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Jia Y, Zhang J, Mo L, Ju B, Hu N, Wang Y, Wang P, Zheng J, He L, Wang J. Low positivity rates for HBeAg and HBV DNA in rheumatoid arthritis patients: a case-control study. BMC Infect Dis 2022; 22:570. [PMID: 35751011 PMCID: PMC9229421 DOI: 10.1186/s12879-022-07536-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background The rates of hepatitis B virus (HBV) infection in rheumatoid arthritis (RA) patients are controversial when considering the reported outcomes. It was speculated that HBV infection status was altered after RA, and variations inn HBV infection rates became apparent. Methods To compare the positive proportions of hepatitis B e antigen (HBeAg) and HBV DNA, a retrospective case–control study was performed between 27 chronic hepatitis B (CHB) patients with RA and 108 age- and gender-matched CHB patients. In addition, the positivity rates of hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) were surveyed among the 892 RA patients. Results Compared to CHB patients, CHB patients with RA exhibited lower rates of HBeAg positivity (11.1% vs. 35.2%, P = 0.003), HBV DNA positivity (37.0% vs. 63.9%, P = 0.007) and ALT elevation (11.1% vs. 35.2%, P = 0.024). In the 892 RA patients, the prevalence of HBsAg (3.0%) was lower than that reported in the Chinese national data (7.2%), whereas the anti-HBc positivity rate of 44.6% was higher than that of 34.1%. Conclusion HBV infection status was altered after suffering from RA. Compared to the matched CHB patients, low positive proportions of HBeAg and HBV DNA were observed for CHB patients with RA.
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Affiliation(s)
- Yue Jia
- Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jingjing Zhang
- Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Lingfei Mo
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China
| | - Bomiao Ju
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China
| | - Nan Hu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China
| | - Yanhua Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China
| | - Pei Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China
| | - Jie Zheng
- Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Lan He
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China.
| | - Jing Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China.
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Ando A, Hagiwara Y, Sekiguchi T, Koide M, Kanazawa K, Watanabe T, Itoi E. Magnetic resonance imaging classification of haemodialysis-related amyloidosis of the shoulder: risk factors and arthroscopic treatment. Knee Surg Sports Traumatol Arthrosc 2017; 25:2217-2224. [PMID: 26860102 DOI: 10.1007/s00167-016-4033-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 01/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE This study proposed new magnetic resonance imaging (MRI) of haemodialysis shoulders (HDS) focusing on the changes of the rotator cuff, and rotator interval and risk factors for the development of HDS were examined. METHODS Eighty-five shoulders in 72 patients with a chief complaint of shoulder pain during haemodialysis and at least 10 years of haemodialysis were included. They were classified into 5 groups based on the thickness of the rotator cuff and conditions of rotator interval. Clinical and radiological findings in each grade were examined, and risk factors for the development of HDS were evaluated. Arthroscopic surgeries were performed on 22 shoulders in 20 patients, and arthroscopic findings were also evaluated. RESULTS Positive correlations for the development of HDS were observed in duration of haemodialysis, positive hepatitis C virus (HCV) infection, and previous haemodialysis-related orthopaedic surgery (P < 0.001, respectively). Strong correlations were observed between positive HCV and the progression of HDS (odds ratio 24.8, 95 % confidence interval 5.7-107.6). Arthroscopically, progression of the surrounding soft tissue degeneration was observed, and operative times were lengthened depending on the progression of MRI grading. CONCLUSION A new MRI classification of HDS which may be helpful when considering arthroscopic surgeries has been proposed. Positive HCV infection was strongly associated with the progression of HDS on MRI. Conditions of the rotator interval and the rotator cuff based on the MRI classification should be examined when treating HDS patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Akira Ando
- Department of Orthopaedic Surgery, JCHO Sendai Hospital, 3-16-1 Tsutsumimachi, Aobaku, Sendai, Japan
| | - Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Japan.
| | - Takuya Sekiguchi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Japan
| | - Masashi Koide
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Japan
| | - Kenji Kanazawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Japan
| | - Takashi Watanabe
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University School of Medicine, 2-1 Seiryomachi, Aobaku, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Japan
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Zignego AL, Ramos-Casals M, Ferri C, Saadoun D, Arcaini L, Roccatello D, Antonelli A, Desbois AC, Comarmond C, Gragnani L, Casato M, Lamprecht P, Mangia A, Tzioufas AG, Younossi ZM, Cacoub P. International therapeutic guidelines for patients with HCV-related extrahepatic disorders. A multidisciplinary expert statement. Autoimmun Rev 2017; 16:523-541. [PMID: 28286108 DOI: 10.1016/j.autrev.2017.03.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 02/26/2017] [Indexed: 02/06/2023]
Abstract
Hepatitis C virus (HCV) is both hepatotrophic and lymphotropic virus that causes liver as well extrahepatic manifestations including cryoglobulinemic vasculitis, the most frequent and studied condition, lymphoma, and neurologic, cardiovascular, endocrine-metabolic or renal diseases. HCV-extrahepatic manifestations (HCV-EHMs) may severely affect the overall prognosis, while viral eradication significantly reduces non-liver related deaths. Different clinical manifestations may coexist in the same patient. Due to the variety of HCV clinical manifestations, a multidisciplinary approach along with appropriate therapeutic strategies are required. In the era of interferon-free anti-HCV treatments, international recommendations for the therapeutic management of HCV-EHMs are needed. This implies the need to define the best criteria to use antivirals and/or other therapeutic approaches. The present recommendations, based on qualified expert experience and specific literature, will focus on etiological (antiviral) therapies and/or traditional pathogenetic treatments that still maintain their therapeutic utility.
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Affiliation(s)
- Anna Linda Zignego
- Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD Josep Font Autoimmune Lab, CELLEX-IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Clodoveo Ferri
- Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, 41124 Modena, Italy
| | - David Saadoun
- Sorbonne University, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; INSERM, UMR S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Dario Roccatello
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Center of Research of Immunopathology and Rare Diseases, and Nephrology and Dialysis Unit, San G. Bosco Hospital and University of Turin, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
| | - Anne Claire Desbois
- Sorbonne University, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; INSERM, UMR S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
| | - Cloe Comarmond
- Sorbonne University, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; INSERM, UMR S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
| | - Laura Gragnani
- Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Milvia Casato
- Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185 Rome, Italy.
| | - Peter Lamprecht
- Klinik für Rheumatologie Oberarzt, Ratzeburger Allee 160 (Haus 40), 23538 Lübeck, Germany.
| | - Alessandra Mangia
- Liver Unit, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy.
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, University of Athens, 75 M. Asias st, Building 16, Room, 32 11527 Athens, Greece.
| | - Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA; Beatty Liver and Obesity Program, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Patrice Cacoub
- Sorbonne University, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; INSERM, UMR S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
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Aktas GE, Sarikaya A, Kandemir O. Hepatitis C Virus-related Arthritis: Bone Scintigraphic Appearances. Indian J Nucl Med 2017; 32:30-32. [PMID: 28242981 PMCID: PMC5317066 DOI: 10.4103/0972-3919.198468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A symptomatic joint involvement and arthralgia are frequent in patients with chronic hepatitis C virus (HCV) infection. However, HCV infection-related arthritis (HCVrA) affects up to 4-11% of the subjects suffering from disease. We reported a patient with HCVrA presented with the commonly accepted diagnostic clinical signs and laboratory parameters. The painful joints distinctly demonstrated increased uptake of Tc-99 m methylene diphosphonate in scintigraphy and normal findings in radiography.
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Affiliation(s)
- Gul Ege Aktas
- Department of Nuclear Medicine, Medical Faculty, Trakya University, 22030 Edirne, Turkey
| | - Ali Sarikaya
- Department of Nuclear Medicine, Medical Faculty, Trakya University, 22030 Edirne, Turkey
| | - Ozan Kandemir
- Department of Nuclear Medicine, Sivas Numune Hospital, 58060 Sivas, Turkey
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5
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Hussein MS, Ghany SEA, Elashkar DS, Rabea MY, Nosair NA. Anti-CCP hs (high sensitive) in Egyptian rheumatoid arthritis patients associated with chronic hepatitis C virus infection. EGYPTIAN RHEUMATOLOGIST 2016. [DOI: 10.1016/j.ejr.2015.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Taha EA, Mekky MA, Morsy H, Saleh MA, Nafeh HM, Ez-Aldin AM, Sayed SK. Study of the impact of viral load of hepatitis C on patients with concomitant psoriasis vulgaris. Arab J Gastroenterol 2014; 15:98-102. [PMID: 25174792 DOI: 10.1016/j.ajg.2014.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 04/04/2014] [Accepted: 08/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIM Concomitant hepatitis C virus (HCV) infection and psoriasis vulgaris (PV) are not uncommon coexisting diseases, especially in areas with high viral hepatitis endemicity. To date, data about the interaction between both diseases are scarce. Therefore, we aimed to describe the possible interplay between the HCV viral load and psoriatic activity in concomitant Egyptian diseased patients. PATIENTS AND METHODS Between December 2011 and August 2013, all psoriatic patients attending Assiut University Hospital outpatient clinics were tested for HCV serologic assay. Patients with positively coexisting diseases were further reevaluated for psoriasis area severity index (PASI) score assessment, liver function tests, HCV-RNA-polymerase chain reaction (PCR) assays, and sonographic examination of the liver. For comparative purposes, another matched group (n=26) with psoriasis only (HCV-negative group) was enrolled as a control. RESULTS During the period of the study, 20 patients with concomitant PV and HCV infection (HCV-positive group; 50% males, mean age of 44.15±10.66 years) were recruited. The mean PASI score was 44.75±10.38 and clinical signs of liver dysfunction were observed in 40% (n=8), 100% had abnormal liver function tests (n=20), and 75% had sonographic findings of cirrhosis (n=15). The PASI score was significantly higher in the HCV-positive psoriatic group compared to the HCV-negative control (p<0.001). Significant correlations were detected between the PASI score and the viral loads, and also with alanine aminotransferase (ALT). CONCLUSION When HCV was found concomitantly with PV, a high possibility of severe disease pattern will be expected that entails special precautions in the treatment process.
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Affiliation(s)
- Emad A Taha
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Mohamed A Mekky
- Department of Gastroenterology & Tropical Medicine, Assiut University, Assiut, Egypt.
| | - Hanan Morsy
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Medhat A Saleh
- Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt
| | - Hanan M Nafeh
- Department of Gastroenterology & Tropical Medicine, Assiut University, Assiut, Egypt
| | - Azza M Ez-Aldin
- Department of Clinical Pathology, Assiut University, Assiut, Egypt
| | - Sohair K Sayed
- Department of Clinical Pathology, Assiut University, Assiut, Egypt
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Palazzi C, D'Amico E, D'Angelo S, Gilio M, Leccese P, Olivieri I. An update on the management of hepatitis C virus-related arthritis. Expert Opin Pharmacother 2014; 15:2039-45. [PMID: 25146875 DOI: 10.1517/14656566.2014.946404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV)-related arthritis is an uncommon disease belonging to the autoimmune disorders due to the chronic stimulus exerted by the virus on the immune system. It shows two clinical subsets: a symmetrical polyarthritis resembling rheumatoid arthritis but less aggressive and an intermittent mono-oligoarthritis involving the lower limbs. AREAS COVERED We extensively review the current literature using the largest electronic databases (MEDLINE, EMBASE and COCHRANE) with regard to HCV-related arthritis (HCVrA) and studies focusing on the co-existence of HCV and other kinds of arthritides. EXPERT OPINION The therapeutic approach to HCVrA remains largely empirical, because few studies have been published on this topic. Mainstream treatment based on the administration of hydroxychloroquine and low doses of corticosteroid is still largely preferred. Cyclosporine represents a useful alternative due to its antiviral properties. Anti-TNF agents are safe, but their hypothetic use appears excessive for a mild disorder such as HCVrA. IFN-α (and more recently pegylated IFN-α) when administered as a component of the combined (IFN-α + ribavirin) anti-HCV therapy can promote the appearance or the worsening of several autoimmune HCV-related disorders, including arthritis. New and forthcoming antiviral molecules will be used in the near future for a revolutionary IFN-free treatment.
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Affiliation(s)
- Carlo Palazzi
- San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Rheumatology Department of Lucania , Potenza , Italy
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Suwannalai P, Trouw LA, Toes REM, Huizinga TWJ. Anti-citrullinated protein antibodies (ACPA) in early rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0486-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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9
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Armstrong AW, Coates LC, Espinoza LR, Ogdie AR, Rich P, Soriano ER. Infectious, Oncologic, and Autoimmune Comorbidities of Psoriasis and Psoriatic Arthritis: A Report from the GRAPPA 2012 Annual Meeting. J Rheumatol 2013; 40:1438-41. [DOI: 10.3899/jrheum.130458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) in Stockholm, Sweden, members addressed the infectious, oncologic, and autoimmune comorbidities of psoriasis and psoriatic arthritis (PsA). Members discussing infectious comorbidities asked whether patients with psoriasis or PsA are predisposed to particular types of infections, and whether the use of biologic agents is advisable in patients with certain preexisting infections. Regarding the oncologic comorbidities of psoriasis and PsA, members addressed cutaneous malignancy screening, lymphoproliferative malignancy risk and the need for screening, and treatment of patients with preexisting oncologic history requiring systemic therapy. Finally, GRAPPA members discussed autoimmune comorbidities associated with psoriasis and PsA; they agreed that research is nascent in this field and larger studies are necessary to determine the precise magnitude of these associations.
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McKenna O, Blake C. Management of hepatitis C: the potential benefits of exercise. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331907x223065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Joseph AM. Treatment of rheumatoid arthritis in patients with concomitant chronic hepatitis C infection. Ther Adv Musculoskelet Dis 2012; 4:35-40. [PMID: 22870493 DOI: 10.1177/1759720x11424459] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hepatitis C virus (HCV) infection is present in 1.8% of the general US population and its prevalence worldwide is estimated at 2-3%. HCV infected patients with concomitant rheumatoid arthritis (RA) pose a particular challenge to the rheumatologist because of the risks of treatment with disease-modifying medications in patients with chronic liver infection. In this paper the difficulties of diagnosing RA in HCV patients and the safety of RA treatment in patients with both conditions are discussed.
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Kanada KN, Schupp CW, Armstrong AW. Association between psoriasis and viral infections in the United States: focusing on hepatitis B, hepatitis C and human immunodeficiency virus. J Eur Acad Dermatol Venereol 2012; 27:1312-6. [PMID: 22564047 DOI: 10.1111/j.1468-3083.2012.04563.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND No published data in the U.S. population regarding an association between viral infections and psoriasis are currently available. Assessment of infection and immunosuppression risk is critical in managing psoriasis patients. OBJECTIVES To examine the association between psoriasis and viral infections including hepatitis B, hepatitis C and human immunodeficiency viral infections in the general U.S. population. METHODS Population data representative of the U.S. cohort were analysed from the National Health and Nutrition Examination Survey (NHANES), 2003-2006. Hepatitis B, hepatitis C, and human immunodeficiency antibodies status were ascertained from laboratory evaluations. Univariate and multivariate analyses were performed to assess the associations between psoriasis and these viral infections. RESULTS Among 6532 participants aged 20-59 years who provided responses to their psoriasis status, 162 patients reported having psoriasis. Based on multivariate regression analyses, psoriasis was not significantly associated with positive serology for hepatitis B core [odds ratio (OR), 0.83; 95% confidence interval (CI), 0.32-2.17; P = 0.7060], hepatitis B surface [OR, 7.89; CI, 0.52-119; P = 0.1355], hepatitis C [OR, 0.24; CI, 0.03-2.01; P = 0.1915], or human immunodeficiency virus [OR, 0.73; CI, 0.09-5.93; P = 0.7646] antibodies, after adjusting for age, gender, race and smoking status. CONCLUSIONS From the limited sample of the NHANES database on psoriasis and viral infections, psoriasis does not appear to be associated with an increased risk of hepatitis B, hepatitis C, or HIV infection in the U.S. population. Epidemiology of these viral infections in psoriasis needs to be continually studied and updated given their importance in management considerations.
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Affiliation(s)
- K N Kanada
- University of California San Diego School of Medicine, San Diego, CA, USA Department of Dermatology, University of California Davis Health System, Sacramento, CA, USA
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Hunyady B, Kovács B, Battyáni Z. Side-effects of pegylated interferon plus ribavirin therapy with or without protease inhibitor direct acting antiviral agents during treatment of chronic hepatitis C virus infection. Orv Hetil 2011; 152:1997-2009. [DOI: 10.1556/oh.2011.29266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Hepatitis C virus (HCV) infection affects 2–3% of the population, approximately 170 million people worldwide, causing chronic HCV-related hepatitis with subsequent liver cirrhosis, hepatic failure, hepatocellular cancer, and liver-related mortality in a large number of patients. The gold standard therapy, pegylated interferon alpha in combination with ribavirin can eradicate hepatitis C virus infection in approx. 40% of treatment-naïve patients infected with HCV genotype G1, and only 15–20% of patients with previous treatment. Success rate is substantially improved with the development and registration of two direct acting anti-hepatitis C virus protease inhibitors (boceprevir and telaprevir) in the second decade of 21st century: combined with the standard therapy, almost three quarter of previously untreated, and more than half of previously unsuccessfully treated patients can achieve sustained viral response with protease inhibitor based triple therapies. A major barrier to successful treatment is the association of peginterferon/ribavirin therapy with frequent and sometimes serious adverse effects. In clinical trials, approximately 10–15% of treated patients discontinue peginterferon and ribavirin due to adverse events; however, in routine clinical practice, the rate of treatment discontinuation has been reported to be substantially higher. The side effects of peginterferon/ribavirin therapy affect virtually all organ systems, and addition of protease inhibitor can amplify these side effects (particularly anemia), and/or may lead to new ones (i.e., dysgeusia with boceprevir or skin rush with telaprevir). There is considerable regional and global variability in the nature and prevalence of these adverse effects as well as in the best strategies to ameliorate their impact on hepatitis C virus treatment. This article summarizes the side effects of dual and triple therapies and their management based on the labels of the drugs, on a comprehensive literature review, as well as on the recently published opinion of an international panel of experts – with the provision of providing help for the physicians treating hepatitis C virus infection to achieve the best possible success with the highest possible safety for the patients. Orv. Hetil., 2011, 152, 1997–2009.
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Affiliation(s)
- Béla Hunyady
- Kaposi Mór Oktató Kórház Belgyógyászati Osztály Kaposvár
- Pécsi Tudományegyetem, Klinikai Központ I. Belgyógyászati Klinika Pécs Ifjúság u. 13. 7624
| | - Balázs Kovács
- Kaposi Mór Oktató Kórház Szemészeti Osztály Kaposvár
| | - Zita Battyáni
- Kaposi Mór Oktató Kórház Bőrgyógyászati Osztály Kaposvár
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Palazzi C, Buskila D, D'Angelo S, D'Amico E, Olivieri I. Autoantibodies in patients with chronic hepatitis C virus infection: pitfalls for the diagnosis of rheumatic diseases. Autoimmun Rev 2011; 11:659-63. [PMID: 22155016 DOI: 10.1016/j.autrev.2011.11.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 11/22/2011] [Indexed: 12/29/2022]
Abstract
Hepatitis C virus infection (HCV) is one of the best mimes in medicine. About 40-70% of patients suffering from this disorder develop at least one extra-hepatic disorder that can have a rheumatic nature (arthralgias, arthritis, vasculitis and sicca syndrome) and must be differentiated from the primitive rheumatic diseases. In addition, HCV infection can also alter the laboratory tests. Several alterations of first line laboratory tests can be usually found in both chronic HCV infection and chronic inflammatory rheumatic disorders. In the present review we analyze the interference of HCV in tests more specifically used in rheumatology: rheumatoid factor and other autoantibodies (ANA, anti-ENA, ANCA, anti-DNA, antiphospholipid, anti-CCP). In patients suffering from HCV infection, the diagnosis of connective tissue diseases (CTD) or rheumatoid arthritis (RA) should be made only when the detected symptoms or laboratory data are not inducible by HCV, otherwise only a diagnosis of "possible CTD" or "possible RA" should be considered.
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Affiliation(s)
- Carlo Palazzi
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Italy.
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Antibodies to mutated citrullinated vimentin in patients with chronic hepatitis C virus genotype IV infection-related arthropathy. Rheumatol Int 2011; 32:3495-501. [PMID: 22068352 DOI: 10.1007/s00296-011-2193-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 10/22/2011] [Indexed: 02/04/2023]
Abstract
One of the extra-hepatic manifestations of hepatitis C virus (HCV) infection is polyarthritis that mimics rheumatoid arthritis (RA). Anti-mutated citrullinated vimentin (MCV) was recently introduced in the diagnostic workup of RA, but its exact role in HCV infection and its related arthropathy is still unclear. The aim of the study is to determine the prevalence of anti-MCV antibodies in HCV-infected patients with or without articular involvement, and to investigate whether anti-MCV antibodies have an additional role to anticyclic citrullinated peptide (CCP) antibodies and rheumatoid factor (RF) in differentiating patients with RA from patients with HCV-related arthropathy. Fifty-five HCV-infected patients (HCV RNA positive) and 30 RA patients (fulfilling the American College of Rheumatology classification criteria for RA and negative for HCV) were included. Anti-MCV antibodies, anti-CCP antibodies, RF and cryoglobulins were measured. Articular involvement in hepatitis C patients was evaluated. Articular involvement was detected in 30/55 (54.5%) of HCV-infected patients. The most frequent pattern was symmetric polyarthralgias and the most frequent joints to be involved were the wrists, metacarpophalangeal joints, shoulders and knees. In HCV arthropathy, anti-MCV was positive in 9/30 (30%), anti-CCP in 0% and RF in 22/30 (73.3%). Whereas, in chronic HCV without arthropathy, anti-MCV was positive in 8 patients (32%), anti-CCP in one patient (4%) and RF in 23/25 (92.0%). There was no significant difference between the two HCV groups as regards the frequencies of anti-MCV (P = 0.89), anti-CCP (P = 0.93) and RF (P = 0.15). In RA, anti-MCV was positive in 93.3% anti-CCP in 96.7% and RF in 86.7%. There was no significant difference in RF between RA and HCV arthropathy (P = 0.33). Meanwhile, there was a highly significant difference between both groups regarding anti-MCV and anti-CCP (P < 0.0001 for each). The sensitivity of anti-MCV, anti-CCP and RF for RA was 93.3, 96.7 and 86.7%, respectively. Whereas their specificity was 69.1, 98.2 and 18.2%, respectively. In addition, the mean levels of anti-MCV and anti-CCP were significantly increased in RA than in all HCV patients (P = 0.038 and P < 0.0001, respectively). Meanwhile, there were no significant differences in mean levels of anti-MCV and anti-CCP between HCV patients with arthropathy and those without arthropathy (P = 0.11 and P = 0.73, respectively). Also, there were no differences in mean RF between both HCV groups. There was a significant positive correlation between anti-MCV and anti-CCP levels in patients with HCV-related arthropathy (r = 0.39, P = 0.032) and in those without arthropathy (r = 0.578, P = 0.002). Cryoglobulins were detected in 7/30 HCV-related arthropathy (23.3%) and were positively correlated with anti-MCV(r = 0.485, P = 0.007). Anti-CCP still attains the major role in differentiating RA from HCV arthropathy. Anti-MCV seems to play no additional role in this aspect. The role of mutation of vimentin in the pathogenesis of HCV arthropathy is not as clear as it is for RA and needs further investigation.
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Abstract
Viral infections may manifest as acute or chronic arthritis. Joint involvement arises from either direct infection of the joint, through an immunological response directed towards the virus or autoimmunity. Epidemiological clues to the diagnosis include geographic location and exposure to vector-borne, blood-borne or sexually transmitted viruses. Although not always possible, it is important to diagnose the pathogenic virus, usually by serology, nucleic acid tests or rarely, viral culture. In general, viral arthritides are self-limiting and treatment is targeted at symptomatic relief. This article focuses on the causes, clinical features, diagnosis and treatment of viral arthritides.
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Affiliation(s)
- Alexander C Outhred
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales 2145, Australia.
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18
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Anti-citrullinated protein antibodies (ACPA) in early rheumatoid arthritis. Mod Rheumatol 2011; 22:15-20. [PMID: 21732051 DOI: 10.1007/s10165-011-0486-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 06/02/2011] [Indexed: 11/26/2022]
Abstract
Autoantibodies with the highest specificity for rheumatoid arthritis (RA) are the antibodies directed to citrulline-containing epitopes, so-called anti-citrullinated peptide/protein antibodies (ACPA). During the past decade it became clear that the presence of these antibodies was highly predictive of and specific for RA, and illustrating the importance of ACPA. Therefore, the presence of these antibodies is one of the new American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 criteria for RA. Apart from the presence of these antibodies, the composition of this antibody response matures during RA development. This review summarizes the current knowledge of the characteristics of ACPA in RA development.
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Ansemant T, Ornetti P, Garrot JF, Pascaud F, Tavernier C, Maillefert JF. Usefulness of routine hepatitis C and hepatitis B serology in the diagnosis of recent-onset arthritis. Systematic prospective screening in all patients seen by the rheumatologists of a defined area--brief report. Joint Bone Spine 2011; 79:268-70. [PMID: 21733731 DOI: 10.1016/j.jbspin.2011.05.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 05/15/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Previous studies evaluating the usefulness of systematic screening for hepatitis B and C in patients with recent-onset arthritis suffered from a major bias since they were conducted in hospitals. The objective of the present study was to evaluate the relevance of such screening, performed by hospital and office-based rheumatologists of a defined area, in the diagnosis of arthritis or inflammatory polyarthralgia of less than 1 year duration. METHODS The CRRRI is a network which includes most hospital and office-based rheumatologists of an area with a population of 506,755 inhabitants. All patients seen by the CRRRI participants in their usual practice between March 2008 and December 2010 for inflammatory polyarthralgia, mono-, oligo-, or polyarthritis of less than 1 year duration were included. Patients' serum samples were screened for the presence of anti-hepatitis C virus (HCV) antibodies, with positive samples further evaluated for HCV-RNA with a reverse transcriptase-polymerase chain reaction, and for the presence of hepatitis B virus (HBV) infection. RESULTS Two hundred and thirty-three patients were included (162 women, 71 men; mean age of 50.6±15.8 years). Patients were evaluated for inflammatory polyarthralgia (n=51), monoarthritis (n=21), oligoarthritis (n=35) or polyarthritis (n=126) lasting for a mean 19.8±29.8 weeks. No new HCV or HBV infection diagnosis was done. CONCLUSION In this study not suffering from a hospital-selection bias, screening for hepatitis C and B infection was not helpful in the diagnosis process of recent-onset arthritis. KEY MESSAGES Systematic hepatitis B and C serology is not relevant in patients with recent-onset (<1 year) arthritis.
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Affiliation(s)
- Thiphaine Ansemant
- Department of rheumatology, Dijon University Hospital, 21078 Dijon, France. ansemant
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20
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Sulkowski MS, Cooper C, Hunyady B, Jia J, Ogurtsov P, Peck-Radosavljevic M, Shiffman ML, Yurdaydin C, Dalgard O. Management of adverse effects of Peg-IFN and ribavirin therapy for hepatitis C. Nat Rev Gastroenterol Hepatol 2011; 8:212-23. [PMID: 21386812 DOI: 10.1038/nrgastro.2011.21] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
HCV infects approximately 2-3% of the global population and is a leading cause of end-stage liver disease and hepatocellular carcinoma. Treatment of HCV infection with Peg-IFN in combination with ribavirin can eradicate HCV infection in 40-90% of patients; however, a major barrier to treatment uptake and delivery is the association of this therapy with frequent and, at times, serious adverse effects. Recognition and effective management of these adverse effects are critical components of the successful treatment of chronic HCV infection. In clinical trials, approximately 10-15% of patients discontinue Peg-IFN and ribavirin therapy due to adverse effects; however, in clinical practice, the rate of treatment discontinuation has been reported to be substantially higher. The off-target effect of Peg-IFN and ribavirin impacts most, if not all, organ systems; the most common adverse effects are hematologic, dermatologic, neurologic, immunologic, gastrointestinal, pulmonary, cardiovascular, and ocular. Regional and global variability exists in the nature of these adverse effects and the strategies employed to ameliorate their impact. This article provides a comprehensive literature review that systematically describes the adverse effects of Peg-IFN-α and ribavirin on various organ systems and, more importantly, recommends consensus approaches to managing those effects.
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Affiliation(s)
- Mark S Sulkowski
- Viral Hepatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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21
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Ogdie A, Schumacher HR, Dai L, Chen LX, Einhorn E, Pessler F. Synovial biopsy findings in arthritis associated with hepatitis C virus infection. J Rheumatol 2010; 37:1361-3. [PMID: 20516045 DOI: 10.3899/jrheum.091309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Ezzat WM, Raslan HM, Aly AA, Emara NA, El Menyawi MM, Edrees A. Anti-cyclic citrullinated peptide antibodies as a discriminating marker between rheumatoid arthritis and chronic hepatitis C-related polyarthropathy. Rheumatol Int 2009; 31:65-9. [PMID: 19882340 DOI: 10.1007/s00296-009-1225-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 10/07/2009] [Indexed: 12/11/2022]
Abstract
Articular involvement is a frequent extrahepatic manifestation of hepatitis C virus (HCV) infection. The distinction between HCV-related polyarthropathy and true RA may be very difficult, especially with recent onset RA before articular damage and erosions develop. The objective of the study is to assess the diagnostic utility of anti-CCP antibodies and compare it with that of rheumatoid factor (RF) in distinguishing between rheumatoid arthritis (RA) and HCV-related polyarthropathy. Anti-cyclic citrullinated peptide (CCP) antibodies and RF were determined in the sera of 30 patients with RA and 22 patients with HCV-related polyarthropathy. Anti-CCP antibodies were positive in 83.3% of patients with RA and in 4.5% in patients with HCV and polyarthropathy. RF was positive in 90% of RA patients and in 81.1% of HCV patients with polyarthropathy. The anti-CCP antibodies showed higher specificity for RA compared with RF (95.4 vs. 18.2%). However, the sensitivity of anti-CCP was comparable to that of RF (83.3 vs. 90%). In conclusions, anti-CCP antibodies are reliable laboratory markers to differentiate between RA and HCV-related polyarthropathy.
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Affiliation(s)
- Wafaa M Ezzat
- Internal Medicine Department, National Research Centre, Cairo, Egypt
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23
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Abstract
Hepatitis C virus (HCV) is an important causative agent of liver diseases. However, HCV infection is also associated with numerous hematologic, renal, dermatologic, rheumatic, and autoimmune disorders. These include arthralgia, arthritis, vasculitis, sicca syndrome, myalgia, and fibromyalgia. The purpose of this article is to review the prevalence and spectrum of rheumatic disorders and autoimmune phenomena in HCV-infected patients. It evaluates and current treatment options including nonsteroidal anti-inflammatory drugs, low-dose corticosteroids, hydroxychloroquine, methotrexate, penicillamine, combined antiviral therapy, cyclosporin A, anti-TNF-a agents, and rituximab. It concludes that larger, controlled studies are needed to establish further the treatment indications, efficacy, and safety of these agents.
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Affiliation(s)
- Dan Buskila
- Division of Internal Medicine, Department of Medicine H, Soroka Medical Center, Ben Gurion University, Beer Sheva, P.O.B 151, 84101 Israel.
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24
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Bassyouni IH, Ezzat Y, Hamdy S, Talaat RM. Clinical significance of anti-cyclic citrullinated peptide antibodies in Egyptian patients with chronic hepatitis C virus genotype IV infection. Clin Chem Lab Med 2009; 47:842-7. [DOI: 10.1515/cclm.2009.189] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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25
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Abstract
Although asymptomatic joint involvement and arthralgias are frequent in patients with hepatitis C virus chronic infection (HCV), a true arthritis affects only up to 4% of the subjects. HCV-related arthritis (HCVrA) is usually distinguished in two clinical subsets: a more frequent symmetrical polyarthritis (SP), similar to rheumatoid arthritis but much less serious, and an intermittent mono-oligoarthritis (IMO) that involves medium and large sized joints, mainly the ankle. This latter subset is strictly related to the presence of HCV-induced mixed cryoglobulinemia and its cutaneous manifestations, in particular purpura. According to recent reports, anti-CCP antibodies are considered very useful in differentiating the SP subset from rheumatoid arthritis. The treatment of HCVrA is still largely empirical because few studies have analyzed this topic. However, COXIBs, NSAIDs, low doses of corticosteroids, hydroxychloroquine and less frequently methotrexate and penicillamine have been used with partial or complete control of symptoms. On the basis of recent studies, the administration of cyclosporine also seems to be sufficiently safe. The scarcely aggressive nature of HCVrA does not favour the use of anti-TNF agents. Specific anti-viral therapy (interferon-alpha+ribavirin) must be accurately evaluated because interferon-alpha can induce the development or the worsening of several autoimmune HCV-related disorders including arthritis.
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Affiliation(s)
- Carlo Palazzi
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
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26
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Palazzi C, D'Amico E, D'Angelo S, Nucera A, Petricca A, Olivieri I. Hepatitis C virus infection in Italian patients with fibromyalgia. Clin Rheumatol 2007; 27:101-3. [PMID: 17943229 DOI: 10.1007/s10067-007-0737-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 08/29/2007] [Indexed: 10/22/2022]
Abstract
We evaluated the prevalence of hepatitis C virus (HCV) infection in Italian patients suffering from fibromyalgia (FM), in comparison with patients affected by non-HCV related rheumatic degenerative disorders. Consecutive patients with FM and a statistically comparable group of patients suffering from peripheral osteoarthritis (OA) or sciatica due to L4-L5 or L5-S1 herniated disc were tested for HCV infection with a third-generation microparticle enzyme immunoassay (MEIA). In the positive cases, a third-generation recombinant immunoblot assay (RIBA) confirmatory test and serum HCV-RNA test were performed. Fisher's exact test was performed to compare the prevalence of HCV infection (MEIA- and RIBA-positive results) obtained in the two enrolled groups. Enrolled were 152 subjects suffering from FM and 152 patients with peripheral OA or sciatica. Anti-HCV antibodies were found in 7/152 (4.6%) patients suffering from FM and in 5/152 (3.3%) of control subjects. No statistically significant differences in HCV prevalence were detected between cases and controls. Our present report does not confirm previous data indicating an increased prevalence of HCV in FM patients and does not seem to support a significant pathogenetic role of HCV under this condition.
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Affiliation(s)
- C Palazzi
- Division of Rheumatology, Villa Pini Clinic, Chieti, Italy
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27
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Raptopoulou A, Sidiropoulos P, Katsouraki M, Boumpas DT. Anti-citrulline antibodies in the diagnosis and prognosis of rheumatoid arthritis: evolving concepts. Crit Rev Clin Lab Sci 2007; 44:339-63. [PMID: 17558653 DOI: 10.1080/10408360701295623] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Citrulline is a non-standard amino acid that can be incorporated into proteins only by post-translational modification of arginine by peptidylarginine deiminase (PAD) enzymes during a variety of biologic processes, including inflammation. Rheumatoid arthritis (RA) is an inflammatory autoimmune disease, with a prevalence of 0.3 to 1% worldwide, which leads to progressive joint erosion and substantial disability if not treated early. A reliable and specific test for a marker present early in the disease would be useful to identify RA patients prior to the occurrence of joint damage. A new group of autoantibodies, the anti-cyclic citrullinated peptide antibodies (anti-CCP), can be detected in up to 80% of patients with RA, are highly specific for the disease, and may be of value for both the diagnosis and the prognosis of RA. The fact that these antibodies may appear before the onset of the disease suggests a potential role in primary prevention. Interestingly, they may also play a role in the pathophysiology of this disabling disease. The process of citrullination, its physiologic role, and citrullination-related pathologies, as well as the use of anti-citrullinated protein antibody tests (ACPA) for the early diagnosis and prognosis of RA and their potential role in the pathophysiology of the disease, are discussed.
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Affiliation(s)
- Amalia Raptopoulou
- Department of Internal Medicine and Division of Rheumatology, Clinical Immunology and Allergy, University of Crete, Heraklion, Greece
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28
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Liu FC, Chao YC, Hou TY, Chen HC, Shyu RY, Hsieh TY, Chen CH, Chang DM, Lai JH. Usefulness of anti-CCP antibodies in patients with hepatitis C virus infection with or without arthritis, rheumatoid factor, or cryoglobulinemia. Clin Rheumatol 2007; 27:463-7. [PMID: 17876647 DOI: 10.1007/s10067-007-0729-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2007] [Revised: 07/14/2007] [Accepted: 08/28/2007] [Indexed: 12/11/2022]
Abstract
The presence of antibodies to cyclic citrullinated peptide (CCP) has high specificity in the diagnosis of rheumatoid arthritis (RA). Hepatitis C virus (HCV) infection may induce extra-hepatic manifestations, such as polyarthritis that mimic RA. The aim of this study was to determine the prevalence of anti-CCP antibodies in HCV-infected patients with or without arthritis, rheumatoid factor (RF), or cryoglobulinemia and to investigate whether anti-CCP antibodies may be helpful in discriminating patients with RA from patients with HCV-associated arthropathy. A total of 44 patients with RA, 34 patients with HCV infections, and 42 control patients with non-RA rheumatic diseases were recruited for the study. Anti-CCP antibody levels were determined by enzyme-linked immunosorbent assay. We found that, consistent with other reports, patients with RA were more likely to have high titers of anti-CCP antibody than HCV-infected or control patients. A significant number of HCV-infected patients with neither RF nor cryoglobulinemia were also positive for anti-CCP antibodies (the three positive values were 36.10, 8.65, and 5.83 U/ml, P < 0.01 compared with the control patients). The presence of cryoglobulinemia and/or RF in HCV-infected patients did not affect the anti-CCP outcomes. Although anti-CCP antibodies remain to be a very useful tool in discriminating RA from non-RA, HCV-infected patients with neither RF nor cryoglobulinemia may have anti-CCP antibodies. Because of limited patient numbers, this tentative conclusion may need further confirmation with inclusion of more patient population.
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Affiliation(s)
- Feng-Cheng Liu
- Division of Rheumatology/Immunology/Allergy, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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29
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30
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Abstract
Extrahepatic symptoms during chronic hepatitis C virus (HCV) infection are common and varied. Arthritis can be seen either as part of autoimmune processes (eg, associated with cryoglobulinemia) or independently. Whether the manifestation is specifically attributable to HCV infection or rather to the nonspecific result of a chronic inflammatory process is not clear. The literature available at this time is insufficient to guide the most appropriate course of treatment of HCV arthritis. Standard antirheumatic treatment can be considered, but with caution, because some of these medications occasionally may be hepatotoxic and response to therapy seems variable. Treatment decisions should be determined on a case-by-case basis.
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Affiliation(s)
- Aja M Sanzone
- Pediatric Infectious Diseases, Combined Fellowship Training Program of Tulane University and Louisiana State University Health Sciences Center, Children's Hospital, 1430 Tulane Avenue, New Orleans, LA 70112, USA
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31
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Wiik AS. The immune response to citrullinated proteins in patients with rheumatoid arthritis. Clin Rev Allergy Immunol 2007; 32:13-22. [PMID: 17426357 DOI: 10.1007/bf02686078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 11/25/2022]
Abstract
This article reviews data concerning the applicability of anti-citrullinated peptide antibodies in the diagnosis, estimation of prognosis, and follow-up of patients with rheumatoid arthritis (RA). The production of anti-citrullinated peptide antibodies is closely associated with the presence of the HLA-DRB1 shared epitope, a known risk factor for development of RA, and the production may be influenced by environmental factors such as tobacco smoking. Patients who harbor this antibody from the early stage of their disease develop more severe erosive disease than patients with RA who lack the antibody. The anti-citrullinated peptide antibody level may be a reflection of disease activity, at least in the early phase of the disease. The antibody can sometimes be found several years before the onset of clinical symptoms of RA, which may represent an open window for preventive measures to be taken.
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Affiliation(s)
- Allan S Wiik
- Department of Autoimmunology, Statens Serum Institut, Copenhagen S, Denmark.
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32
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Bizzaro N. Antibodies to citrullinated peptides: a significant step forward in the early diagnosis of rheumatoid arthritis. Clin Chem Lab Med 2007; 45:150-7. [PMID: 17311500 DOI: 10.1515/cclm.2007.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractThe early diagnosis of rheumatoid arthritis (RA) has become a priority owing to the availability of effective disease-modifying agents that can improve patient wellbeing and influence the clinical outcome. However, this represents a real challenge, as no clinical, radiological or immunological features are pathognomonic at the time of presentation. For this reason, development of the anti-cyclic citrullinated peptide (CCP) antibody assay, a highly disease-specific serological marker for RA, has been a great step forward for the rheumatologist and the clinical laboratory. Over recent years, this test has increased in popularity and many studies have been performed. This review briefly considers the most recent data on the diagnostic accuracy of the CCP test, the genetic background that predisposes to antibody production, the diagnostic, prognostic and predictive values, and the clinical use of the assay in patients with RA.Clin Chem Lab Med 2007;45:150–7.
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Affiliation(s)
- Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale Civile, Tolmezzo, Italy.
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Palazzi C, D'Amico E, Pennese E, Petricca A, Olivieri I. Purpura and serum mixed cryoglobulinemia in psoriatic arthritis. Rheumatol Int 2006; 27:187-9. [PMID: 16900374 DOI: 10.1007/s00296-006-0172-x] [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] [Received: 01/22/2006] [Accepted: 07/07/2006] [Indexed: 11/30/2022]
Abstract
We here firstly describe the case of a psoriatic arthritis associated with cutaneous purpura and lower limbs weakness. The presence of type III mixed cryoglobulinemia in serum was the only possible detected cause. Discrepancies with the hepatitis C virus-related mixed cryoglobulinemia picture are discussed.
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Affiliation(s)
- Carlo Palazzi
- Division of Rheumatology, Villa Pini Clinic, Chieti, Italy.
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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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Wright H, Alex P, Nguyen T, Bader T, Gurakar A, Sebastian A, Gonzales L, Wallis G, Naylor M, Dozmorov I, Centola M, Nour B. Multiplex cytokine profiling of initial therapeutic response in patients with chronic hepatitis C virus infection. Dig Dis Sci 2005; 50:1793-803. [PMID: 16187176 PMCID: PMC7087834 DOI: 10.1007/s10620-005-2940-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2004] [Accepted: 01/10/2005] [Indexed: 01/13/2023]
Abstract
Currently available prognostic tools are inadequate to discern the molecular basis of the heterogenic response in hepatitis C virus (HCV)-infected patients treated with the current standard of therapy. The expression and biological function of immune mediators have been shown to be critical in all phases of the immune response to HCV infection and likely therefore influence host response. Herein, a biometric multiplex serum cytokine assay was utilized to characterize the immunomodulatory effects of host response in 10 HCV patients. Serum levels of 17 cytokines were compared before and after 1 month of treatment and against controls. Overall serum cytokine levels were significantly higher in patients (P < 0.05) than controls. Additionally, viral titers decreased in all patients after 1 month of therapy, as did overall serum cytokine levels in the cohort (P < 0.05). To assess relationships between changes in cytokine levels and changes in viral titer, the cohort was divided into three statistically distinct subgroups based on changes in viral titers. Specific sets of cytokines decreased in each group: decreases in CCL4, interleukin (IL)-2, CXCL8, and IL-1beta correlated with the greatest drops in viral titer, decreases in IL-5, granulocyte colony stimulating factor (G-CSF), and CCL4 correlated with moderate drops in viral titer, and only CCL2 correlated with the lowest drops in viral titer. Interestingly, decreases in CCL4 levels correlated with decreases in viral titers in all patients. CCL4 controls leukocyte influx and thus propagates inflammation. In conclusion, these data raise the possibility that characteristic changes in host response modulate the therapeutic response, demonstrating the prognostic power of serum cytokine profiling in chronic HCV.
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Affiliation(s)
- Harlan Wright
- Nazhi Zuhdi Transplant Institute, Integris Baptist Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Philip Alex
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Thuan Nguyen
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Teddy Bader
- Nazhi Zuhdi Transplant Institute, Integris Baptist Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Ahmet Gurakar
- Nazhi Zuhdi Transplant Institute, Integris Baptist Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Anthony Sebastian
- Nazhi Zuhdi Transplant Institute, Integris Baptist Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Liberty Gonzales
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Gemma Wallis
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Mark Naylor
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Igor Dozmorov
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Michael Centola
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
- Oklahoma Medical Research Foundation, 825 N.E. 13th Street, MS#58, Oklahoma City, Oklahoma 73104 USA
| | - Bakr Nour
- Nazhi Zuhdi Transplant Institute, Integris Baptist Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
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Rulli NE, Suhrbier A, Hueston L, Heise MT, Tupanceska D, Zaid A, Wilmes A, Gilmore K, Lidbury BA, Mahalingam S. Ross River virus: Molecular and cellular aspects of disease pathogenesis. Pharmacol Ther 2005; 107:329-42. [PMID: 15923040 DOI: 10.1016/j.pharmthera.2005.03.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2005] [Indexed: 11/16/2022]
Abstract
Ross River virus (RRV) is a mosquito-borne alphavirus indigenous to Australia and the Western Pacific region and is responsible for several thousand cases of human RRV disease (RRVD) per annum. The disease primarily involves polyarthritis/arthralgia, with many patients also presenting with rash, myalgia, fever, and/or lethargy. The symptoms can be debilitating at onset, but they usually resolve within 3-6 months. Recent insights into the RRV-host relationship, associated pathology, and molecular biology of infection have generated a number of potential avenues for improved treatment. Although vaccine development has been proposed, the small market size and potential for antibody-dependent enhancement (ADE) of disease make this approach unattractive. Recent insights into the molecular basis of RRV-ADE and the virus's ability to manipulate host inflammatory and immune responses create potential new opportunities for therapeutic invention. Such interventions should overcome virus-induced dysregulation of protective host responses to promote viral clearance and/or ameliorate inflammatory immunopathology.
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Affiliation(s)
- Nestor E Rulli
- School of Health Sciences, University of Canberra, Kirinari Street, Canberra ACT 2601, Australia
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Palazzi C, Olivieri I, D'Amico E, D'Agostino L, Nicolucci A, Pennese E, Petricca A. Hepatitis C virus infection in psoriatic arthritis. ACTA ACUST UNITED AC 2005; 53:223-5. [PMID: 15818717 DOI: 10.1002/art.21079] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the prevalence of hepatitis C virus (HCV) infection in patients with psoriatic arthritis (PsA), compared with patients affected by non HCV-related rheumatic degenerative disorders. METHODS One-hundred consecutive subjects with PsA, and a statistically comparable group of 100 consecutive patients with peripheral osteoarthritis (OA) or sciatica due to L4-L5 or L5-S1 herniated disc were tested for HCV infection with a third-generation microparticle enzyme immunoassay (MEIA). Positive cases were submitted to a third-generation recombinant immunoblot assay (RIBA) confirmatory test. Comparison between the HCV prevalence obtained in the 2 enrolled groups was performed using Fisher's exact test. RESULTS Anti-HCV antibodies were found with the MEIA method, in 1 patient with PsA, and in 4 patients with OA or sciatica. The RIBA method confirmed MEIA results in all positive patients. The difference in HCV prevalence detected in the PsA group and in the control group was not statistically significant (P = 0.68). Furthermore, HCV prevalence in PsA patients was lower than the ones reported in different geographic areas of Italy. CONCLUSION Our present report does not confirm previous data that indicated an increased prevalence of HCV in PsA patients, and as a consequence, does not sustain a possible trigger role of HCV in cases of PsA. The absence of clinical or instrumental resources that consent a definite differential diagnosis between PsA and HCV-related arthritis was outlined and analyzed.
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Nijenhuis S, Zendman AJW, Vossenaar ER, Pruijn GJM, vanVenrooij WJ. Autoantibodies to citrullinated proteins in rheumatoid arthritis: clinical performance and biochemical aspects of an RA-specific marker. Clin Chim Acta 2005; 350:17-34. [PMID: 15530456 DOI: 10.1016/j.cccn.2004.07.016] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 06/30/2004] [Accepted: 07/15/2004] [Indexed: 12/01/2022]
Abstract
Rheumatoid arthritis (RA) is a common, systemic autoimmune disease of which the exact etiology is not known. In the past 10 years, substantial progress has been made in the identification of the antigens specifically recognized by the autoantibodies of RA patients. A central factor in this respect is citrullination, a form of post-translational modification that is strongly associated with autoimmunity in RA. Here, we summarize and discuss our current knowledge on (i) autoantibody systems in RA, (ii) the occurrence of peptidylarginine deiminases and (iii) citrullinated proteins in natural and diseased environments, and (iv) genetic factors involved in RA that may influence the generation and presentation of citrullinated proteins and the resulting antibody production against these modified proteins. Citrullination of proteins may play a key role in the initiation and/or the progression of RA. The onset of citrulline-specific autoimmunity in RA is probably mediated by both environmental and genetic factors, and future studies will learn whether therapeutic intervention at the level of citrullination may provide new possibilities to treat RA.
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Affiliation(s)
- Suzanne Nijenhuis
- Department of Biochemistry 161, Radboud University Nijmegen, PO Box 9101, NL-6500 HB Nijmegen, The Netherlands
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Bombardieri M, Alessandri C, Labbadia G, Iannuccelli C, Carlucci F, Riccieri V, Paoletti V, Valesini G. Role of anti-cyclic citrullinated peptide antibodies in discriminating patients with rheumatoid arthritis from patients with chronic hepatitis C infection-associated polyarticular involvement. Arthritis Res Ther 2004; 6:R137-41. [PMID: 15059277 PMCID: PMC400432 DOI: 10.1186/ar1041] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Accepted: 01/13/2004] [Indexed: 12/02/2022] Open
Abstract
This study was performed to assess the utility of anti-cyclic citrullinated peptide (anti-CCP) antibodies in distinguishing between patients with rheumatoid arthritis (RA) and patients with polyarticular involvement associated with chronic hepatitis C virus (HCV) infection. Serum anti-CCP antibodies and rheumatoid factor (RF) were evaluated in 30 patients with RA, 8 patients with chronic HCV infection and associated articular involvement and 31 patients with chronic HCV infection without any joint involvement. In addition, we retrospectively analysed sera collected at the time of first visit in 10 patients originally presenting with symmetric polyarthritis and HCV and subsequently developing well-established RA. Anti-CCP antibodies and RF were detected by commercial second-generation anti-CCP2 enzyme-linked immunosorbent assay and immunonephelometry respectively. Anti-CCP antibodies were detected in 23 of 30 (76.6%) patients with RA but not in patients with chronic HCV infection irrespective of the presence of articular involvement. Conversely, RF was detected in 27 of 30 (90%) patients with RA, 3 of 8 (37.5%) patients with HCV-related arthropathy and 3 of 31 (9.7%) patients with HCV infection without joint involvement. Finally, anti-CCP antibodies were retrospectively detected in 6 of 10 (60%) patients with RA and HCV. This indicates that anti-CCP antibodies can be useful in discriminating patients with RA from patients with HCV-associated arthropathy.
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Affiliation(s)
- Michele Bombardieri
- Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata – Università degli Studi di Roma 'La Sapienza', Roma, Italy
| | - Cristiano Alessandri
- Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata – Università degli Studi di Roma 'La Sapienza', Roma, Italy
| | - Giancarlo Labbadia
- Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata – Università degli Studi di Roma 'La Sapienza', Roma, Italy
| | - Cristina Iannuccelli
- Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata – Università degli Studi di Roma 'La Sapienza', Roma, Italy
| | - Francesco Carlucci
- Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata – Università degli Studi di Roma 'La Sapienza', Roma, Italy
| | - Valeria Riccieri
- Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata – Università degli Studi di Roma 'La Sapienza', Roma, Italy
| | - Vincenzo Paoletti
- Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata – Università degli Studi di Roma 'La Sapienza', Roma, Italy
| | - Guido Valesini
- Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata – Università degli Studi di Roma 'La Sapienza', Roma, Italy
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Affiliation(s)
- Mark W Russo
- Division of Digestive Diseases, University of North Carolina at Chapel Hill, 27599, USA
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