myelodysplastic syndromes ( mds ) describe a heterogeneous group of malignant hematopoietic stem cell disorders which characterized by dysplastic and ineffective blood cell production and a variable risk of transformation to acute leukemia . because of a variable reduction in production of normal blood cells , a variety of systemic consequences including anemia , bleeding , and an increased risk of infection may occur .
there are some case reports and series indicating the association of mds with inflammatory arthritis or vasculitis syndromes . in some cases ,
patients with inflammatory arthritis and cytopenia are often diagnosed with sle , ra ( felty 's syndrome ) or sarcoidosis , but clinician should remember that it may be a combination of inflammatory arthritis and mds .
from jan 2013 to may 2014 , eighty consecutive patients with mds were referred by a hematologist to the rheumatology clinic in sari , northern iran .
the diagnosis of mds and its subtypes was confirmed by study of peripheral blood smear ( pbs ) and bone marrow aspiration .
all patients with unexplained cytopenia including monocytopenia , bicytopenia or pancytopenia in initial evaluation underwent bone marrow aspiration ; biopsy and iron staining for ringed sideroblasts .
patients with unexplained morphologic features of dysplasia in blood and marrow were included in the study .
the subtypes of mds are refractory cytopenia with unilinage dysplasia refractory anemia with ring sideroblasts(rars ) , refractory cytopenia with multilinage dysplasia ( rcmd ) , refractory anemia with excess blast ( raeb ) , mds with isolated del(5q ) and mds unclassified .
patients ' information including age , gender , and history of systemic disorders , disease duration and subtype of mds were recorded .
a rheumatologist evaluated the patients by history ( for joint symptoms , skin rashes , and family and drug history ) and physical examination for inflammatory rheumatic diseases including rheumatoid arthritis ( ra ) , systemic lupus erythematosus ( sle ) and vasculitis syndromes .
patients who had any signs or symptoms for inflammatory arthritis were evaluated by laboratory tests .
patients with and without inflammatory rheumatic disorders were compared for their hematologic and basic characteristics by t - test and chi - square test with spss v ( 20 ) package .
this cross sectional study surveyed the characteristics of inflammatory arthritis in patients with mds in hematology and rheumatology clinics in sari , iran .
thirty - six ( 45% ) of 80 patients enrolled in the study were females .
systemic or metabolic disorders included diabetes mellitus , hyperlipidemia , hypothyroidism , renal failure in 10(12.5% ) , 16(20% ) , 16(20% ) , 10(12.5% ) of participants , respectively .
the subtypes of mds included rc in 28 ( 35% ) , rars in 1(1.3% ) , rcmd in 47(58.8% ) , raeb1 in 3 ( 3.8% ) and raeb2 in 1(1.3% ) .
the subtypes of mds in these patients included rc in 4(44.4% ) , rcmd in 4(44.4% ) and raeb1 in 1(11.1% ) .
no significant difference was found in hematologic parameters including white blood cell count ( wbc ) , hemoglobin ( hg ) , red blood cell count ( rbc ) and platelet count between the two groups ( p>0.05 ) .
various types of inflammatory rheumatologic disorders may be associated with mds ( table 1 ) .
characteristics of mds patients with inflammatory rheumatologic disorder rcmd : refractory cytopenia with multilinage dysplasia , rc : refractory cytopenia , raeb 1 : refractory anemia with excess blast 1 . demographic data and underling disease in mds patients with and without rheumatologic disorders
the co - existence of mds and rheumatologic disorders was shown in 11.3% of patients .
several reports showed that about 10% of mds patients have clinical autoimmune disorders such as skin vasculitis and rheumatic disease or autoimmune hemolytic anemia .
george et al . , and mendez et al . , reported the association of mds with inflammatory arthritis in 8 of 28(28.5% ) patients and 3 of 55 patients(5.4% ) , respectively .
but in a recent study conducted by mekinian , 22 patients with mds were evaluated for inflammatory arthritis and polyarthritis was diagnosed in 17(77% ) cases . inflammatory arthritis was recorded between 5.4 and 77% in patients with mds .
there are some kinds of immunological abnormalities in patients with mds , including defective b- and t - cell function , hyper or hypogammaglobulinemia and monoclonal gammopathy .
positive antinuclear antibody and positive direct coombs test or inverted cd4/8 ratios were found in 1865% of patients with mds ( 12 , 13 ) .
considering the unavailability of cytogenetic study in our center , we suggest future surveys on the association of rheumatologic disorders in mds patients with different kinds of cytogenetic anomalies .
the findings of this study indicate that rheumatologic manifestations may be present in mds patients .
 abstractbackgroundthe aim of this study was to determine the prevalence and characteristics of rheumatologic manifestations associated with mds.methods:eighty patients with mds were evaluated by history and physical examination for inflammatory rheumatologic disorders from jan 2013 to may 2014 . 
 patients who had any signs or symptoms of rheumatologic disorders underwent evaluation by laboratory tests . 
 patients with and without inflammatory rheumatic disorders were compared for their characteristics.results:of 80 participants with mds , 9 ( 11.3% ) patients were diagnosed as having rheumatic disorders . 
 mds patients with or without rheumatologic disorder were similar in demographic and hematologic parameters , except age which was lower in patients with rheumatologic disorders . 
 ( p=0.016 ) . in younger patients , refractory cytopenia and refractory cytopenia with multilinage dysplasia were more prevalent.conclusion:the findings of this study indicate that rheumatologic manifestations may be present in mds patients . 
 younger patients are more prone to the occurrence of mds and rheumatic disorders . 
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
CONCLUSION