Reactive arthritis after COVID-19: a case-based review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 19 (COVID-19) pandemic, which is deeply affecting the whole world. In this new case for the scientific world, scientists are investigating the etiopathogenesis of viral infection-induced damage and have started to focus on the short and long-term immune system effects and alterations after SARS-CoV-2 infection. The case is here reported of a 53-year-old female patient with acute monoarthritis after SARS-CoV-2 infection, who responded adequately to 150 mg/day diclofenac treatment, and the available case reports are comprehensively reviewed. With the focus on arthritis after SARS-CoV2 infection, which emerges as a new pathological condition associated with COVID-19, it was aimed to examine the possible immunological mechanisms of post-COVID-19 arthritis based on the current data on SARS-CoV-2 and the known pathogenetic background of viral arthritis.

Emerging new avian reovirus variants from cases of enteric disorders and arthritis/tenosynovitis in Brazilian poultry flocks.

1. The objective of this study was to characterise circulating Brazilian avian reovirus (ARV) strains by genetic analysis of the σC protein encoded by segment 1 of the viral genome and compare these with those of viral strains used for immunising commercial poultry.2. The analysis detected the presence of ARV genomes by quantitative reverse transcriptase PCR (RT-qPCR) in the enteric samples and the joint tissues (JT) of birds with signs of viral arthritis/tenosynovitis. Nucleotide sequencing used 16 strains (three commercial vaccines, 10 from enteric tissues and three from JT). The results indicated high variability in the amino acid sequences of 13 wild strains, showing between 40% and 75% similarity compared with the vaccine strains (S1133 and 2177).3. The sequences were grouped into three well-defined clusters in a phylogenetic tree, two of these clusters together with previous Brazilian σC ARV sequences, and one cluster (VII) that was novel for Brazilian strains. Antigenic analysis showed that there were amino acids within putative epitopes located on the surface of the receptor-binding region of the σC protein with a high degree of variability.4. The study confirmed the presence of ARV genetic variants circulating in commercial birds in Brazil, and according to the antigenic prediction, the possibility of antigenic variants appears to be high.

Arthritogenic alphaviral infection perturbs osteoblast function and triggers pathologic bone loss.

Arthritogenic alphaviruses including Ross River virus (RRV), Sindbis virus, and chikungunya virus cause worldwide outbreaks of musculoskeletal disease. The ability of alphaviruses to induce bone pathologies remains poorly defined. Here we show that primary human osteoblasts (hOBs) can be productively infected by RRV. RRV-infected hOBs produced high levels of inflammatory cytokine including IL-6. The RANKL/OPG ratio was disrupted in the synovial fluid of RRV patients, and this was accompanied by an increase in serum Tartrate-resistant acid phosphatase 5b (TRAP5b) levels. Infection of bone cells with RRV was validated using an established RRV murine model. In wild-type mice, infectious virus was detected in the femur, tibia, patella, and foot, together with reduced bone volume in the tibial epiphysis and vertebrae detected by microcomputed tomographic (µCT) analysis. The RANKL/OPG ratio was also disrupted in mice infected with RRV; both this effect and the bone loss were blocked by treatment with an IL-6 neutralizing antibody. Collectively, these findings provide previously unidentified evidence that alphavirus infection induces bone loss and that OBs are capable of producing proinflammatory mediators during alphavirus-induced arthralgia. The perturbed RANKL/OPG ratio in RRV-infected OBs may therefore contribute to bone loss in alphavirus infection.

High risk of misclassification of acute Parvovirus B19 infection into a systemic rheumatic disease.

Objectives: Parvovirus B19 most frequently causes epidemics of erythema infectiosum in children but also affects adults often leading to rheumatologic manifestations. While the serum profile allows the diagnosis, manifestations may mimic autoimmune conditions. The aim was to evaluate the proportion of patients with acute Parvovirus B19 infection fulfilling classification criteria for rheumatic diseases (RA and SLE). Methods: We evaluated the clinical and serological features of 54 patients diagnosed with acute Parvovirus B19 infection seeking rheumatological attention between March and June 2024. Results: The majority of patients were females (78%), with a mean (s.d.) age of 45 (13) years and 54% could not recall any known exposure. Fifty-one/54 (94%) had arthralgia, 27 (50%) arthritis (oligoarthritis in 67% of them), 24 (44%) fever, 19 (35%) skin rash and 7 (13%) purpura. Symptoms resolution generally occurred within 6 weeks. Complement levels were low in 14/33 (42%) tested patients, while the presence of serum ANA, anti-dsDNA, anti-phospholipids and rheumatoid factor was detected in 21/38 (55%), 10/26 (38%), 6/12 (50%) and 5/37 (13%) patients, respectively. Classification criteria for SLE were fulfilled in 93% of ANA-positive patients and RA criteria in 38% of patients with arthritis. Conclusions: Parvovirus B19 infection manifestations may vary and nearly all patients with positive serum ANA fulfil the classification criteria for SLE. The risk of misclassification in patients with viral infection should not be overlooked.

Genetic characterization of newly emerging avian reovirus variants in chickens with viral arthritis/tenosynovitis in Israel.

In recent years, new avian reovirus (ARV) variants caused a variety of symptoms in chickens worldwide, the most important of which was Viral arthritis/tenosynovitis which caused substantial economic losses and has become a concern to the worldwide chicken industry. In this study, we characterized emerging ARV variants in Israel and analyzed their genetic relationship with reference strains. One hundred thirty-four ARV variants were isolated from tendons and synovial fluids of commercial broiler chickens with signs of arthritis/tenosynovitis. Phylogenetic analysis of the partial segment of the sigma C (σC) gene confirmed that these field isolates from Israel could be clustered into all six known clusters. The majority of ARV isolates in Israel belonged to the genotypic cluster 5 (GC5). The strains in this study had a low sequence identity when compared to the commercial vaccine (strain S1133). The findings of this study demonstrated the genetic diversity of ARV strains in Israel from 2015 to 2022. It is reasonable to conclude from the preliminary results of this investigation that Israel has not been subject to selection pressure or the emergence of new ARV variants since the introduction of the live vaccine (ISR-7585). Due to the ongoing emergence of ARV variants, a robust epidemiological monitoring program supported by molecular biology techniques is required to track ARV strains in Israeli poultry flocks.

JMM Profile: Sindbis virus, a cause of febrile illness and arthralgia.

Sindbis virus (SINV) is the causative agent of a febrile infection commonly called Ockelbo disease, Pogosta disease or Karelian fever in northern Europe. Finland, Sweden, Russia and South Africa experience periodic SINV outbreaks. SINV is classified within the family Togaviridae and genus Alphavirus. Symptoms of SINV infection in humans include joint inflammation and pain, fever, rash and fatigue. In some cases, joint symptoms can persist for years after recovery from the initial infection. Clinical signs of SINV infection are rarely reported in animals, although infection in horses has been documented. There is no specific treatment or vaccination. The virus is transmitted by mosquitoes, particularly those belonging to the Culex genus, but Aedes, Culiseta or Mansonia species may also act as vectors. Wild birds act as amplifying hosts and are implicated in the long-distance spread of the virus.

Avian reovirus: a furious and fast evolving pathogen.

Avian reoviruses (ARVs) have a significant economic impact on the poultry industry, affecting commercial and backyard flocks. Spread feco-orally, or vertically, many do not cause morbidity, but pathogenic strains can contribute to several diseases, including tenosynovitis/arthritis, which is clinically the most significant. The last decade has seen a surge in cases in the US, and due to ongoing evolution, seven genotypic clusters have now been identified. Control efforts include strict biosecurity and vaccination with commercial and autogenous vaccines. Research priorities include improving understanding of pathogenesis and developing new vaccines guided by ongoing molecular and serologic surveillance.

Treatment of chikungunya-associated joint pain: a systematic review of controlled clinical trials.

Post-chikungunya joint pain (arthritis or arthralgia) is a clinical concern in endemic regions as it may cause a debilitating illness sometimes years after the acute infection. This systematic review analyses evidence from controlled clinical trials regarding the efficacy of pharmacological and non-pharmacological interventions to treat post-chikungunya joint pain. PubMed, EMBASE, Scopus, Cochrane library and Web of Science were searched for eligible studies without any language or time limits, excluding retrospective studies, and prospective observational studies without a control group. Eleven studies met the inclusion criteria. Seven assessed pharmacological interventions and four assessed non-pharmacological interventions (exercise, neuromodulation). The number of participants in each intervention arm varied from 10 to 75 and, given the heterogeneity of interventions, a meta-analysis was not possible. Available evidence does not show any added benefit of chloroquine, hydroxychloroquine, stand-alone methotrexate or ribavirin compared with anti-inflammatory drugs or placebo/no treatment. Non-steroidal anti-inflammatory drugs may reduce pain up to 24 wk of treatment but long-term residual impact after stopping treatment is unassessed. Currently, there is also no high certainty evidence to recommend non-pharmacological methods such as exercise and neuromodulation.

Reactive arthritis with SARS-COV-2 as a trigger.

We present the case of a 19-year-old male patient who developed symmetrical distal polyarthritis which was diagnosed as a reactive atypical arthritis caused by SARS-COV-2 infection after dismissing other causes of arthritis.

Genotypic characterization of two novel avian orthoreoviruses isolated in Iran from broilers with viral arthritis and malabsorption syndrome.

Background: Avian reovirus (ARV) is a major poultry pathogen associated with arthritis, malabsorption, and enteric diseases in chickens. In recent years, emerging ARV strains have become a growing concern causing significant economic losses in broiler chickens around the world. This report focuses on the isolation of ARV from the clinical occurrence of ARV-associated diseases in commercial broiler chickens in Iran and the genotypic characterization of the selected isolates. Case description: In 2018, two distinct clinical diseases, suggestive of malabsorption syndrome (MAS) and viral arthritis, were noticed in commercial broiler chickens in the north of Iran. Laboratory investigations were carried out following necropsy, documentation of the gross lesions, and sampling of the affected tissues for histopathology and virology. Molecular diagnosis and characterization of ARV were performed targeting Sigma C (σC) gene sequences of the virus. Findings/treatment and outcome: Two variant ARV strains were isolated from tendon and gizzard of broilers with clinical viral arthritis and MAS, respectively. Phylogenetic analysis of the ARV σC gene sequences revealed that field isolates were clustered in genotypes 2 and 4 (which were distinct from previous Iranian field ARV strains) with relatively low sequence identity (59.2% and 49.1%) to the classical vaccine strains (S1133 and 1733) in genotype 1. Conclusion: This report, for the first time, represents new emerging ARV variants associated with clinical events in Iran, providing insights on the diversity of endemic ARV field isolates, and urges the need for national-wide surveillance of ARV.

[Reactive arthritis with SARS-COV-2 as a trigger]. / Artritis reactiva con SARS-CoV-2 como desencadenante.

We present the case of a 19-year-old male patient who developed symmetrical distal polyarthritis which was diagnosed as a reactive atypical arthritis caused by SARS-COV-2 infection after dismissing other causes of arthritis.

Avian Reoviruses from Clinical Cases of Tenosynovitis: An Overview of Diagnostic Approaches and 10-Year Review of Isolations and Genetic Characterization.

Reoviral-induced tenosynovitis/viral arthritis is an economically significant disease of poultry. Affected birds present with lameness, unilateral or bilateral swollen hock joints or shanks, and/or reluctance to move. In severe cases, rupture of the gastrocnemius or digital flexor tendons may occur, and significant culling may be necessary. Historically, vaccination with a combination of modified live and inactivated vaccines has successfully controlled disease. Proper vaccination reduced vertical transmission and provided maternal-derived antibodies to progeny to protect against disease, at an age when they were most susceptible. Starting in 2011-2012, an increased incidence of tenosynovitis/viral arthritis was observed in chickens and turkeys. In chickens, progeny from reovirus-vaccinated breeders were affected, suggesting commercial vaccines did not provide adequate protection against disease. In turkeys, clinical disease was primarily in males, although females can also be affected. The most significant signs were observed around 14-16 wks of age and include reluctance to move, lameness, and limping on one or both legs. The incidence of tenosynovitis/viral arthritis presently remains high. Reoviruses isolated from clinical cases are genetically and antigenically characterized as variants, meaning they are different from vaccine strains. Characterization of the field isolates reveals multiple new genotypes and serotypes that are significantly different from commercial vaccines and each other. In 2012, a single prevalent virus was isolated from a majority of the cases submitted to the Poultry Diagnostic and Research Center at the University of Georgia. Genetic characterization of the σC protein revealed the early isolates belonged to genetic cluster (GC) 5. Soon after the initial identification of the GC5 variant reovirus, many broiler companies incorporated these isolates from their farms into their autogenous vaccines and continue to do so today. The incidence of GC5 field isolates has decreased significantly, likely because of the widespread use of the isolates in autogenous vaccines. Unfortunately, variant reoviruses belonging to multiple GCs have emerged, despite inclusion of these isolates in autogenous vaccines. In this review, an overview of nomenclature, sample collection, and diagnostic testing will be covered, and a summary of variant reoviruses isolated from clinical cases of tenosynovitis/viral arthritis over the past 10 yrs will be provided.

Estudio recapitulativo- Reovirus aviares de casos clínicos de tenosinovitis: una descripción general de los enfoques de diagnóstico y una revisión de 10 años de aislamientos y caracterización genética. La tenosinovitis/artritis viral inducida por reovirus es una enfermedad económicamente significativa de la avicultura. Las aves afectadas presentan cojera, articulaciones de corvejones o patas inflamadas unilateral o bilateralmente y/o renuencia a moverse. En casos severos, puede ocurrir la ruptura de los tendones del gastrocnemio o del flexor digital, y puede ser necesario una eliminación de aves afectadas significativa. Históricamente, la vacunación con una combinación de vacunas vivas modificadas e inactivadas ha controlado con éxito la enfermedad. La vacunación adecuada redujo la transmisión vertical y proporcionó anticuerpos derivados de las reproductoras a la progenie para protegerlos contra la enfermedad, a una edad en la que eran más susceptibles. A partir de los años 2011-2012, se observó una mayor incidencia de tenosinovitis/artritis viral en pollos y pavos. En los pollos, la progenie de reproductores vacunados con reovirus se vio afectada, lo que sugiere que las vacunas comerciales no brindaron una protección adecuada contra la enfermedad. En pavos, la enfermedad clínica fue principalmente en machos, aunque las hembras también pueden verse afectadas. Los signos más significativos se observaron alrededor de las 14 a 16 semanas de edad e incluyen renuencia a moverse y cojera en una o ambas piernas. La incidencia de tenosinovitis/artritis viral actualmente sigue siendo alta. Los reovirus aislados de casos clínicos se caracterizan genética y antigénicamente como variantes, lo que significa que son diferentes de las cepas vacunales. La caracterización de los aislamientos de campo revela múltiples genotipos y serotipos nuevos que son significativamente diferentes de las vacunas comerciales y entre sí. En 2012, se aisló un solo virus prevalente de la mayoría de los casos presentados al Centro de Investigación y Diagnóstico Avícola de la Universidad de Georgia. La caracterización genética de la proteína sigma C reveló que los primeros aislamientos pertenecían al grupo genético 5 (GC5). Poco después de la identificación inicial de la variante GC5 del reovirus, muchas empresas de pollos de engorde incorporaron estos aislamientos de sus granjas en sus vacunas autógenas y continúan haciéndolo en la actualidad. La incidencia de aislamientos de campo de GC5 ha disminuido significativamente, probablemente debido al uso generalizado de los aislamientos en vacunas autógenas. Desafortunadamente, han surgido variantes de reovirus que pertenecen a múltiples grupos genéticos, a pesar de la inclusión de estos aislados en vacunas autógenas. En esta revisión, se cubrirá una descripción general de la nomenclatura, la recolección de muestras y las pruebas de diagnóstico, y se brindará un resumen de las variantes de reovirus aisladas de casos clínicos de tenosinovitis/artritis viral durante los últimos 10 años.

Infectious mimics of rheumatoid arthritis.

Rheumatoid arthritis (RA) can have various infectious mimics. As immunosuppressive agents used in treatment can aggravate the underlying infections, correct diagnosis of RA and ruling out infections is important. Numerous viral infections (Parvovirus B19, Hepatitis B, Hepatitis C, Chikungunya and other alphaviruses, human immunodeficiency virus (HIV) and various other viruses), mycobacterial infections (Poncet's disease, tubercular septic arthritis, and leprosy), bacterial arthritis, brucellosis and Lyme disease are among common infections that mimic RA. Widespread travel and tourism, especially to exotic areas, high risk sexual behavior and widespread use of immunosuppressive and chemotherapeutic agents has led to numerous outbreaks of infections in areas where these infections were never reported before. Hence, rheumatologists all over the world should be familiar with musculoskeletal manifestations of infections. History of travel, comorbid fever, skin rash, genital ulcers, urethral discharge, the consumption of unpasteurized milk, lymphadenopathy, tenosynovitis, low platelet count, and positive Mantoux test can offer potential diagnostic clues. Serological testing, cultures, specific radiological signs and deoxyribonucleic Acid (DNA) amplification techniques often aid in diagnosis. Treatment mainly consists of antimicrobial agents, analgesics, and nonsteroidal anti-inflammatory drugs (NSAIDs). However, immunosuppressive agents including steroids and disease modifying anti-rheumatic drugs (DMARDs) are needed occasionally in different refractory and prolonged illnesses. Most of the times, episodes of arthritis are self-limiting and respond to treatment of underlying cause. However, few infections like Chikungunya and Lyme's disease can lead to chronic arthritis as well.

Field Control of Avian Reoviruses in Commercial Broiler Production.

Prevention of tenosynovitis/viral arthritis caused by variant avian reoviruses within commercial broiler production has become increasingly more challenging because of the lack of protection afforded by the current commercially available vaccines. Avian reoviruses isolated from clinical cases of tenosynovitis/viral arthritis in recent years are antigenically distinct from nearly all of the commercially licensed modified live and inactivated biologics available in the United States. The emergence of new variants is likely shaped by a lack of homologous protection coupled with selection pressure influences and results in antigenically diverse populations of avian reoviruses. One tool available to the poultry industry is the use of autogenous (custom) vaccines. Although these can be effective, isolation, characterization, and screening of isolates from clinical cases is paramount for the selection of isolates to include in these vaccines. With no treatment options, control can only be attained via prevention of infection. To achieve this goal, commercially licensed products with antigenic applicability and broadly cross-protective vaccine strains are needed.

Estudio recapitulativo- Control de campo de los reovirus aviares en la producción comercial de pollos de engorde. La prevención de la tenosinovitis/artritis viral causada por variantes de reovirus aviares dentro de la producción comercial de pollos de engorde se ha vuelto cada vez más difícil debido a la falta de protección que brindan las vacunas disponibles comercialmente en la actualidad. Los reovirus aviares aislados de casos clínicos de tenosinovitis/artritis viral en los últimos años son antigénicamente distintos de casi todos los biológicos vivos modificados e inactivados con licencia y disponibles comercialmente en los Estados Unidos. La aparición de nuevas variantes probablemente se deba a la falta de protección homóloga junto con las influencias de la presión de selección y da como resultado poblaciones antigénicamente diversas de reovirus aviares. Una herramienta disponible para la industria avícola es el uso de vacunas autógenas (elaboradas de acuerdo a los virus de cada compañía). Si bien estos pueden ser efectivos, el aislamiento, la caracterización y la detección de aislamientos de casos clínicos son de suma importancia para la selección de aislamientos para incluir en estas vacunas. Sin opciones de tratamiento, el control solo se puede lograr a través de la prevención de la infección. Para lograr este objetivo, se necesitan productos comercialmente autorizados con aplicabilidad antigénica y cepas de vacunas que induzcan protección cruzada amplia.

Avian Reovirus in Israel, Variants and Vaccines-A Review.

Avian reovirus (ARV) has been determined to be the etiologic agent of viral arthritis/tenosynovitis. In Israel, meat-type chickens, including broilers and breeders, are the most affected. Severe disease symptoms can appear in broiler flocks at a very young age because of early exposure and vertical transmission, causing significant welfare problems. Jewish laws define birds with inflamed, damaged, or torn gastrocnemius and digital flexor tendons as religious condemnations (non-kosher), resulting in severe economic losses for the poultry industry. Vaccination of breeders is a strategy to control the disease by reducing vertical transmission and providing maternal-derived antibodies to the progeny. This review describes Israel's ARV variants and the various vaccines developed over the years. Identification of co-circulating variants triggered the development of multivalent autogenous inactivated vaccines. However, the genotype-matched vaccines failed to provide protection, resulting in an increased prevalence of Cluster II ARV (classified as genotyping cluster 5 in the ARV common world classification). Since 2014, ARV Cluster II has been dominant in Israel. In 2015, the dominant variant s7585 tropism changed the virus pathogenesis and affected broilers with severe clinical signs between 12 and 15 days of age. A new vaccine approach developed in Israel used controlled exposure of the breeding flock to virulent ARV at the age when they are resistant to infection. This approach significantly reduced clinical field cases and reovirus isolations of breeding and broiler flocks between 2020 and 2022.

Estudio recapitulativo- Reovirus aviares en Israel, variantes y vacunas: Una revisión. Se ha determinado que el reovirus aviar (ARV) es el agente etiológico de la artritis/tenosinovitis viral. En Israel, los pollos de carne, incluidos los pollos de engorde y reproductores, son los más afectados. Los signos severos de la enfermedad pueden aparecer en parvadas de pollos de engorde a una edad muy temprana debido a la exposición temprana y la transmisión vertical, lo que causa problemas significativos de bienestar. Las leyes judías definen a las aves con gastrocnemio inflamado, dañado o desgarrado y tendones flexores digitales como decomiso religiosas (no kosher), lo que resulta en graves pérdidas económicas para la industria avícola. La vacunación de reproductoras es una estrategia para controlar la enfermedad al reducir la transmisión vertical y proporcionar anticuerpos derivados de las reproductoras a la progenie. Esta revisión describe las variantes de reovirus aviares de Israel y las diversas vacunas desarrolladas a lo largo de los años. La identificación de variantes co-circulantes desencadenó el desarrollo de vacunas inactivadas autógenas multivalentes. Sin embargo, las vacunas elaboradas con genotipos compatibles no brindaron protección, lo que resultó en una mayor prevalencia de reovirus aviares del grupo II. Desde 2014, el grupo II de los reovirus aviares ha sido dominante en Israel. En 2015, el tropismo de la variante dominante s7585 cambió la patogenia del virus y afectó a los pollos de engorde con signos clínicos severos entre los 12 y los 15 días de edad. Un nuevo enfoque de vacuna desarrollado en Israel utilizó la exposición controlada de la parvada reproductora a reovirus aviares virulentos a la edad en que son resistentes a la infección. Este enfoque redujo significativamente los casos clínicos de campo y los aislamientos de reovirus de parvadas de reproductores y pollos de engorde entre 2020 y 2022.

Review of Viral Arthritis in Canada.

Viral arthritis/tenosynovitis, a disease caused by avian reovirus (ARV), leads to great economic losses for the chicken industry worldwide. Since autumn 2011, the poultry industries in the United States and Canada have sustained significant economic losses in the progeny of broiler breeders vaccinated with classic strains of ARV. Vaccination failure has been caused by field challenge with variant ARVs. The variant field ARVs are refractory to the immunity stimulated by classic vaccines and have become the prevalent challenge in the field. Because all genotypes described in the literature have been reported to be circulating in Canada, genotyping of circulating ARVs is paramount for the selection of appropriate isolates, representative of the field challenge, for use in autogenous vaccines. In this review, the history of ARVs and the current situation in Canada are discussed. On the basis of recent field data, inadequate measures commonly used in the field are discussed, and successful vaccination strategies are recommended.

Estudio recapitulativo- Revisión de la artritis viral en Canadá La artritis/tenosinovitis viral, una enfermedad causada por el reovirus aviares (ARV), genera grandes pérdidas económicas para la industria avícola en todo el mundo. Desde el otoño del 2011, las industrias avícolas de los Estados Unidos y Canadá han sufrido pérdidas económicas significativas en la progenie de reproductoras de pollos de engorde vacunadas con cepas clásicas de reovirus aviares. Las fallas de la vacunación han sido causadas por el desafío de campo con reovirus aviares variantes. Los reovirus aviares de campo variantes son refractarios a la inmunidad estimulada por las vacunas clásicas y se han convertido en el desafío predominante en el campo. Debido a que se ha reportado que todos los genotipos descritos en la literatura están circulando en Canadá, la determinación del genotipo de los reovirus aviares circulantes es fundamental para la selección de aislamientos apropiados, representativos del desafío de campo, para su uso en vacunas autógenas. En esta revisión, se discute la historia de los reovirus aviares y la situación actual en Canadá. Sobre la base de datos de campo recientes, se analizan las medidas inadecuadas comúnmente utilizadas en el campo y se recomiendan estrategias de vacunación exitosas.

Regulatory T-cells and GARP expression are decreased in exercise-associated chikungunya viral arthritis flares.

Objective: Chikungunya virus (CHIKV) causes persistent arthritis, and our prior study showed that approximately one third of CHIKV arthritis patients had exacerbated arthritis associated with exercise. The underlying mechanism of exercise-associated chikungunya arthritis flare (EACAF) is unknown, and this analysis aimed to examine the regulatory T-cell immune response related to CHIKV arthritis flares. Methods: In our study, 124 Colombian patients with a history of CHIKV infection four years prior were enrolled and 113 cases with serologically confirmed CHIKV IgG were used in this analysis. Patient information was gathered via questionnaires, and blood samples were taken to identify total live peripheral blood mononuclear cells, CD4+ cells, T regulatory cells, and their immune markers. We compared outcomes in CHIKV patients with (n = 38) vs. without (n = 75) EACAF using t-tests to assess means and the Fisher's exact test, chi-squared to evaluate categorical variables, and Kruskal-Wallis tests in the setting of skewed distributions (SAS 9.3). Results: 33.6% of CHIKV cases reported worsening arthritis with exercise. EACAF patients reported higher global assessments of arthritis disease ranging from 0-100 (71.2 ± 19.7 vs. 59.9 ± 28.0, p=0.03). EACAF patients had lower ratios of T regulatory (Treg)/CD4+ T-cells (1.95 ± 0.73 vs. 2.4 ± 1.29, p = 0.04) and lower percentage of GARP (glycoprotein-A repetitions predominant) expression per Treg (0.13 ± 0.0.33 vs. 0.16 ± 0.24 p= 0.020). Conclusion: These findings suggest relative decreases in GARP expression may indicate a decreased level of immune suppression. Treg populations in patients with CHIKV arthritis may contribute to arthritis flares during exercise, though current research is conflicting.

Rheumatological complications of Covid 19.

INTRODUCTION: COVID-19 has caused unprecedented hardships in the 21st century with more than 150 million infections. Various immunological phenomena have been described during the course of the infection, and this infection has also triggered autoimmunity. Rheumatological illnesses have been described following resolution of the acute infection; hence we sought to conduct a review of the rheumatological complications of COVID-19. METHODS: We conducted a literature search for articles relating to sequelae of COVID-19 from Jan 2020 to 30th April 2021. RESULTS: We found a number of reports of inflammatory arthritis after SARS-CoV-2 infection. SLE and renal disease have been described, and vasculitis also appears to be a common complication. Rhabdomyolysis and myositis has also been reported in a number of patients. We also found some evidence of large vessel vasculitis in 'long COVID' patients. CONCLUSIONS: This review highlights a number of important complications such as inflammatory arthritis, lupus-like disease, myostis and vasculitis following SARS-CoV-2 infection.

CME-Rheumatologie 20: Parvovirus-B19-induzierte Tenosynovitis? CME-Fragen.

CME Rheumatology 20: Parvovirus B19-Induced Tenosynovitis? Abstract. In this case presentation we discuss diagnostic algorithms and differential diagnoses in undifferentiated tenosynovitis. We present a case of a patient with chronic tenosynovitis in the 4th extensor tendon compartment. With unremarkable anamnesis and due to normal laboratory results a «seronegative (RF), ACPA (CCP)-negative tenosynovitis without arthritis¼ had been reported. Diagnostic and therapeutic tenosynovectomy was performed. Histologic processing revealed a positive PCR for parvovirus B19. We discuss articular and extraarticular manifestations. A parvovirus B19-associated manifestation in the musculoskeletal system is usually self-limiting. The therapy should be carried out symptomatically. In our patient there was a marked local finding, so that the complete tenosynovectomy followed by a single steroid injection led to a persistent restitutio ad integrum.

Methotrexate in Early Chikungunya Arthritis: A 6 Month Randomized Controlled Open-label Trial.

OBJECTIVE: Evidence for treating chikungunya arthritis early in the course of illness is scarce. This study assesses the efficacy of Methotrexate in early Chikungunya arthritis. METHODS: It is a randomized controlled open-label assessor-blinded trial with a crossover design. Sixty patients with persistent post chikungunya arthritis with at least 3 or more tender or swollen joints (28 joint count) were recruited. MTX arm was given oral Methotrexate and NSAID arm was given NSAIDs (Naproxen 1 gm/day or Etoricoxib 120 mg/day). Patients were followed at 1, 2, 4 and 6 months. After 2 months patients in NSAID arm who have not achieved remission were given MTX. The primary endpoint was remission (no tender or swollen joints by 28 joint count) at 6 months. Secondary endpoints were change in CDAI, Indian HAQ, total steroid use, total NSAID use, and serious adverse effects. Intention to treat analysis was used. RESULTS: TJC, SJC, CDAI and HAQ were matched between two at baseline. Remission was achieved by 28 patients (93%, CI- 78%-98%) in the NSAID arm and 26 patients (86%, CI-70%- 94%) in MTX arm (p=0.18). There was no significant difference in steroid need, change in HAQ, CDAI, TJC or SJC. Those who have not achieved remission had higher disease activity at baseline. CONCLUSION: A protocol-based approach with steroid and NSAIDs helped to achieve remission in most patients with early subacute phase of post-Chikungunya arthritis and the effect was comparable to that of early initiation of methotrexate.