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Akram B, Khan M, Humphrey MB. HIV-Associated Rheumatic Diseases: A Narrative Review. J Clin Rheumatol 2024; 30:e42-e45. [PMID: 37723618 DOI: 10.1097/rhu.0000000000002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
ABSTRACT Human immunodeficiency virus (HIV) is widely prevalent among the world population. Although, historically, it has been linked to opportunistic infections in keeping with immunodeficiency and immune dysregulation, it has also been associated with a wide variety of autoimmune manifestations. With the introduction of highly active antiretroviral therapy and subsequent restoration of immunity, there have been multiple immune-mediated diseases that have resurfaced in the HIV population. Our review highlights autoimmune diseases in association with HIV and its targeted therapies in detail.
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Rheumatoid arthritis and HIV-associated arthritis: Two sides of the same coin or different coins. Best Pract Res Clin Rheumatol 2022; 36:101739. [PMID: 34998696 DOI: 10.1016/j.berh.2021.101739] [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: 11/22/2022]
Abstract
The relationship between rheumatoid arthritis (RA) and human immunodeficiency virus (HIV)-associated arthritis is a complex one that was first described more than three decades ago. There are many similarities and some differences in the clinical presentations of both diseases. In addition, treatment options and long-term monitoring can be challenging in the presence of both disorders, as HIV causes an immunocompromised state and medications used to treat RA are immunosuppressive. In this chapter, we discuss the clinical presentation and the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic disease-modifying antirheumatic drugs (bDMARDs) in the management of these conditions.
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Silvério-António M, Parlato F, Martins P, Khmelinskii N, Braz S, Fonseca JE, Polido-Pereira J. Gastric Adenocarcinoma Presenting as a Rheumatoid Factor and Anti-cyclic Citrullinated Protein Antibody-Positive Polyarthritis: A Case Report and Review of Literature. Front Med (Lausanne) 2021; 8:627004. [PMID: 34109188 PMCID: PMC8180584 DOI: 10.3389/fmed.2021.627004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/21/2021] [Indexed: 11/22/2022] Open
Abstract
A 64-year-old male presented with a 6-month history of symmetric polyarthritis involving proximal interphalangeal joints and metacarpophalangeal joints of the hands, wrists, and ankles. Associated symptoms included vomiting, progressive fatigue, and weight loss. Laboratory results showed microcytic anemia, leukocytosis, thrombocytosis, elevated C-reactive protein and erythrocyte sedimentation rate, and rheumatoid factor (RF) and anti-cyclic citrullinated protein (ACPA) antibody positivity. Joints radiographs were normal, without erosions. Upper endoscopy and gastric endoscopic ultrasonography showed a gastric adenocarcinoma with lymphatic involvement. Intraoperatively, peritoneal carcinomatosis was documented, and the patient started palliative chemotherapy. A paraneoplastic seropositive arthritis was assumed, and treatment with low-dose prednisolone and hydroxychloroquine was started. Arthritis remission was achieved and sustained up to 18 months of follow-up, although gastric cancer progression was documented. We describe a unique phenotype of paraneoplastic arthritis (PA) presenting as a seropositive (RF and ACPA positivity) rheumatoid arthritis (RA) with a good response to both low dose corticosteroids and hydroxychloroquine therapy. We also review the literature of PA, mostly the RA-like pattern, and the association between PA and ACPA positivity. This case highlights the importance of considering underlying cancer in elderly male patients, presenting with polyarthritis and systemic symptoms, even in those with ACPA-positive RA-like arthritis.
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Affiliation(s)
- Manuel Silvério-António
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Federica Parlato
- Medicina 2 Department, University Hospital Center of Lisbon North, Lisbon, Portugal
| | - Patrícia Martins
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Sandra Braz
- Medicina 2 Department, University Hospital Center of Lisbon North, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim Polido-Pereira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
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Kaleidoscope of autoimmune diseases in HIV infection. Rheumatol Int 2016; 36:1481-1491. [DOI: 10.1007/s00296-016-3555-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/13/2016] [Indexed: 12/23/2022]
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Carroll MB, Fields JH, Clerc PG. Rheumatoid arthritis in patients with HIV: management challenges. Open Access Rheumatol 2016; 8:51-59. [PMID: 27843370 PMCID: PMC5098761 DOI: 10.2147/oarrr.s87312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Over the past few decades, HIV has been transformed from a once-uniformly fatal disease to now a manageable but complex multisystem illness. Before highly active antiretroviral therapy (HAART), reports suggested that HIV-infected patients with rheumatoid arthritis (RA) would experience remission of their disease. It has now become clear that RA can develop in HIV-infected patients at any time, independent of HAART. Choosing the right medication to treat symptoms related to RA while avoiding excess weakening of the immune system remains a clinical challenge. Agents such as hydroxychloroquine and sulfasalazine might best balance safety with efficacy, making them reasonable first choices for therapy in HIV-infected patients with RA. More immune suppressing agents such as methotrexate may balance safety with efficacy, but data are limited. Corticosteroids such as prednisone may also be reasonable but could increase the risk of osteonecrosis. Among biologic response modifiers, tumor necrosis factor α inhibitors may balance safety with efficacy, but perhaps when HIV replication is controlled with HAART. Monitoring RA disease activity remains challenging as only one retrospective study has been published in this area. Those with HIV infection and RA can experience comorbidities such as accelerated heart disease and osteoporosis, a consequence of the chronic inflammatory state that each illness generates. Although HIV-infected patients are at risk for developing the immune reconstitution inflammatory syndrome when starting HAART, it appears that immune reconstitution inflammatory syndrome has a minimal effect on triggering the onset or the worsening of RA.
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Affiliation(s)
- Matthew B Carroll
- Department of Rheumatology, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS, USA
| | - Joshua H Fields
- Department of Rheumatology, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS, USA
| | - Philip G Clerc
- Department of Rheumatology, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS, USA
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Cunha BM, Mota LMH, Pileggi GS, Safe IP, Lacerda MVG. HIV/AIDS and rheumatoid arthritis. Autoimmun Rev 2015; 14:396-400. [PMID: 25578483 DOI: 10.1016/j.autrev.2015.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/01/2015] [Indexed: 12/24/2022]
Abstract
The acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). It was first recognized in the United States in 1981, and the HIV/AIDS epidemic has since spread to affect all countries. The interface of HIV/AIDS with opportunistic infectious diseases is well characterized, but further research is required into the concurrence of other chronic diseases. The objective of this review was to identify possible interferences of HIV infection in the diagnosis and management of rheumatoid arthritis (RA). A review of the available evidence was conducted using the GRADE approach. Overall, the quality of evidence was low. Our main conclusions were: (1) the occurrence of rheumatoid-like arthritis in patients with HIV/AIDS is quite rare; therefore, it is not recommended that HIV infection be considered routinely as a differential diagnosis in this condition (C2); (2) HIV infection may lead to rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody positivity, but usually at low titers (C1); (3) RA might cause false-positive HIV serology and ELISA seems to be a more specific test for HIV in patients with RA (C2); (4) RA and AIDS may coexist, even in cases of severe immunosuppression (C1); (5) RA emergence may seldom occur during or after immune reconstitution (C1); and (6) there is insufficient safety data to recommend use of specific disease-modifying antirheumatic drugs (DMARDs) in RA patients with HIV/AIDS. Therefore, these drugs should be used cautiously (C1).
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Affiliation(s)
| | | | - Gecilmara S Pileggi
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Izabella P Safe
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
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Kaku Y, Kodama S, Higuchi M, Nakamura A, Nakamura M, Kaieda T, Takahama S, Minami R, Miyamura T, Suematsu E, Yamamoto M. Corticoid therapy for overlapping syndromes in an HIV-positive patient. Intern Med 2015; 54:223-30. [PMID: 25743017 DOI: 10.2169/internalmedicine.54.3094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection disturbs the host's immune function and often coexists with various autoimmune and/or systemic rheumatic diseases with manifestations that sometimes overlap with each other. We herein present the case of a 43-year-old Japanese man infected with HIV who exhibited elevated serum creatine kinase and transaminases levels without any symptoms. He was diagnosed with autoimmune hepatitis, polymyositis and Sjögren's syndrome and received combined antiretroviral therapy (cART); however, the laboratory abnormalities persisted. We successfully administered cART with the addition of oral prednisolone, and the patient's condition recovered without side effects related to the metabolic or immunosuppressive effects of these drugs.
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Affiliation(s)
- Yu Kaku
- Department of Internal Medicine, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
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Iordache L, Launay O, Bouchaud O, Jeantils V, Goujard C, Boue F, Cacoub P, Hanslik T, Mahr A, Lambotte O, Fain O. Autoimmune diseases in HIV-infected patients: 52 cases and literature review. Autoimmun Rev 2014; 13:850-7. [PMID: 24747058 DOI: 10.1016/j.autrev.2014.04.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/04/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES 1) To describe autoimmune diseases (AD) in HIV-infected people; and 2) to perform a literature review concerning this issue. DESIGN 52 HIV-infected patients that presented an AD in 14 medical departments in Paris and Ile-de-France area were retrospectively included in this study. RESULTS The ADs were vasculitis (11), immune cytopenias (8), rheumatic diseases (8), lupus (7), sarcoidosis (7), thyroid diseases (6), hepatic diseases (5), and antiphospholipid syndrome (4). Four patients presented 2 ADs. In 5 patients the AD preceded HIV infection, in 14 HIV infection was diagnosed at the same time as the AD and 34 were HIV-infected when they developed an AD. 40 ADs (80%) occurred in patients with a CD4 T lymphocyte count of more than 200/mm(3). Cases of autoimmune hemolytic anemia occurred only in patients severely immunodepressed. In five patients (a vasculitis case, a sarcoidosis case, three thyroid disease cases) the AD presented as a form of immune restoration inflammatory syndrome (IRIS). Some ADs allowed HIV-infection diagnosis at a stage of moderate immune deficiency (vasculitis, antiphospholipid syndrome, immune thrombocytopenia). 37 patients received immunosuppressant treatments with good tolerance. These results confirm in a large series of patients previous data concerning autoimmune diseases occurrence in HIV-infected people. CONCLUSION In the HAART era, when HIV-infected people are treated more and more early, autoimmune diseases can occur, mainly at the phase of immunological recovery. HIV infection should not limit immunosuppressant treatment use.
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Affiliation(s)
- Laura Iordache
- Internal Medicine Department, Jean Verdier Hospital, Avenue du 14 Juillet, 93140 Bondy, France.
| | - Odile Launay
- Clinical Investigation Centre, Cochin Hospital, 27 rue du Fbg St.-Jacques, 75014 Paris, France
| | - Olivier Bouchaud
- Infectious Diseases Department, Avicenne Hospital, 125 rue de Stalingrad, 93009 Bobigny, France
| | - Vincent Jeantils
- Infectious Diseases Department, Jean Verdier Hospital, Avenue du 14 Juillet, 93140 Bondy, France
| | - Cécile Goujard
- Internal Medicine Department, Kremlin Bicetre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicetre, France
| | - Francois Boue
- Internal Medicine Department, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Patrice Cacoub
- Internal Medicine and Clinical Immunology Department, Pitié-Salpétrière Hospital, 47-83 bd de l'Hopital, 75013 Paris, France; Hospital-University Department I2B, Sorbonne Universités, UPMC Paris 6 University, UMR 7211, F-75005, Paris, France; INSERM, UMR S959, F-75013, Paris, France; CNRS, UMR 7211, F-75005, Paris, France
| | - Thomas Hanslik
- Internal Medicine Department, Ambroise Paré Hospital, 9 Avenue Charles-de-Gaulle, 92100 Boulogne Billancourt, France
| | - Alfred Mahr
- Internal Medicine Department, St. Louis Hospital, 1 Avenue Claude-Vellefaux, 75010 Paris, France
| | - Olivier Lambotte
- Internal Medicine Department, Kremlin Bicetre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicetre, France
| | - Olivier Fain
- Internal Medicine Department, Jean Verdier Hospital, Avenue du 14 Juillet, 93140 Bondy, France
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