TY - JOUR T1 - Hyperviscosity Syndrome in Rheumatoid Arthritis JF - The Journal of Rheumatology JO - J Rheumatol SP - 788 LP - 789 DO - 10.3899/jrheum.200591 VL - 48 IS - 5 AU - John B. Miller AU - Alan N. Baer Y1 - 2021/05/01 UR - http://www.jrheum.org/content/48/5/788.1.abstract N2 - To the Editor:Hyperviscosity syndrome (HVS) is a life-threatening condition often occurring as a complication of Waldenström macroglobulinemia (WM) but rarely in the context of rheumatic disease. Given its rarity, diagnosis can be delayed, leading to greater morbidity. Our interest was sparked by a recent experience with a patient with rheumatoid arthritis (RA) who developed epistaxis with progressively worsening dyspnea, confusion, and visual deficits culminating in hospitalization due to HVS1. As HVS is uncommon in the era of biologic medications, we conducted a systematic review (Supplementary Figure 1, available from the authors on request) to define factors that predispose to HVS and describe outcomes of previous treatment approaches. We identified 25 cases of hyperviscosity attributed to RA.The most common presenting features for HVS included bleeding diathesis (e.g., epistaxis, gastrointestinal hemorrhage, gingival bleeding), heart failure (dyspnea and/or pedal edema), neurologic symptoms (dizziness, syncope, confusion), and constitutional symptoms (Table 1). RA developed years before HVS (7.9 ± 7.4 yrs) but was the presenting manifestation in 3 cases. Synovitis was often active … Address correspondence to Dr. J.B. Miller, Instructor of Medicine, 5200 Eastern Ave., Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD 21224, USA. Email: JMill237{at}jhmi.edu. ER -