Multicentric Reticulohistiocytosis Treatment & Management

  • Author: Jeffrey P Callen, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Aug 16, 2011
 

Medical Care

  • No effective treatment is known for multicentric reticulohistiocytosis (MRH).
  • Therapy with nonsteroidal anti-inflammatory agents may help the arthritis.
  • Systemic corticosteroids and/or cytotoxic agents, particularly cyclophosphamide,[7, 8] chlorambucil,[7] or methotrexate,[9, 10, 8, 11] may affect the inflammatory response, prevent further joint destruction, and cause skin lesions to regress.
  • Antimalarials have also been used.
  • Alendronate and other bisphosphonates have been reported to be effective in an individual patient.[12, 13]
  • TNF-alpha antagonists have been reported to be effective in many, but not all, patients. Reports of both etanercept[3, 4] and infliximab[14, 15] have been reported as effective in recent literature, and one would expect that adalimumab might also be effective in an individual patient.
  • Several reports have suggested that the combination of methotrexate with a TNF antagonist is more effective than either alone.[16]
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Surgical Care

Joint replacement may improve function in patients with burned-out disease that has resulted in deformity.

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Consultations

A rheumatologist and a dermatologist may be consulted.

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Activity

Activity may be limited by the severity of the disease. Physical therapy may prevent deformities and relieve symptoms.

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Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Specialty Editor Board

Bryan L Martin, DO  Associate Dean for Graduate Medical Education, Designated Institutional Official, Associate Medical Director, Director, Allergy Immunology Program, Professor of Medicine and Pediatrics, Ohio State University College of Medicine

Bryan L Martin, DO is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Osteopathic Internists, American College of Physicians, American Medical Association, and American Osteopathic Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Marcel E Conrad, MD  Distinguished Professor of Medicine (Retired), University of South Alabama College of Medicine

Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, and Southwest Oncology Group

Disclosure: No financial interests None None

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

References

  1. Goltz RW, Laymon CW. Multicentric reticulohistiocytosis of the skin and synovia; reticulohistiocytoma or ganglioneuroma. AMA Arch Derm Syphilol. Jun 1954;69(6):717-31. [Medline].

  2. Nunnink JC, Krusinski PA, Yates JW. Multicentric reticulohistiocytosis and cancer: a case report and review of the literature. Med Pediatr Oncol. 1985;13(5):273-9. [Medline].

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

  4. 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].

  5. Fett N, Liu RH. Multicentric reticulohistiocytosis with dermatomyositis-like features: a more common disease presentation than previously thought. Dermatology. 2011;222(2):102-8. [Medline].

  6. Valencia IC, Colsky A, Berman B. Multicentric reticulohistiocytosis associated with recurrent breast carcinoma. J Am Acad Dermatol. Nov 1998;39(5 Pt 2):864-6. [Medline].

  7. Ginsburg WW, O'Duffy JD, Morris JL, Huston KA. Multicentric reticulohistiocytosis: response to alkylating agents in six patients. Ann Intern Med. Sep 1 1989;111(5):384-8. [Medline].

  8. 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].

  9. Franck N, Amor B, Ayral X, et al. Multicentric reticulohistiocytosis and methotrexate. J Am Acad Dermatol. Sep 1995;33(3):524-5. [Medline].

  10. Gourmelen O, Le Loet X, Fortier-Beaulieu M, et al. Methotrexate treatment of multicentric reticulohistiocytosis. J Rheumatol. Apr 1991;18(4):627-8. [Medline].

  11. 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].

  12. Goto H, Inaba M, Kobayashi K, et al. Successful treatment of multicentric reticulohistiocytosis with alendronate: evidence for a direct effect of bisphosphonate on histiocytes. Arthritis Rheum. Dec 2003;48(12):3538-41. [Medline].

  13. Satoh M, Oyama N, Yamada H, Nakamura K, Kaneko F. Treatment trial of multicentric reticulohistiocytosis with a combination of predonisolone, methotrexate and alendronate. J Dermatol. Mar 2008;35(3):168-71. [Medline].

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

  15. Kalajian AH, Callen JP. Multicentric reticulohistiocytosis successfully treated with infliximab: an illustrative case and evaluation of cytokine expression supporting anti-tumor necrosis factor therapy. Arch Dermatol. Oct 2008;144(10):1360-6. [Medline].

  16. De Knop KJ, Aerts NE, Ebo DG, Van Offel JF, Stevens WJ, De Clerck LS. Multicentric reticulohistiocytosis associated arthritis responding to anti-TNF and methotrexate. Acta Clin Belg. Jan-Feb 2011;66(1):66-9. [Medline].

  17. Barrow MV, Holubar K. Multicentric reticulohistiocytosis. A review of 33 patients. Medicine (Baltimore). Jul 1969;DA - 19690930(4):287-305. [Medline].

  18. Blanco JJ, Hernandez FJ, Cerezo JG, et al. Multicentric reticulohistiocytosis. The long course of a rare disease. Scand J Rheumatol. 2002;31(2):107-9. [Medline].

  19. Callen JP. Miscellaneous disorders that commonly affect both skin and joints. In: Provost TT, ed. Cutaneous Manifestations of Rheumatic Diseases. Lippincott Williams & Wilkins; 1996:278-9.

  20. Candell Chalom E, Elenitsas R, Rosenstein ED, Kramer N. A case of multicentric reticulohistiocytosis in a 6-year-old child. J Rheumatol. Apr 1998;25(4):794-7. [Medline].

  21. Cox NH, West NC, Popple AW. Multicentric reticulohistiocytosis associated with idiopathic myelofibrosis. Br J Dermatol. Dec 2001;145(6):1033-4. [Medline].

  22. Hiramanek N, Kossard S, Barnetson RS. Multicentric reticulohistiocytosis presenting with a rash and arthralgia. Australas J Dermatol. May 2002;43(2):136-9. [Medline].

  23. Hsiung SH, Chan EF, Elenitsas R, et al. Multicentric reticulohistiocytosis presenting with clinical features of dermatomyositis. J Am Acad Dermatol. Feb 2003;48(2 Suppl):S11-4. [Medline].

  24. Lesher JL Jr, Allen BS. Multicentric reticulohistiocytosis. J Am Acad Dermatol. Oct 1984;DA - 19841212(4 Pt 2):713-23. [Medline].

  25. Orkin M, Goltz RW, Good RA, et al. A study of multicentric reticulohistiocytosis. Arch Dermatol. May 1964;89:640-54. [Medline].

  26. Outland JD, Keiran SJ, Schikler KN, Callen JP. Multicentric reticulohistiocytosis in a 14-year-old girl. Pediatr Dermatol. Nov-Dec 2002;19(6):527-31. [Medline].

  27. Peters MS. Histiocytic and Langerhans cell reactions. In: Farmer ER, Hood AF, eds. Pathology of the Skin. 1990:263-5.

  28. Raphael SA, Cowdery SL, Faerber EN, et al. Multicentric reticulohistiocytosis in a child. J Pediatr. Feb 1989;114(2):266-9. [Medline].

  29. Santilli D, Lo Monaco A, Cavazzini PL, Trotta F. Multicentric reticulohistiocytosis: a rare cause of erosive arthropathy of the distal interphalangeal finger joints. Ann Rheum Dis. Jun 2002;61(6):485-7. [Medline].

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

  31. Weber FP, Freudenthal W. Nodular non-diabetic cutaneous xanthomatosis with hypercholesterolemia and atypical histologic features. Proc R Soc Med. 1937;30:522-6.

  32. Yee KC, Bowker CM, Tan CY, Palmer RG. Cardiac and systemic complications in multicentric reticulohistiocytosis. Clin Exp Dermatol. Nov 1993;18(6):555-8. [Medline].

  33. Zvaifler NJ. Uncommon arthropathies. In: Klippel JH, Dieppe PA, eds. Rheumatology. 2nd ed. 1998:4-5.

 
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Multiple erythematous nodules are present on the dorsal hands of this adolescent with an inflammatory arthropathy.
Multiple erythematous to brown nodules on the fingers.
Erythematous, poikilodermatous mamillated plaque on the anterior chest.
Histopathology of multicentric reticulohistiocytosis (MRH) skin lesions.
Histopathology of multicentric reticulohistiocytosis (MRH) skin lesions. Higher power demonstrating the ground glass cytoplasm and multinucleated giant cells.
 
 
 
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