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Abstract
Recently, the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has spread worldwide. Although nearly all patients incur mild-to-moderate disease from this viral infection, some develop severe manifestations with a poor prognosis. COVID-19 can also induce autoimmune disease; several cases of arthritis following COVID-19 have been documented in the literature, such as reactive arthritis and chronic arthritis. We herein report a case of psoriatic arthritis triggered by COVID-19. Although the arthritis had been refractory to glucocorticoids and methotrexate, certolizumab pegol subsequently led to remission.
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Affiliation(s)
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Shiho Hanai
- Department of Dermatology, Seirei Hamamatsu General Hospital, Japan
| | - Toshiaki Miyamoto
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Japan
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2
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Affiliation(s)
- Lin H Chen
- Mount Auburn Hospital, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Shiv T Sehra
- Mount Auburn Hospital, Cambridge, MA; Harvard Medical School, Boston, MA
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3
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Chiu YM, Lai MS, Chan KA. Commensurate incidence and outcomes of liver enzyme elevation between anti-tumor necrosis factor users with or without prior hepatitis B virus infections. PLoS One 2018; 13:e0196210. [PMID: 29694398 PMCID: PMC5919014 DOI: 10.1371/journal.pone.0196210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/09/2018] [Indexed: 02/06/2023] Open
Abstract
Background and objective Potential hepatoxicity is an important clinical concern when administering immunosuppressive therapies to patients infected by hepatitis B virus (HBV). Tumor necrosis factor inhibitors (anti-TNF) increase the likelihood of hepatitis consequent to HBV reactivation, but reported risks and outcomes vary. We determined the risks of liver enzyme elevation in anti-rheumatic drug users from an HBV-endemic region with differing HBV serostatus. Methods We established retrospective cohorts with rheumatoid arthritis, ankylosing spondylitis, or psoriasis/psoriatic arthritis who: 1) received anti-TNF agents from 1 January 2004 to 30 June 2013; 2) received care from 1 June 2011 to 30 June 2013 but only ever used conventional disease-modifying anti-rheumatic drugs (DMARDs). Serology results defined three subgroups: HBV surface antigen positive (HBsAg+), HBsAg negative/HBV core antibody positive (HBsAg−/HBcAb+), or uninfected. We compared incidences of serum alanine aminotransferase (ALT) exceeding twice the upper reference limit between HBV serostatus subgroups in each treatment cohort. Results Among 783 patients treated with anti-TNF (n = 472) or DMARDs only (n = 311), HBsAg−/HBcAb+ anti-TNF users had incidence of ALT elevation commensurate with uninfected counterparts (6.1 vs. 6.0/100 person-years), compared to 19.6/100 person-years in HBsAg+ patients (standardized rate ratio 3.3, 95% CI 1.3–8.2); none effected had severe or fatal hepatitis and ALT levels in all HBsAg−/HBcAb+ patients remained stable, mostly normalizing spontaneously, or after moderating treatment. Patterns of of ALT elevation associated with differing HBV serostatus in the DMARD cohort, resembled those in anti-TNF users. Conclusions In this large HBV-endemic cohort, the absolute incidence of ALT elevation in anti-TNF users was more than three-fold higher in HBsAg+ patients than in uninfected counterparts; however, no such association was evident in patients with HBsAg−/HBcAb+ serotype, whose risk and outcomes of liver enzyme elevation were similar to uninfected patients, suggesting that anti-TNF use by HBsAg−/HBcAb+ patients is probably safe.
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Affiliation(s)
- Ying-Ming Chiu
- Division of Allergy, Immunology and Rheumatology, Changhua Christian Hospital, Changhua City, Taiwan
- Department of Nursing, College of Medicine and Nursing, Hungkuang University, Taichung City, Taiwan
- * E-mail:
| | - Mei-Shu Lai
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - K. Arnold Chan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Zavos C, Kountouras J, Zavos N, Chatzopoulos D. Inhibition of tumour necrosis factor-α in patients with chronic hepatitis C infection. Clin Rheumatol 2006; 26:283. [PMID: 17003955 DOI: 10.1007/s10067-006-0437-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Accepted: 08/31/2006] [Indexed: 10/24/2022]
MESH Headings
- Antibodies, Monoclonal/therapeutic use
- Antirheumatic Agents/therapeutic use
- Apoptosis
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/pathology
- Arthritis, Psoriatic/virology
- Disease Progression
- Hepacivirus/drug effects
- Hepacivirus/immunology
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/drug therapy
- Hepatitis C, Chronic/pathology
- Humans
- Liver/drug effects
- Liver/pathology
- Liver/virology
- Liver Cirrhosis/immunology
- Liver Cirrhosis/pathology
- Liver Cirrhosis/virology
- Spondylitis, Ankylosing/drug therapy
- Spondylitis, Ankylosing/pathology
- Spondylitis, Ankylosing/virology
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Virus Activation/drug effects
- Virus Activation/immunology
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Aslanidis S, Vassiliadis T, Pyrpasopoulou A, Douloumpakas I, Zamboulis C. Inhibition of TNFalpha does not induce viral reactivation in patients with chronic hepatitis C infection: two cases. Clin Rheumatol 2006; 26:261-4. [PMID: 16924392 DOI: 10.1007/s10067-006-0394-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 06/27/2006] [Indexed: 02/06/2023]
Abstract
Chronic infections, such as hepatitis C, in the setting of rheumatic disorders pose a potential hindrance to optimal management because of possible complications linked to the institution of immune suppression, as well as the high incidence of hepatotoxicity associated with many of the disease-modifying antirheumatic drugs included in the conventional therapeutic regimens. In the setting of hepatitis C, however, the effect of TNFalpha blockade may be potentially beneficial because TNFalpha appears to be involved in the pathogenesis of liver fibrosis through the stimulation of apoptotic pathways. Data related to this subject are, unfortunately, still limited and without detailed information regarding the clinical progression of the rheumatic disorder. We report the cases of two patients, one with ankylosing spondylitis and one with psoriatic arthritis, who were efficiently treated long-term with anti-TNF agents for their rheumatic disease without any evidence of reactivation or flaring of their hepatitis C infection or deterioration of their liver function. Our results indicate that TNFalpha blockade is a highly efficient and uncompromising therapy in hepatitis C-affected individuals with connective tissue disorders. However, systematic, large-scale studies addressing the issue of safety of these new efficient drugs, i.e., monoclonal antibodies targeted against TNFalpha, in patients with chronic hepatitis C will be needed to properly assess the risks and benefits of this treatment in analogous cases.
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MESH Headings
- Adalimumab
- Adult
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antirheumatic Agents/therapeutic use
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/immunology
- Arthritis, Psoriatic/pathology
- Arthritis, Psoriatic/virology
- Female
- Hepacivirus/drug effects
- Hepacivirus/immunology
- Hepatitis C, Chronic/drug therapy
- Hepatitis C, Chronic/immunology
- Hepatitis C, Chronic/pathology
- Humans
- Infliximab
- Liver/pathology
- Liver Cirrhosis/pathology
- Male
- Middle Aged
- Spondylitis, Ankylosing/drug therapy
- Spondylitis, Ankylosing/immunology
- Spondylitis, Ankylosing/pathology
- Spondylitis, Ankylosing/virology
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Virus Activation/drug effects
- Virus Activation/immunology
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Affiliation(s)
- S Aslanidis
- B' Propaedeutic Department of Internal Medicine, Hippokration General Hospital, Konstantinoupoleos 49, 54642, Thessaloniki, Greece.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mehraein Y, Lennerz C, Ehlhardt S, Zang KD, Madry H. Replicative multivirus infection with cytomegalovirus, herpes simplex virus 1, and parvovirus B19, and latent Epstein–Barr virus infection in the synovial tissue of a psoriatic arthritis patient. J Clin Virol 2004; 31:25-31. [PMID: 15288610 DOI: 10.1016/j.jcv.2004.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/26/2004] [Accepted: 02/12/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND Psoriatic arthropathy occurs as complicating feature in about 5-7% of psoriasis patients. Infectious mechanisms including viral antigens have been suggested by serologic data as CD8 T cellular specifity towards viral epitopes. OBJECTIVE AND RESULTS We here reported a case of a 32-year-old male psoriatic arthritis patient, where we could demonstrate simultaneous infection with cytomegalovirus (CMV), herpes simplex virus type I (HSV1) and parvovirus B19 (B19), as well as latent Epstein-Barr virus (EBV) infection within the synovial tissue by immunohistochemistry (CMV, parvovirus B19, HSV1, EBV-LMP) and DNA-in situ-hybridization (CMV). Serologic examination revealed positive EBV and parvovirus B19-IgG-antibodies, but no antibody response to HSV1 and CMV. CONCLUSION This case is of special interest, since replicative viral infections have not yet been demonstrated localised in the psoriatic arthritis synovia. Thus, with particular regard to the limited information of the serologic data and the possible need of immuno suppressive therapy direct synovial testing for viral antigenes may be considered in psoriatic arthritis patients.
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Affiliation(s)
- Yasmin Mehraein
- Department of Human Genetics, Saarland University, University Hospital, Bldg. 60, 66421 Homburg/Saar, Germany.
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Abstract
Arthritis is one of the several autoimmune disorders induced by HCV infection. There is not a specific clinical pattern of HCV-related arthritis, but two nonerosive subsets have more frequently been described: a RA-like polyarthritis and a less common mono-oligoarthritis involving medium-sized and large joints, often showing an intermittent course. This latter form is associated with the presence of serum cryoglobulins. Because of its variable characteristics, HCV-related arthritis must be considered in the differential diagnosis of many patients having inflammatory joint involvement. Antikeratin antibodies and possibly IgA RF can be useful in distinguishing between RA and HCV-related RA-like polyarthritis. In fact, these tests are highly specific in RA patients. In any case, the search for HCV antibodies should be more widely performed in the diagnostic approach to rheumatic diseases. An association between PsA and HCV infection has been described in the literature, but the authors were unable to confirm these data. Nonsteroidal anti-inflammatory drugs, hydroxychloroquine, and low doses of corticosteroids are the cornerstones of the treatment of HCV-related arthritis. An etiologic therapy with alpha-interferon and ribavirin is useful when required by hepatic or systemic involvement; such therapy could also be considered in selected cases of isolated arthritis that are unresponsive to other drugs. Few case reports described the onset of polyarthritis after the administration of alpha-interferon for HCV-related chronic hepatitis. This topic should be more accurately studied in the future to exclude a spurious association between the two events.
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Affiliation(s)
- Ignazio Olivieri
- Lucania Department of Rheumatology, San Carlo Hospital, Contrada Macchia Romana, Potenza 85100, Italy.
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Abstract
Etanercept may play an important role in modulating the inflammatory activity and progression of human immunodeficiency virus (HIV)-associated psoriasis and psoriatic arthritis. We report the case of a 45-year-old homosexual man with a CD4 cell count of less than 0.05 x 10(9)/L and an HIV viral load of 4200 copies/mL (while receiving highly active antiretroviral therapy) who developed extensive psoriatic plaques, 4.5-kg weight loss, onychodystrophy, and psoriatic arthropathy with severe periarticular bone demineralization. The arthritis progressed despite the use of several disease-modifying medications, including corticosteroids, hydroxychloroquine, and minocycline. Because of uncontrolled, progressive, and disabling arthritis and resulting profound disability, he was treated with etanercept. Within 3 weeks, his psoriasis had improved dramatically and his joint inflammation had stabilized. For the next 4 months, immunologic and viral parameters remained stable, but his clinical course was complicated by frequent polymicrobial infections. Etanercept was thus discontinued despite continued improvements in his psoriasis, psoriatic arthritis, and functional status. While both cutaneous and joint manifestations of psoriasis improved dramatically, the experience with this patient dictates that caution and careful follow-up must be exercised when prescribing etanercept in the setting of HIV infection.
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Affiliation(s)
- D M Aboulafia
- Division of Hematology/Oncology, Virginia Mason Medical Center, Seattle, WA 98111, USA.
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Abstract
Infection by human immunodeficiency virus is characterized by a myriad of clinical manifestations affecting almost every organ system in the body. If untreated, it follows an inexorable course, leading to a profound state of immunosuppression and eventually death from opportunistic infection and/or development of lymphoproliferative malignancy and Kaposi's sarcoma. Rheumatic manifestations may develop at any time of the clinical spectrum, but usually are more often seen in late stages. A variety of disorders may be seen, particularly Reiter's syndrome and undifferentiated spondyloarthropathy. Most patients do well with conventional anti-inflammatory therapy, but some will require the use of immunosuppressive-cytotoxic therapy.
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Affiliation(s)
- M L Cuellar
- Section of Rheumatology, Department of Medicine, Tulane University Medical Center, 1415 Tulane Avenue, New Orleans, LA, 70112, USA
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Melaku Z, Haga HJ. [Rheumatological manifestations in HIV infections]. Tidsskr Nor Laegeforen 2000; 120:1326-8. [PMID: 10868096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The recognised clinical spectrum of disease associated with HIV infection is rapidly expanding and now includes a variety of rheumatological manifestations. MATERIAL AND METHODS In this review of the literature of the last 15 years, we present the most common rheumatic manifestations described in association with HIV infection. RESULTS Manifestations include a wide array of articular syndromes and autoimmune manifestations such as Reiter's syndrome, psoriatic arthritis, HIV associated arthritis and septic arthritis. Autoimmune diseases associated with HIV infection include a Sjögren-like syndrome, myopathies and systemic vasculitis. INTERPRETATION Rheumatological manifestations of HIV infection may present earlier than clinical signs of the infection itself. Steroid and cytostatic treatment of rheumatic diseases may worsen the HIV disease.
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Affiliation(s)
- Z Melaku
- Revmatologisk avdeling, Haukeland Sykehus, Bergen
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Winchester R. Psoriatic arthritis and the spectrum of syndromes related to the SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. Curr Opin Rheumatol 1999; 11:251-6. [PMID: 10411378 DOI: 10.1097/00002281-199907000-00005] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During the past year, the increasing use of nuclear magnetic resonance imaging techniques, with their ability to delineate cartilage and ligamentous structures and to identify edema, are providing a radical improvement in ascertainment of musculoskeletal abnormalities, although their significance remains incompletely delineated. A second theme has come from the study of spondyloarthropathies in different ethnic groups and societal environments, revealing that the Northern European and North American form of the disease, with its powerful association with HLA-B27, is little evident in the rest of the world's population and that different susceptibility genes and environmental factors operate in other regions and peoples. Related to this theme is the compelling evidence of the marked influence of HIV infection on the development of spondyloarthropathies in Africa. Two areas of immune recognition are discussed as examples of emerging fields that may provide useful paradigms for the experimental approach to mechanisms in psoriatic arthritis. One of these is the three-cell model of CD8 T-cell interaction, in which a dendritic cell presents a peptide from an immunogenic protein to both a CD4 and CD8 T-cell clone, providing a cognitive interaction that disrupts tolerance and results in the expansion of the cytotoxic T-cell clone. In this respect, the combination of an activated dendritic cell, together with enhanced availability of arthritogenic microbial antigens caused by microbial persistence, are interesting candidates to explore as the basis of the HIV-associated rheumatic diseases. The second area of immune recognition is the growing understanding of the outline of the solution to the problem of the association of a spondyloarthropathy with several
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Affiliation(s)
- R Winchester
- Division of Autoimmune and Molecular Diseases, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
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Taglione E, Vatteroni ML, Martini P, Galluzzo E, Lombardini F, Delle Sedie A, Bendinelli M, Pasero G, Bencivelli W, Riente L. Hepatitis C virus infection: prevalence in psoriasis and psoriatic arthritis. J Rheumatol 1999; 26:370-2. [PMID: 9972971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To study the prevalence of hepatitis C virus (HCV) infection in 2 groups of patients, one group with psoriasis and the other with psoriatic arthritis (PsA). METHODS We detected anti-HCV antibodies by ELISA and by a recombinant immunoblot assay (RIBA) in the sera of 50 patients with psoriasis and 50 with PsA. As controls we used a group of 76 patients with rheumatoid arthritis (RA), and referred to data on the prevalence of HCV in the general Italian population. RESULTS By ELISA, anti-HCV antibodies were detected in 6/50 (12%) patients with PsA, in 5/50 (10%) patients with psoriasis, and in 4/76 (5.2%) patients with RA. All the reactive PsA and RA sera also tested positive on RIBA, while only 3 of the 5 positive results for sera of patients with psoriasis were confirmed by RIBA. The prevalence of HCV infection in patients with psoriasis was not significantly higher than in controls. In contrast, the rate of HCV infection observed in the 50 patients with PsA was higher than that in the other groups, the difference being statistically significant between patients with PsA and the general population. CONCLUSION Our data do not support the hypothesis that HCV infection may play a role in the pathogenesis of psoriasis. On the other hand they show a statistically significant difference between the prevalence of HCV infection in patients with PsA and the general population.
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Affiliation(s)
- E Taglione
- Department of Biomedicine, University of Pisa, Italy
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Eustace SJ, Lan HH, Katz J, Aliabadi P. HIV arthritis. Radiol Clin North Am 1996; 34:450-3. [PMID: 8633127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- S J Eustace
- Department of Radiology and Musculoskeletal Radiology Section, Boston University Medical Center and Boston City Hospital, Massachusetts, USA
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