Impact of hepatitis C virus infection on disease activity, functional status and ultrasonography findings in Egyptian rheumatoid arthritis patients

Direct antiviral drugs in the treatment of hepatitis C-infected rheumatoid arthritis Egyptian cohort: safety and clinical impact

BACKGROUND AND AIM

Data about the safety and efficacy of direct-acting antivirals (DAAs) in the treatment of hepatitis C virus (HCV) patients with concomitant rheumatoid arthritis (RA) are scarce. We assessed the impact and safety of DAAs treatment of hepatitis C on rheumatoid arthritis disease activity.

PATIENTS AND METHODS

Prospectively, we enrolled 65 patients with RA and HCV. A clinico-laboratory evaluation was done at baseline, including liver assessment and RA disease activity score-28 (DAS28). At 12 weeks of post-DAAs treatment, sustained virologic response (SVR12) and DAS28 were reevaluated.

RESULTS

The SVR12 was achieved in 59 (90.8%) patients. RA control was achieved in 47 (79.9%) patients. The post SVR12 DAS28 score was significantly lower than the baseline (3.32 ± 0.93 vs. 4.37 ± 0.90; P < 0.001). There was a significant decline in the mean values of serum anticyclic citrullinated peptide, rheumatoid factor, erythrocyte sedimentation rate and C-reactive protein after achieving an SVR12 (30.47 ± 12.37 vs. 57.61 ± 15.91 U/ml; 29.78 ± 19.58 vs. 55.14 ± 16.89 IU/ml; 17.13 ± 10.84 vs. 29.68 ± 14.32 mm/h and 5.76 ± 1.57 vs. 11.44 ± 4.13 mg/l, respectively; P < 0.05). RA activity and antirheumatic drugs were stepped-down [12 (20.3%) and 35 (59.3%) patients showed good and moderate RA response, respectively]. The baseline viral load, absence of cirrhosis and SVR12 were the only predictors of disease control (P  < 0.05). No drug-related adverse events or drug-related discontinuation.

CONCLUSIONS

Unlike interferon, HCV elimination by DAAs significantly improves RA activity and treatment outcome with high safety and efficacy.

Impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection and disease-2019 (COVID-19) on the quality of life of rheumatoid arthritis patients in Benin

Aim of the work

To study the impact on the quality of life (QoL) of rheumatoid arthritis (RA) patients following up in a university hospital in Benin during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) disease 2019 (COVID-19) pandemic.

Patients and methods

The QoL of 68 RA patients was assessed using Medical Outcome Study Short Form 36 (MOS-SF36) scale across the physical (PCS) and mental (MCS) components scores. The disease activity score (DAS28) was considered. Patients accepting to participate and having a mean of communication via social network, in particular WhatsApp were included.

Results

The mean age of the patients was 49.9 ± 12.1 years (11-83 years) and were 65 females and 3 males. The mean DAS-28 at the start of the restriction measures was 3.4 ± 1.5, the mean PCS and MCS were 71.1 ± 20.3 and 67.1 ± 16.02 respectively and became 4.7 ± 2.04, 38.1 ± 4.96 and 36.8 ± 3.8 respectively. After 2 months, none of the RA patients presented with classic symptoms of COVID-19 infection. 8 patients were screened by Rapid Diagnostic Test and Reverse Transcription-Polymerase Chain Reaction. Only 1 case was positive but asymptomatic. All patients had altered QoL according to MOS-SF36. Factors associated with this deterioration were stress related to SARS-CoV2 isolation (p = 0.001), stress of having an activity flare-up (p = 0.001), fear of being stigmatized (p = 0.009). The economic factors were significantly associated with temporary unemployment, decrease in monthly income, and drug discontinuation (p = 0.001, p = 0.002 and p = 0.046 respectively).

Conclusion

The impact of the SARS-CoV2 pandemic is negative on the QoL of RA patients and many factors were contributing.