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Eickhoff JC, Collamer AN. Autoimmunity Mimics: Infection and Malignancy. Prim Care 2018; 45:343-360. [PMID: 29759128 DOI: 10.1016/j.pop.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Musculoskeletal rheumatic syndromes are commonly encountered in the primary care setting. A plethora of commonly encountered and rare infectious agents can produce osteoarticular and soft tissue manifestations. Likewise, malignancies may manifest rheumatic symptoms via direct tumor invasion or paraneoplastic effects. Awareness of these diseases and their clinical risk factors should result in improved screening and earlier recognition and intervention, leading to improved long-term outcomes and overall patient care.
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Affiliation(s)
- Jeffrey C Eickhoff
- Rheumatology Service, U.S. Navy, Medical Corps, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
| | - Angelique N Collamer
- Rheumatology Service, U.S. Air Force, Medical Corps, Walter Reed National Military Medical Center, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA
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2
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Vassilopoulos D, Calabrese LH. Rheumatologic aspects of viral infections. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00110-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Adams MH, Lovejoy TI, Turk DC, Dobscha SK, Hauser P, Morasco BJ. Pain-related anxiety mediates the relationship between depressive symptoms and pain interference in veterans with hepatitis C. Gen Hosp Psychiatry 2015; 37:533-7. [PMID: 26265311 PMCID: PMC4630124 DOI: 10.1016/j.genhosppsych.2015.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Depression and chronic pain are common in persons chronically infected with the hepatitis C virus (HCV), although little is known about the rate of co-occurrence or mechanisms by which they are associated. We evaluated whether pain-related anxiety mediates the relationship between depressive symptoms and pain-related physical functioning in patients with HCV. METHODS Patients with HCV (n=175) completed self-report measures assessing demographic characteristics, pain-related function and mental health. Path analyses examined direct effects of cognitive-affective and somatic symptoms of depression on pain interference and indirect effects of these relationships via four subscales of the Pain Anxiety Symptoms Scale-20. RESULTS Cognitive-affective and somatic symptoms of depression were positively and significantly related to pain interference. Pain-related anxiety mediated the relationship between both cognitive-affective and somatic symptoms of depression, and this mediation was predominantly accounted for by the escape-avoidance component of pain-related anxiety. CONCLUSIONS Findings indicate a potential mediating role of pain-related anxiety, particularly escape-avoidance anxiety, on the relationship between depression and pain interference in patients with HCV. These findings suggest that escape-avoidance anxiety may be a particularly germane target for treatment in patients with HCV and chronic pain, particularly when depression, with characteristic features of withdrawal and inhibition, is a comorbid condition.
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Affiliation(s)
- Melissa H. Adams
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
| | - Travis I. Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
| | - Dennis C. Turk
- Department of Anesthesiology and Pain Medicine and Center for Pain Research on Impact, Measurement, & Effectiveness, University of Washington
| | - Steven K. Dobscha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
| | - Peter Hauser
- VISN 22 Network Office and Division of Mental Health, Long Beach VA Medical Center,Department of Psychiatry, University of California San Diego & Department of Psychiatry and Human Behavior, University of California-Irvine
| | - Benjamin J. Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
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Viral hepatitis: review of arthritic complications and therapy for arthritis in the presence of active HBV/HCV. Curr Rheumatol Rep 2013; 15:319. [PMID: 23436024 DOI: 10.1007/s11926-013-0319-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic infection with hepatitis B (HBV) or C (HCV) virus, which currently affect approximately 7 % of the world population, is encountered with the same frequency among patients with arthritis starting biological or non-biological disease-modifying anti-rheumatic drugs (DMARDs). Treatment with biological agents, including anti-tumor necrosis factor agents, rituximab, and abatacept, without appropriate antiviral therapy has been associated with reactivation of HBV infection which in some cases can lead to life-threatening complications, indicating the need for appropriate screening and treatment of these patients. In this review, the latest data regarding HBV or HCV-related arthritic complications and treatment of rheumatic diseases in the presence of chronic HBV or HCV infection will be critically presented.
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Gillis J, Cooper C, Rourke S, Rueda S, O'Brien K, Collins E, Rachlis A, Hart TA, Raboud J. Impact of hepatitis B and C co-infection on health-related quality of life in HIV positive individuals. Qual Life Res 2012; 22:1525-35. [PMID: 23070749 DOI: 10.1007/s11136-012-0283-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE Concurrent infection with HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) often occurs due to the commonality in risk factors for acquisition. Few studies have examined the effect of co-infection on health-related quality of life (HRQOL) in HIV positive individuals. METHODS Ontario HIV Treatment Network Cohort Study (OCS) participants who completed an annual interviewer-administered questionnaire on up to three occasions were included. Generalized estimating equations (GEE) were used to assess the impact of HBV and HCV co-infection on physical and mental HRQOL component summary scores (range 0-100) as measured by the Medical Outcomes SF-36 health survey. RESULTS As of March 2010, 1,223 participants had completed the questionnaire; 964 were HIV mono-infected, 128 were HIV-HBV co-infected, 112 were HIV-HCV co-infected, and 19 were HIV-HBV-HCV tri-infected. Eighty percent were male, median age 46 (IQR 40-53) years, 61% Caucasian, median CD4 count 464 (IQR 319-636) cells/mm(3), and 74% had undetectable HIV viremia. Physical HRQOL was lower in HIV-HBV and HIV-HCV co-infected individuals (49.4 (IQR 42.0-53.9) and 48.1 (IQR 36.9-52.8) vs. 51.5 (IQR 45.0-55.4); p = 0.01 and <0.0001) compared to mono-infected individuals. In the multivariable GEE model, the negative impact of HCV remained significant (-2.18; p = 0.01) after adjusting for drug use, smoking, age, and gender. Unadjusted mental HRQOL was lower in HIV-HCV co-infected individuals (44.6 (IQR 34.6-54.0) vs. 48.9 (IQR 36.8-55.9); p = 0.03) compared to mono-infected individuals but no association of mental HRQOL with either co-infection was observed in multivariable GEE models. CONCLUSIONS HCV appears to negatively impact physical HRQOL suggesting a greater health burden for co-infected individuals. HBV and HCV co-infections were not related to lower mental HRQOL among people living with HIV/AIDS.
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Affiliation(s)
- Jennifer Gillis
- Clinical Decision Making and Health Care, Toronto General Hospital, University Health Network, 200 Elizabeth St., Room 13EN226, Toronto, ON, M5G 2C4, Canada
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Prevalence of fibromyalgia among patients with chronic hepatitis C infection: relationship to viral characteristics and quality of life. J Clin Gastroenterol 2012; 46:407-12. [PMID: 22499073 DOI: 10.1097/mcg.0b013e3182485528] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We determined the prevalence of fibromyalgia syndrome (FMS) in a cohort of subjects with chronic hepatitis C virus (HCV), and the relationship to subject demographics, viral characteristics, and quality of life. METHODS In a cross-sectional study of a cohort of HCV-infected individuals, all subjects underwent a standard assessment including history, clinical examination, and functional assessments for pain and disability. RESULTS A total of 185 subjects met the inclusion criteria. Median age was 48.7 years, and 110 (59%) were women. A total of 106 (57%) of the subjects met criteria for the presence of FMS. Widespread pain and ≥11 tender points were present in all of the subjects with FMS, fatigue in 98 (92%), and depression in 60 (57%). Among those with FMS, mean pain score was 70±11.78 and 36% reported some functional impairment on (HAQ-DI>0), with 17% reporting moderate-to-severe functional impairment (HAQ-DI≥1.5). CONCLUSIONS This study reveals a high prevalence of FMS (57%) among subjects with chronic HCV infection, one third of whom reported some degree of functional impairment. Recognition and management of this condition in such patients will help improve their quality of life.
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Vassilopoulos D, Calabrese LH. Rheumatologic aspects of viral infections. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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The Complex Management of Viral-Related Autoimmune Diseases. Autoimmune Dis 2011. [DOI: 10.1007/978-0-85729-358-9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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LANDAU DANAVI, SCERRA SAMY, SENE DAMIEN, RESCHE-RIGON MATHIEU, SAADOUN DAVID, CACOUB PATRICE. Causes and Predictive Factors of Mortality in a Cohort of Patients with Hepatitis C Virus-related Cryoglobulinemic Vasculitis Treated with Antiviral Therapy. J Rheumatol 2010; 37:615-21. [DOI: 10.3899/jrheum.090790] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective.Hepatitis C virus (HCV)-associated mixed cryoglobulinemia (MC) vasculitis is an autoimmune disorder with significant morbidity and mortality. Renal involvement was associated with an increased mortality, and was the most common cause of death; these data were obtained before effective antiviral treatment was available. We studied causes of death and predictive factors in patients with HCV-associated MC vasculitis treated with antivirals.Methods.Case histories of 85 patients with HCV-associated MC vasculitis treated in a single center between 1990 and 2006 were retrospectively reviewed. Prognostic factors affecting mortality were studied by comparing 23 patients who died with 62 survivors, using the Cox model regression analysis.Results.The most common cause of death was infection, accounting for 34.7%, followed by endstage liver disease in 30.4% (including 4 patients with hepatocellular carcinoma), and cardiovascular disease in 17.4% of patients. Endstage renal disease accounted for only 8.7% of deaths, as did central nervous system vasculitis and nonhepatic malignancy. Increased mortality was strongly associated with immunosuppressive treatment [hazard ratio (HR) 6.51, 95% CI 2.75–15.37], cutaneous ulcers (HR 5.37, 95% CI 1.79–16.14), and renal insufficiency (HR 3.25, 95% CI 1.37–7.72). A 2 log10 decrease in HCV viral load at month 3 after starting antiviral treatment was associated with decreased mortality (HR 0.39, 95% CI 0.16–0.95).Conclusion.While renal involvement is still associated with poorer prognosis, infectious processes are now the most common cause of death in HCV cryoglobulinemia vasculitis. Immunosuppressive treatment is associated with an increased risk of death, independently from disease severity. Response to antiviral treatment is associated with significantly reduced mortality risk.
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Agmon-Levin N, Ram M, Barzilai O, Porat-Katz BS, Parikman R, Selmi C, Gershwin ME, Anaya JM, Youinou P, Bizzaro N, Tincani A, Tzioufas AG, Cervera R, Stojanovich L, Martin J, Gonzalez-Gay MA, Valentini G, Blank M, SanMarco M, Rozman B, Bombardieri S, De Vita S, Shoenfeld Y. Prevalence of hepatitis C serum antibody in autoimmune diseases. J Autoimmun 2009; 32:261-6. [PMID: 19356903 DOI: 10.1016/j.jaut.2009.02.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 02/11/2009] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the prevalence of serum antibodies against hepatitis C virus and other infectious agents in a large cohort of well-characterized patients with autoimmune diseases (AID). METHODS We utilized 1322 sera from patients with 18 different AID and 236 sera from healthy controls from the same countries and with similar age and sex distribution. All sera were tested for the presence of serum anti-hepatitis C virus (HCV) antibodies as well as antibodies directed at other infectious agents and autoantibodies. RESULTS Anti-HCV antibody was detected in 115/1322 (8.7%) of patients with AID and 0.4% of matched healthy controls (P < 0.0001). The prevalence of anti-HCV antibody was significantly higher in 7/18 different AID (i.e. cryoglobulinemia, mixed cryoglobulinemia pemphigus vulgaris, vasculitis, secondary anti-phospholipid syndrome, Hashimoto's thyroiditis, and inflammatory bowel disease) compared to controls. Patients with AID and serum anti-HCV positivity had an increased prevalence of antibodies against hepatitis B virus, Toxoplasma gondii and Cytomegalovirus as opposed to a lower frequency of serum autoantibodies. CONCLUSIONS The enhanced prevalence of anti-HCV serum antibodies in AID may suggest a role for HCV in tolerance to breakdown, similarly to its established role in mixed cryoglobulinemia. This immune mediated effect does not rule out the role of other infectious agents.
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Affiliation(s)
- Nancy Agmon-Levin
- Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
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Vassilopoulos D, Calabrese LH. Virally associated arthritis 2008: clinical, epidemiologic, and pathophysiologic considerations. Arthritis Res Ther 2008; 10:215. [PMID: 18828883 PMCID: PMC2592818 DOI: 10.1186/ar2480] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Several viruses have been associated with the development of inflammatory arthritis, including the hepatitis viruses (hepatitis B virus and hepatitis C virus), HIV, the parvovirus B19, the human T-cell lymphotropic virus-I, and the alphaviruses. Here, we review the epidemiology, the pathophysiological mechanisms, the pertinent clinical and laboratory findings as well as the principles of therapy of the most common virus-associated arthritides. We believe that the knowledge of these key diagnostic and therapeutic features of virus-associated arthritides is important for the rheumatologist of the 21st century.
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Affiliation(s)
- Dimitrios Vassilopoulos
- Athens University School of Medicine, 2nd Department of Medicine, Hippokration General Hospital, 114 Vass., Sophias Avenue, 115 27 Athens, Greece
| | - Leonard H Calabrese
- Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A50, Cleveland, OH 44195, USA
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Landau DA, Rosenzwajg M, Saadoun D, Trébeden-Negre H, Klatzmann D, Cacoub P. Correlation of clinical and virologic responses to antiviral treatment and regulatory T cell evolution in patients with hepatitis C virus-induced mixed cryoglobulinemia vasculitis. ACTA ACUST UNITED AC 2008; 58:2897-907. [DOI: 10.1002/art.23759] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Galeazzi M, Giannitti C, Manganelli S, Benucci M, Scarpato S, Bazzani C, Caporali R, Sebastiani GD. Treatment of rheumatic diseases in patients with HCV and HIV infection. Autoimmun Rev 2008; 8:100-3. [PMID: 18694850 DOI: 10.1016/j.autrev.2008.07.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A wide variety of rheumatic diseases has been documented in the presence of hepatitis C virus (HCV) infection and in human immunodeficiency virus (HIV) infection. In this conditions, physicians are refrained from using corticosteroids and/or immunosuppressants agents because of the risk of favouring viral replication and the progression of the underlying viral disease. In the present review we have focused our attention on the possible role of cyclosporine A (CsA), anti-Tumour Necrosis Factor (TNF) alpha agents in the treatment of HIV or HCV infected autoimmune patients. The results drown from the literature and from our personal experience confirm the safety of CsA and anti-TNF alpha agents, in terms of viral load and liver toxicity. A limited experience also suggest that both therapies can be given in combination in rheumatoid arthritis patients without increasing the risk of adverse events.
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Affiliation(s)
- Mauro Galeazzi
- Sezione di Reumatologia, Dipartimento di Medicina Clinica e Scienze Imunologiche, Università di Siena, Italy.
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Whitehead AJ, Dobscha SK, Morasco BJ, Ruimy S, Bussell C, Hauser P. Pain, substance use disorders and opioid analgesic prescription patterns in veterans with hepatitis C. J Pain Symptom Manage 2008; 36:39-45. [PMID: 18358690 DOI: 10.1016/j.jpainsymman.2007.08.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 08/13/2007] [Accepted: 08/15/2007] [Indexed: 02/07/2023]
Abstract
To examine the prevalence of pain, substance use disorder (SUD) diagnoses, and opioid analgesic prescription patterns among veterans infected with the hepatitis C virus (HCV), a retrospective review of the medical records of 8,224 HCV-positive (HCV+) veterans was performed. Twenty-nine percent and 46% of HCV+ patients were prescribed opioids in the prior one and three years, respectively. Sixty-seven percent of HCV+ patients had documented pain diagnoses and 56% had SUD diagnoses. Patients with co-occurring pain and SUD were less likely to be prescribed opioids than patients with pain only (prior year: 36% vs. 43%, P<0.001; three years: 56% vs. 60%, P<0.01). There were no differences in numbers of early opioid prescription fills or numbers of opioid prescribers when comparing patients with co-occurring pain and SUD to patients with pain only. Veterans with co-occurring pain and opioid use disorder had fewer early opioid fills than veterans with pain only (prior year: 2.6 vs. 5.3 days, P<0.01; three years: 6.1 vs. 13.4 days, P<0.001). These data demonstrate that pain and SUD diagnoses were common among HCV+ patients, and that opioids were frequently prescribed. Co-occurring SUD was not associated with indicators of prescription opioid misuse.
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Lormeau C, Falgarone G, Roulot D, Boissier MC. Rheumatologic manifestations of chronic hepatitis C infection. Joint Bone Spine 2006; 73:633-8. [PMID: 17056293 DOI: 10.1016/j.jbspin.2006.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 05/03/2006] [Indexed: 02/07/2023]
Abstract
The many rheumatologic manifestations associated with chronic hepatitis C virus (HCV) infection include arthralgia, myalgia, arthritis, vasculitis, and sicca syndrome. Arthralgia is the most common extrahepatic manifestation and may indicate mixed cryoglobulinemia or an adverse reaction to interferon therapy. HCV arthritis unrelated to cryoglobulinemia is far less common but constitutes an independent entity. The picture may mimic rheumatoid arthritis (RA), particularly as rheumatoid factor is present in 50-80% of cases. Tests are usually negative for antibodies to cyclic citrullinated peptides (anti-CCP), which may help to differentiate the two conditions. The management of HCV arthritis is empirical and poorly standardized. Although low-dose glucocorticoid therapy, hydroxychloroquine, and methotrexate have been used successfully in several patients, little is known about their hepatic safety profile. Arthritis associated with cryoglobulinemia usually responds to antiviral treatment. Sicca syndrome is common in patients with chronic HCV infection and shares similarities with primary Sjögren syndrome, suggesting that HCV infection may deserve to be included among the causes of secondary Sjögren syndrome. HCV-associated vasculitis is usually related to cryoglobulinemia, although a few cases of polyarteritis nodosa-like disease affecting the medium-sized vessels have been reported. Other conditions reported in patients with chronic HCV infection include fibromyalgia, systemic lupus erythematosus (SLE), antiphospholipid syndrome, and osteosclerosis.
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Affiliation(s)
- Christian Lormeau
- Rheumatology Department and INSERM ERI-18, Avicenne Teaching Hospital (AH-HP) and Paris 13 University, 125, rue de Stalingrad, 93009 Bobigny, France.
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Loftis JM, Matthews AM, Hauser P. Psychiatric and substance use disorders in individuals with hepatitis C: epidemiology and management. Drugs 2006; 66:155-74. [PMID: 16451091 DOI: 10.2165/00003495-200666020-00003] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hepatitis C virus (HCV) infection is a major health concern in the US as well as in other countries worldwide. Treatment issues and disease management strategies are complicated by the extremely high rate of psychiatric and substance use disorders in those who have HCV. The majority of new and existing cases of HCV are related to injection drug use and, in this population, the prevalence of psychiatric comorbidity is high. Optimally, all patients with HCV should be screened for psychiatric and substance use disorders before initiation of antiviral therapy. If a patient screens positive, he or she should be referred to a mental healthcare provider or addiction specialist, assessed for the presence of a psychiatric or substance use disorder, and appropriately treated prior to initiation of antiviral (i.e. interferon) therapy. Although interferon-based therapies can lead to severe neuropsychiatric adverse effects, including in rare instances suicide, evidence suggests that many patients with comorbid psychiatric and substance use diagnoses can be treated safely and effectively using comanagement strategies. However, most patients with HCV are not treated with antiviral therapy. Therefore, we must expand our definition of HCV 'treatment' to include treatment of the comorbid psychiatric and substance use disorders that accompany HCV infection and precede antiviral therapy. This paper reviews the epidemiology and management of psychiatric and substance use disorders in patients with HCV, the issue of psychiatric and substance use disorders as contraindications for antiviral therapy, and current treatment strategies for HCV patients with these comorbid conditions.
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Affiliation(s)
- Jennifer M Loftis
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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D'Amico E, Chincoli C, Cacciatore P, di Pasqua G, Cosentino L, Riario-Sforza G, Pennese E, Capani F, Palazzi C. Effects of combined antiviral therapy on asymptomatic mixed cryoglobulinemia in naive patients with chronic hepatitis C virus infection: a preliminary study. Dig Dis Sci 2005; 50:2344-7. [PMID: 16416186 DOI: 10.1007/s10620-005-3059-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2004] [Accepted: 03/22/2005] [Indexed: 12/28/2022]
Abstract
The clinical spectrum of mixed cryoglobulinemia embraces several manifestations: recurrent vascular purpura, weakness, arthralgia/arthritis, glomerulonephritis, peripheral neuropathies, and Raynaud's phenomenon. Mixed cryoglobulinemia is currently treated with steroids, low-antigen content diet, immunosuppressors, plasma exchange, and antiviral therapy, namely, alpha -interferon alone or, more recently, in association with ribavirin. In the present research, we verified the effectiveness of combined therapy with interferon and ribavirin on asymptomatic mixed cryoglobulinemia in naïve (never treated before) patients with chronic hepatitis C. We enrolled 50 consecutive patients, 31 males and 19 females, with chronic hepatitis C who showed a sustained response to combined antiviral therapy (interferon and ribavirin). Before treatment, cryoglobulins were detected in 25 subjects (50%). Only 1 of the 25 patients with asymptomatic mixed cryoglobulinemia had persistence of cryoglobulins at the end of the follow-up period. Unexpectedly, in 7 of 25 subjects without mixed cryoglobulinemia before treatment, cryoglobulins became detectable after antiviral therapy. Our present study first reports the onset of asymptomatic mixed cryoglobulinemia in hepatitis C virus patients after clearance of the virus from blood obtained with a combined antiviral treatment. Possible explanations are discussed. Our data also suggest that the appearance of a clinically evident mixed cryoglobulinemia cannot be excluded in this kind of subject.
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Abstract
The role of viruses in the development of acute and chronic arthritis is complex, because viruses are ubiquitous, and all human beings are occasionally afflicted by viral infections. In general, most viral infections are acute and self-limiting and survive by infecting one susceptible host, then moving on to another. Some viruses establish prolonged latency in the host after acute infection, whereas other agents produce chronic infections following the primary stage. The mechanisms whereby these infections produce arthritis are diverse and still poorly understood, but are clearly influenced by both host and viral factors. This review addresses these and other common forms of viral arthritis, such as that caused by parvovirus B19.
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Affiliation(s)
- Leonard H Calabrese
- Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic, Cleveland, OH 44195, USA.
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Abstract
Chronic hepatitis C virus (HCV) infection is frequently associated with a number of extrahepatic complications. In the majority of cases the underlying pathogenetic mechanisms are immune mediated, as evidenced by the presence of circulating autoantibodies (mixed cryoglobulinemia), whereas for others a localized host cellular immune response is implicated (e.g. sialadenitis, lichen planus). In this review, the latest data on the pathogenesis and clinical manifestations of the most common autoimmune extrahepatic manifestations of chronic HCV infection are presented.
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Affiliation(s)
- Dimitrios Vassilopoulos
- Academic Department of Medicine, Athens University School of Medicine, Hippokration General Hospital, Athens, Greece
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Roca B. Manifestaciones extrahepáticas de la infección por el virus de la hepatitis C. Enferm Infecc Microbiol Clin 2004; 22:467-70. [PMID: 15482689 DOI: 10.1016/s0213-005x(04)73142-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hepatitis C virus predominantly affects the liver, although it may also produce a number of extrahepatic manifestations, such as mixed cryoglobulinemia, salivary and lacrimal gland dysfunction, and several types of kidney disease. The pathogenesis of these conditions is not completely understood, but immunologic mechanisms are involved in many cases. In some patients with hepatitis C virus infection, the extrahepatic manifestations predominate and their proper diagnosis and management is very important.
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Affiliation(s)
- Bernardino Roca
- Unidad de Enfermedades Infecciosas, Hospital General de Castellón, Spain.
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Abstract
PURPOSE OF THE REVIEW To summarize the current literature on central nervous system vasculitis in childhood because this condition remains a diagnostic and therapeutic challenge. RECENT FINDINGS Central nervous system vasculitis in childhood may be primary or secondary to a variety of conditions including infections, collagen vascular diseases, systemic vasculitides, and malignancies. Conditions that result in vasospasm or are associated with noninflammatory vasculopathies may mimic the features of central nervous system vasculitis. Recent studies have described the clinical spectrum of CNS vasculitis in childhood. The most common presenting features are headaches and focal neurologic deficits. The diagnosis of central nervous system vasculitis remains particularly difficult because the available investigative modalities have limited sensitivities and specificities. The most helpful diagnostic tests include cerebrospinal fluid analysis, MRI of the brain, and angiography. However, brain biopsy may be required to diagnose small vessel vasculitis. SUMMARY This review summarizes recent data on primary central nervous system vasculitis and some of the secondary CNS vasculitides in children. Awareness of the presenting clinical features of CNS vasculitis should lead to consideration of the diagnosis. Awareness of the sensitivity and specificity of the various diagnostic tests should lead to the more prudent use of invasive diagnostic tests including angiography and brain biopsy.
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Affiliation(s)
- Susanne Benseler
- Department of Pediatrics, The Hospital for Sick Children, and University of Toronto, Ontario, Canada M5G1X8
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