, prednisolone, dexamethasone high-dose pulse)
    • Intralesional corticosteroids (eg, triamcinolone acetonide)
    • Nonsteroidal anti-inflammatory drugs (eg, aspirin, indomethacin)
  • Second-line therapies
    • Psoralen plus ultraviolet light (PUVA)
    • Antimalarials (eg, chloroquine, hydroxychloroquine5 )
    • Cyclophosphamide6
    • Chlorambucil
    • Azathioprine
    • Vincristine
    • Methotrexate5,6,7
    • Topical nitrogen mustard
    • Antitumor necrosis factor-alpha drugs8 (eg, etanercept,9 infliximab10 )
    • Bisphosphonate drugs (eg, alendronate, zoledronic acid11 )
    • Concomitant combinations of several of the above therapies5

Surgical Care

  • Orthopedic surgery may be useful for joint deformities.
  • General surgeons and other surgeons may be needed to excise internal malignancies that may occur.

Consultations

  • Dermatologists and rheumatologists often see patients with MRH.
  • Oncologists or surgeons may be needed if internal malignancy occurs.
  • Other specialists are occasionally needed if internal organs are involved.

More on Multicentric Reticulohistiocytosis

Overview: Multicentric Reticulohistiocytosis
Differential Diagnoses & Workup: Multicentric Reticulohistiocytosis
Treatment & Medication: Multicentric Reticulohistiocytosis
Follow-up: Multicentric Reticulohistiocytosis
Multimedia: Multicentric Reticulohistiocytosis
References
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References

  1. Kishikawa T, Miyashita T, Fujiwara E, Shimomura O, Yasuhi I, Niino D, et al. Multicentric reticulohistiocytosis associated with ovarian cancer. Mod Rheumatol. Oct 2007;17(5):422-5. [Medline].

  2. Yamada T, Kurohori YN, Kashiwazaki S, Fujibayashi M, Ohkawa T. MRI of multicentric reticulohistiocytosis. J Comput Assist Tomogr. Sep-Oct 1996;20(5):838-40. [Medline].

  3. Kamel H, Gibson G, Cassidy M. Case report: the CT demonstration of soft tissue involvement in multicentric reticulohistiocytosis. Clin Radiol. Jun 1996;51(6):440-1. [Medline].

  4. Kroot EJ, Weel AE, Hazes JM, Zondervan PE, Heijboer MP, van Daele PL, et al. Diagnostic value of blind synovial biopsy in clinical practice. Rheumatology (Oxford). Feb 2006;45(2):192-5. [Medline].

  5. Cash JM, Tyree J, Recht M. Severe multicentric reticulohistiocytosis: disease stabilization achieved with methotrexate and hydroxychloroquine. J Rheumatol. Nov 1997;24(11):2250-3. [Medline].

  6. Liang GC, Granston AS. Complete remission of multicentric reticulohistiocytosis with combination therapy of steroid, cyclophosphamide, and low-dose pulse methotrexate. Case report, review of the literature, and proposal for treatment. Arthritis Rheum. Jan 1996;39(1):171-4. [Medline].

  7. Rentsch JL, Martin EM, Harrison LC, Wicks IP. Prolonged response of multicentric reticulohistiocytosis to low dose methotrexate. J Rheumatol. May 1998;25(5):1012-5. [Medline].

  8. Shannon SE, Schumacher HR, Self S, Brown AN. Multicentric reticulohistiocytosis responding to tumor necrosis factor-alpha inhibition in a renal transplant patient. J Rheumatol. Mar 2005;32(3):565-7. [Medline].

  9. Lovelace K, Loyd A, Adelson D, Crowson N, Taylor JR, Cornelison R. Etanercept and the treatment of multicentric reticulohistiocytosis. Arch Dermatol. Sep 2005;141(9):1167-8. [Medline].

  10. Sellam J, Deslandre CJ, Dubreuil F, Arfi S, Kahan A. Refractory multicentric reticulohistiocytosis treated by infliximab: two cases. Clin Exp Rheumatol. Jan-Feb 2005;23(1):97-9. [Medline].

  11. Mavragani CP, Batziou K, Aroni K, Pikazis D, Manoussakis MN. Alleviation of polyarticular syndrome in multicentric reticulohistiocytosis with intravenous zoledronate. Ann Rheum Dis. Oct 2005;64(10):1521-2. [Medline].

  12. Barrow MV, Holubar K. Multicentric reticulohistiocytosis. A review of 33 patients. Medicine (Baltimore). Jul 1969;48(4):287-305. [Medline].

  13. Brackenridge A, Bashir T, Wheatley T. Multicentric reticulohistiocytosis and pregnancy. BJOG. May 2005;112(5):672-3. [Medline].

  14. Kovach BT, Calamia KT, Walsh JS, Ginsburg WW. Treatment of multicentric reticulohistiocytosis with etanercept. Arch Dermatol. Aug 2004;140(8):919-21.

  15. Luz FB, Gaspar AP, Ramos-e-Silva M, Carvalho da Fonseca E, Villar EG, Cordovil Pires AR, et al. Immunohistochemical profile of multicentric reticulohistiocytosis. Skinmed. Mar-Apr 2005;4(2):71-7. [Medline].

  16. Mody GM, Cassim B. Rheumatologic manifestations of malignancy. Curr Opin Rheumatol. Jan 1997;9(1):75-9. [Medline].

  17. Rapini RP. Multicentric reticulohistiocytosis. Clin Dermatol. Jan-Mar 1993;11(1):107-11. [Medline].

  18. Tajirian AL, Malik MK, Robinson-Bostom L, Lally EV. Multicentric reticulohistiocytosis. Clin Dermatol. Nov-Dec 2006;24(6):486-92. [Medline].

  19. Trotta F, Castellino G, Lo Monaco A. Multicentric reticulohistiocytosis. Best Pract Res Clin Rheumatol. Oct 2004;18(5):759-72.

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Further Reading

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Keywords

MRH, lipoid dermatoarthritis, lipoid rheumatism, giant cell reticulohistiocytosis, arthritis mutilans, arthritis

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Contributor Information and Disclosures

Author

Ronald P Rapini, MD, Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School, MD Anderson Cancer Center
Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, Southern Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Takeji Nishikawa, MD, Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Rosalie Elenitsas, MD, Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Society of Dermatopathology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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