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The relevance of monoclonal gammopathy in relation to rheumatic disorders has recently been reviewed.1 Monoclonal gammopathy or paraproteins can be detected in healthy adults and in different disease entities like amyloidosis, malignant proliferative disorders,2 associated with hepatitis C infections,3 and rheumatic diseases.4 The overall incidence of paraproteins in adults is about 1%.5 This incidence is higher in people over 70 and increases with age.6 When a paraprotein is detected and no underlying disease is present, the condition is referred to as a monoclonal gammopathy of undetermined significance.
Owing to their immunochemical properties, paraproteins can be precipitated by lowering the temperature below 37°C. In this way they form an essential part of the so-called cryoglobulins. When cryoglobulins are detected in the serum of a patient, this finding is usually associated with the coexistence of paraproteins. Recently, three patients with a clinical picture of a necrotising vasculitis associated with an essential cryoglobulinaemia (type 1) were admitted to our department. The causative relationship between the cryoglobulinaemia and the clinical symptoms was shown by the reduced severity of the …