Severe hypovitaminosis D correlates with increased inflammatory markers in HIV infected patients.

BACKGROUND: Even though it has been suggested that antiretroviral therapy has an impact on severe hypovitaminosis D (SHD) in HIV infected patients, it could be speculated that the different levels of residual inflammation on HAART (Highly Active Anti Retroviral Therapy) could contribute to SHD and aggravate bone catabolism in these patients. METHODS: A cross-sectional study was carried out in an unselected cohort of 263 HIV infected outpatients consulting during Spring 2010. Clinical examinations were performed and medical history, food habits, sun exposure and addictions were collected. Fasting blood samples were taken for immunological, virological, inflammation, endocrine and bone markers evaluations. RESULTS: Ninety-five (36%) patients had SHD. In univariate analysis, a significant and positive association was found between SHD and IL6 (p = 0.001), hsCRP (p = 0.04), increased serum C-Telopeptides X (CTX) (p = 0.005) and Parathyroid Hormon (PTH) (p < 0.0001) levels. In multivariate analysis, SHD deficiency correlated significantly with increased IL-6, high serum CTX levels, lower mean daily exposure to the sun, current or past smoking, hepatitis C, and functional status (falls), but not with the time spent on the current HAART (by specific drug or overall). CONCLUSIONS: SHD is frequent and correlates with inflammation in HIV infected patients. Since SHD is also associated with falls and increased bone catabolism, it may be of interest to take into account not only the type of antiretroviral therapy but also the residual inflammation on HAART in order to assess functional and bone risks. This finding also suggests that vitamin D supplementation may be beneficial in these HIV-infected patients.

Development of inflammatory bowel disease during anti-TNF-α therapy for inflammatory rheumatic disease: a nationwide series.

OBJECTIVES: To describe cases of new onset of inflammatory bowel disease (IBD) in patients with inflammatory rheumatic disease (IRD) receiving anti-TNF-α therapy. METHODS: A call for observations of such cases was sent to members of the French "Club rhumatismes et inflammation". Only patients without intestinal symptoms before introduction of anti TNF-α agents were included. RESULTS: During a 2-year period, 16 patients were declared: nine men and seven women, mean age 41.5 ± 17.4 years, 12 patients with ankylosing spondylitis, one with rheumatoid arthritis, one with psoriatic arthritis and two juvenile idiopathic arthritis with enthesitis related arthritis. Overall, 14 patients received etanercept and two had infliximab. The meantime frame between onsets of anti-TNF--α drugs and development of IBD was 29.3 ± 20.1 months. According to endoscopic and histological findings, IBD was classified as typical Crohn's disease in eight cases, Crohn's-like disease in six cases, indeterminate in one case and definite ulcerative colitis in one case. For all cases, each TNF-α blocking agent was discontinued and replaced by another monoclonal anti TNF-α antibody. After a mean follow up period of 23.4 ± 19.5 months, outcome was favorable without recurrent or flaring IBD. CONCLUSIONS: Paradoxical IBD may occur during anti TNF-α therapy for inflammatory rheumatic disease, mostly in patients with spondylarthropathies while receiving etanercept, at a frequency estimated to 0.15% in the French patients with spondylarthropathies exposed to TNF-α antagonists. The IBD mainly corresponded to Crohn's or Crohn's-like disease. On the contrary, new onset IBD is less frequently observed in other cases of IRD and with other TNF--α blockers.

Usefulness of routine hepatitis C and hepatitis B serology in the diagnosis of recent-onset arthritis. Systematic prospective screening in all patients seen by the rheumatologists of a defined area--brief report.

OBJECTIVE: Previous studies evaluating the usefulness of systematic screening for hepatitis B and C in patients with recent-onset arthritis suffered from a major bias since they were conducted in hospitals. The objective of the present study was to evaluate the relevance of such screening, performed by hospital and office-based rheumatologists of a defined area, in the diagnosis of arthritis or inflammatory polyarthralgia of less than 1 year duration. METHODS: The CRRRI is a network which includes most hospital and office-based rheumatologists of an area with a population of 506,755 inhabitants. All patients seen by the CRRRI participants in their usual practice between March 2008 and December 2010 for inflammatory polyarthralgia, mono-, oligo-, or polyarthritis of less than 1 year duration were included. Patients' serum samples were screened for the presence of anti-hepatitis C virus (HCV) antibodies, with positive samples further evaluated for HCV-RNA with a reverse transcriptase-polymerase chain reaction, and for the presence of hepatitis B virus (HBV) infection. RESULTS: Two hundred and thirty-three patients were included (162 women, 71 men; mean age of 50.6±15.8 years). Patients were evaluated for inflammatory polyarthralgia (n=51), monoarthritis (n=21), oligoarthritis (n=35) or polyarthritis (n=126) lasting for a mean 19.8±29.8 weeks. No new HCV or HBV infection diagnosis was done. CONCLUSION: In this study not suffering from a hospital-selection bias, screening for hepatitis C and B infection was not helpful in the diagnosis process of recent-onset arthritis. KEY MESSAGES: Systematic hepatitis B and C serology is not relevant in patients with recent-onset (<1 year) arthritis.