Rheumatoid arthritis in patients with HIV: management challenges

Matthew B Carroll, Joshua H Fields, Philip G Clerc Department of Rheumatology, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS, USA Abstract: Over the past few decades, HIV has been transformed from a once-uniformly fatal disease to now a manageable but complex multisystem illness. Befor...

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Autores principales:	Carroll MB, Fields JH, Clerc PG
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Human Immunodeficiency Virus Rheumatoid Arthritis Osteoporosis Cardiovascular Disease Immune Reconstitution Inflammatory Syndrome Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/f03066bb24ca4c4cbddbf3a659e2d380
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spelling	oai:doaj.org-article:f03066bb24ca4c4cbddbf3a659e2d3802021-12-02T01:29:33ZRheumatoid arthritis in patients with HIV: management challenges1179-156Xhttps://doaj.org/article/f03066bb24ca4c4cbddbf3a659e2d3802016-04-01T00:00:00Zhttps://www.dovepress.com/rheumatoid-arthritis-in-patients-with-hiv-management-challenges-peer-reviewed-article-OARRRhttps://doaj.org/toc/1179-156XMatthew B Carroll, Joshua H Fields, Philip G Clerc Department of Rheumatology, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS, USA 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 a 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. Keywords: human immunodeficiency virus, rheumatoid arthritis, osteoporosis, cardiovascular disease, immune reconstitution inflammatory syndromeCarroll MBFields JHClerc PGDove Medical PressarticleHuman Immunodeficiency VirusRheumatoid ArthritisOsteoporosisCardiovascular DiseaseImmune Reconstitution Inflammatory SyndromeDiseases of the musculoskeletal systemRC925-935ENOpen Access Rheumatology: Research and Reviews, Vol 2016, Iss Issue 1, Pp 51-59 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Human Immunodeficiency Virus Rheumatoid Arthritis Osteoporosis Cardiovascular Disease Immune Reconstitution Inflammatory Syndrome Diseases of the musculoskeletal system RC925-935
spellingShingle	Human Immunodeficiency Virus Rheumatoid Arthritis Osteoporosis Cardiovascular Disease Immune Reconstitution Inflammatory Syndrome Diseases of the musculoskeletal system RC925-935 Carroll MB Fields JH Clerc PG Rheumatoid arthritis in patients with HIV: management challenges
description	Matthew B Carroll, Joshua H Fields, Philip G Clerc Department of Rheumatology, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS, USA 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 a 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. Keywords: human immunodeficiency virus, rheumatoid arthritis, osteoporosis, cardiovascular disease, immune reconstitution inflammatory syndrome
format	article
author	Carroll MB Fields JH Clerc PG
author_facet	Carroll MB Fields JH Clerc PG
author_sort	Carroll MB
title	Rheumatoid arthritis in patients with HIV: management challenges
title_short	Rheumatoid arthritis in patients with HIV: management challenges
title_full	Rheumatoid arthritis in patients with HIV: management challenges
title_fullStr	Rheumatoid arthritis in patients with HIV: management challenges
title_full_unstemmed	Rheumatoid arthritis in patients with HIV: management challenges
title_sort	rheumatoid arthritis in patients with hiv: management challenges
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/f03066bb24ca4c4cbddbf3a659e2d380
work_keys_str_mv	AT carrollmb rheumatoidarthritisinpatientswithhivmanagementchallenges AT fieldsjh rheumatoidarthritisinpatientswithhivmanagementchallenges AT clercpg rheumatoidarthritisinpatientswithhivmanagementchallenges
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Rheumatoid arthritis in patients with HIV: management challenges

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