University of Texas Southwestern Medical Center, Dallas VA Medical Center, 75390-8884, USA.
Am J Med Sci. 2010 Jun;339(6):549-56. doi: 10.1097/MAJ.0b013e3181c6440e.
Although many viruses produce musculoskeletal symptoms during an acute infection, a long-term inflammatory arthritis remains an unusual consequence. When evaluating arthritis in a patient with a chronic or latent viral infection, serologic testing and therapeutic options are significantly altered.
The example of hepatitis C reveals how chronic infection can complicate the diagnosis of rheumatoid arthritis. Determination of rheumatoid factor is of limited utility, whereas the anticyclic citrullinated peptide has become a new test with improved specificity. Therapeutic options are severely constrained because of potential hepatotoxicity of oral agents such as methotrexate and leflunomide. Antitumor necrosis factor alpha biologics have demonstrated initial safety in the setting of hepatitis C virus but may be associated with reactivation of hepatitis B virus. Biologics such as abatacept and rituximab have been inadequately studied in this population to date. Prevention of viral infections by influenza and herpes zoster vaccines in rheumatoid arthritis patients needs improved administration rates and careful planning to maximize efficacy.
Chronic viral infections complicate the diagnosis and therapy of inflammatory arthritis. The antitumor necrosis factor alpha biologics have become important therapeutic options for patients with hepatitis C. Vaccination against influenza and herpes zoster are underused in health maintenance of arthritis patients.
尽管许多病毒在急性感染期间会引起肌肉骨骼症状，但长期炎症性关节炎仍是一种不常见的后果。在评估慢性或潜伏性病毒感染患者的关节炎时，血清学检测和治疗选择会发生明显改变。
丙型肝炎的例子揭示了慢性感染如何使类风湿关节炎的诊断变得复杂。类风湿因子的测定实用性有限，而环瓜氨酸肽已成为一种新的具有改善特异性的检测方法。由于甲氨蝶呤和来氟米特等口服药物有潜在的肝毒性，治疗选择受到严重限制。抗肿瘤坏死因子 α 生物制剂在丙型肝炎病毒感染的情况下显示出初始安全性，但可能与乙型肝炎病毒的再激活相关。迄今为止，阿巴西普和利妥昔单抗等生物制剂在该人群中的研究还不够充分。需要提高接种率并精心规划，以最大限度地提高流感和带状疱疹疫苗在类风湿关节炎患者中的效果，从而预防病毒感染。
慢性病毒感染使炎症性关节炎的诊断和治疗变得复杂。抗肿瘤坏死因子 α 生物制剂已成为丙型肝炎患者的重要治疗选择。流感和带状疱疹疫苗在关节炎患者的常规保健中使用率较低。
