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 TNFα blockade may be potentially beneficial because TNFα 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 TNFα 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 TNFα, in patients with chronic hepatitis C will be needed to properly assess the risks and benefits of this treatment in analogous cases.
References
Gumber SC, Chopra S (1995) Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations. Ann Intern Med 123:615–620
Rosner I, Rozenbaum M, Toubi E, Kessel A, Naschitz JE, Zuckerman E (2004) The case for hepatitis C arthritis. Semin Arthritis Rheum 33:375–387
Nishikai M, Miyairi M, Kosaka S (1994) Dermatomyositis following infection with hepatitis C virus. J Rheumatol 21:1584–1585
Garcia-Carrasco M, Ramos M, Cervera R, Font J, Vidal J, Munoz FJ et al. (1997) Hepatitis C virus infection in primary Sjogren’s syndrome: prevalence and clinical significance in series of 90 patients. Ann Rheum Dis 56:173–175
Font J, Ramos-Casals M, Garcia-Carrasco M, Cervera R, Jimenez S, Trejo O et al. (2000) Hepatitis C virus infection in systemic lupus erythematosus. Study in a series of 134 patients. Arthritis Rheum 43:S251 (Suppl)
Taglione E, Vatteroni ML, Martini P, Galluzo E, Lombardini F, Delle Sedie A et al. (2000) Hepatitis C virus infection: prevalence in psoriasis and psoriatic arthritis. J Rheumatol 26:370–372
Maillefert JF, Muller G, Falgarone G, Bour JB, Ratovohery D, Dougados M et al. (2002) Prevalence of hepatitis C virus infection in patients with rheumatoid arthritis. Ann Rheum Dis 61:635–637
Parke FA, Reveille JD (2004) Anti-tumor necrosis factor agents for rheumatoid arthritis in the setting of chronic hepatitis C infection. Arthritis Care Res 51:800–804
Magliocco MA, Gottlieb AB (2004) Etanercept therapy for patients with psoriatic arthritis and concurrent hepatitis C virus infection: report of 3 cases. J Am Acad Dermatol 51:580–584
Peterson JR, Hsu FC, Simkin PA, Wener MH (2003) Effect of tumor necrosis alpha antagonists on serum transaminases and viraemia in patients with rheumatoid arthritis and chronic hepatitis C infection. Ann Rheum Dis 62:2078–2082
Shankar S, Handa R (2004) Biological agents in rheumatoid arthritis. J Postgrad Med 50:293–299
Mok MY, Ng WL, Yuen MF, Wong RW, Lau CS (2000) Safety of disease modifying anti-rheumatic agents in rheumatoid arthritis patients with chronic viral hepatitis. Clin Exp Rheumatol 18:363–368
Ghavami S, Hashemi M, Kadkhoda K, Alavian SM, Bay GH, Los M (2005) Apoptosis in liver diseases—detection and therapeutic applications. Med Sci Monit 11:RA337–RA345
Wang H, Czura C, Tracey KJ (2003) Tumor necrosis factor. In: Thomson A, Lotze M (eds) The cytokine handbook. Elsevier, London, pp 837–860
Moore TA, Lau HY, Cogen AL, Monteleon CL, Standiford TJ (2003) Anti-tumor necrosis factor-alpha therapy during murine Klebsiella pneumoniae bacteremia: increased mortality in the absence of liver injury. Shock 20:309–315
Moore TA, Lau HY, Cogen AL, Standiford TJ (2005) Defective innate antibacterial host responses during murine Klebsiella pneumoniae bacteremia: tumor necrosis factor (TNF) receptor 1 deficiency versus therapy with anti-TNF-alpha. Clin Infect Dis 41(Suppl 3):S213–S217
Hyrich KL, Silman AJ, Watson KD, Symmons DP (2004) Anti-tumour necrosis factor alpha therapy in rheumatoid arthritis: an update on safety. Ann Rheum Dis 63:1538–1543
Khanna D, McMahon M, Furst DE (2004) Safety of tumour necrosis factor-alpha antagonists. Drug Saf 27:307–324
Khanna M, Shirodkar MA, Gottlieb AB (2003) Etanercept therapy in patients with autoimmunity and hepatitis C. J Derm Treat 14:229–232
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Aslanidis, S., Vassiliadis, T., Pyrpasopoulou, A. et al. Inhibition of TNFα does not induce viral reactivation in patients with chronic hepatitis C infection: two cases. Clin Rheumatol 26, 261–264 (2007). https://doi.org/10.1007/s10067-006-0394-z
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DOI: https://doi.org/10.1007/s10067-006-0394-z