Viral arthritis including HIV

HIV and COVID-19 Coinfection: A Synergism That Results in More Severe Forms of Reactive Arthritis

Reactive arthritis is defined as arthritis that arises after infection, where pathogens cannot grow in the affected joints. Although the human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2 are not among the most commonly implicated pathogens, there is growing evidence that they have major implications in the genesis of reactive arthritis. However, there are no described cases of coinfection of both entities that cause reactive arthritis at the same time, and the alterations involved in the immune system that could cause the change of certain clinical characteristics to more severe forms of the disease are unknown. The following describes the case of a male patient in his third decade of life who has an unusual and severe presentation of reactive arthritis associated with coinfection by COVID-19 and the human immunodeficiency virus.

The potential role of human endogenous retrovirus K10 in the pathogenesis of rheumatoid arthritis: a preliminary study

OBJECTIVE

To examine whether human endogenous retrovirus K10 is associated with autoimmune rheumatic disease.

DESIGN

A novel multiplex reverse transcription polymerase chain reaction (RT-PCR) system was developed to investigate HERV-K10 mRNA expression in patients with rheumatoid arthritis.

METHODS

40 patients with rheumatoid arthritis, 17 with osteoarthritis, and 27 healthy individuals were recruited and total RNA was extracted from peripheral blood mononuclear cells (PBMCs) and analysed using multiplex RT-PCR for the level of HERV-K10 gag mRNA expression. Southern blot and DNA sequencing confirmed the authenticity of the PCR products.

RESULTS

Using the histidyl tRNA synthetase (HtRNAS) gene as a housekeeping gene in the optimised multiplex RT-PCR, a significantly higher level of HERV-K10 gag mRNA expression was found in rheumatoid arthritis than in osteoarthritis (p = 0.01) or in the healthy controls (p = 0.02).

CONCLUSION

There is enhanced mRNA expression of the HERV-K10 gag region in rheumatoid arthritis compared with osteoarthritis or healthy controls. This could contribute to the pathogenesis of rheumatoid arthritis.

Do antivirals have any utility in the treatment of arthritis?

Viruses have been linked to arthritides by several pathways. Apart from the ability of different viral pathogens to cause arthritic symptoms directly, only some circumstantial evidence for the involvement of (retro)viruses in the pathogenesis of rheumatoid arthritis has been presented in recent years. Therefore, the question of whether antiviral agents can be used to treat arthritis has become of interest. However, the mechanisms by which exogenous retroviral infection as well as activation of endogenous retroviral sequences may potentially lead to the induction of rheumatoid arthritis is just beginning to emerge. Moreover, the hypothesis that persistent viral infection may account for some hitherto unclassified, chronic arthritides, still needs to be confirmed. Therefore, the use of antiviral agents in the treatment of arthritides has been limited to viral complications of anti-arthritic therapy and to some experimental approaches. In this review, we will focus on current concepts of viral involvement in arthritis and point to future directions in the use of antiviral agents for arthritis.

Parvovirus B19 in the acute arthropathies and juvenile rheumatoid arthritis

OBJECTIVE

To evaluate the prevalence of recent parvovirus B19 infection in a cohort of children presenting with acute arthropathy and to determine the prevalence of a subsequent diagnosis of juvenile rheumatoid arthritis in this cohort.

METHOD

In this prospective study, parvovirus B19 IgM antibody was investigated in 75 patients who were referred to our clinic with acute joint complaints and also in 75 healthy controls. One patient in each group was excluded due to neuroblastoma and acute lymphoblastic leukaemia. The characteristics of parvovirus B19 IgM positive patients who were accepted as parvovirus B19 arthropathy were further evaluated. All the patients were followed up for at least 6 weeks and the patients with chronic progression of joint complaints were followed for at least 6 months to determine their progress. The cases of juvenile rheumatoid arthritis in this chronic group were identified.

RESULTS

Parvovirus B19 IgM was detected in 16 of 74 patients (21.6%) with acute arthropathy compared with 3 of 74 (4.1%) in the healthy control group (chi(2) = 8.67; P = 0.003). The parvovirus B19 positive patients with arthropathy were more likely to become chronic (P = 3.7 x 10(-7)) and to be diagnosed as juvenile rheumatoid arthritis (P = 0.03) than the parvovirus B19 IgM negative group with arthropathy. Additional joint destruction developed in one case who was parvovirus B19 IgM positive in whom juvenile rheumatoid arthritis was diagnosed during follow up.

CONCLUSION

These data support the hypothesis that parvovirus B19 infection may be associated with the onset of juvenile rheumatoid arthritis in a proportion of patients.

Quantitative direct probe method for the detection of parvovirus B19

Parvovirus B19 infection is associated with anemia and spontaneous abortions. While many qualitative assays are available, a few molecular-based quantitative methods have been described. This study reports the development and optimization of a quantitative direct-probe method for the detection of Parvovirus B19 DNA. Different concentrations of RNA probes were used to identify the optimal conditions for hybridizing to the target DNA. Detection of DNA was linear between concentrations of 2 ng/ml to 200 pg/ml. Because this method requires no enzymatic amplification, it is not susceptible to amplifier contamination or enzymatic inhibitors, and it can be applied to serum samples or paraffin-embedded tissue.

An aggressive form of polyarticular arthritis in a man with CD154 mutation (X-linked hyper-IgM syndrome)

Hyper-IgM syndrome (HIM) is a rare immunodeficiency disorder that has been associated with the development of symptoms and clinical features characteristic of rheumatoid arthritis (RA). We describe a patient with HIM and severe erosive arthritis with prominent nodules in the absence of detectable serum rheumatoid factor. Because HIM results from defects in either T cell CD154 (CD40 ligand) expression or abnormal CD40 signaling, the molecular basis of the patient's disease was analyzed. Activated CD4+ T cells failed to express surface CD154 protein, and molecular analysis of CD154 complementary DNA revealed a nucleotide transversion resulting in the nonconservative amino acid substitution G-D at amino acid 257. This case indicates that defective CD154-dependent CD40 signaling can be associated with susceptibility to a severe inflammatory arthritis that has both similarities to and differences from idiopathic RA.

Retroviral sequences in rheumatoid arthritis synovium

There are several relationships between retroviruses and cellular transformation, as well as retroviruses being involved in the development of autoimmune diseases. Retroviruses have been discussed as etiologic agents modulating or triggering certain pathways in the pathogenesis of rheumatoid arthritis (RA). However, none of the currently known retroviruses has been identified as specific for RA. Due to the unique properties of retroviruses, distinct experimental approaches can be used to detect retroviral activity in cells and tissues. Current research in RA using state-of-the-art molecular biology techniques includes both the search for exogenous and endogenous retroviral gene sequences in synovium of patients with RA.