Rheumatology Department, Hospital Provincial del Centenario, National University of Rosario (UNR), Santa Fe 3100, Rosario, Argentina.
Cardiology Department, Hospital Provincial del Centenario, National University of Rosario (UNR), Rosario, Santa Fe, Argentina.
Clin Rheumatol. 2021 Jul;40(7):2955-2963. doi: 10.1007/s10067-021-05581-2. Epub 2021 Jan 12.
Evidence for Chagas disease reactivation (CDR) in rheumatologic patients under rheumatologic treatments (RTs) is scarce. To screen and follow-up patients with rheumatic diseases and concomitant Chagas disease under RT to detect CDR and to describe a possible relationship between CDR and specific RT. An observational, longitudinal, prospective, consecutive study was carried out between 2018 and 2020. Included patients were evaluated during the follow-up for clinical and laboratorial manifestations of CDR. Direct blood parasitological examination (Strout method) and polymerase chain reaction (PCR) were employed to diagnose CDR. The dynamic of anti-T. cruzi-specific antibodies was also assessed by IHA and ELISA (total IgG and Anti-SAPA). Fifty-one patients were included (86% women). Rheumatoid arthritis was the predominant disease (57%). Classic DMARDs (86.3%) and corticosteroids (61%) were the most frequent RT. CDR was developed in 6 patients (11.7%), exhibiting both positive Strout and PCR. Symptomatic reactivation of CD (fever, asthenia, arthralgias, myalgias) occurred in two patients who had previously been diagnosed with it. Regardless of the different RT, all patients who experienced CDR had previously received more than ≥ 20 mg/day of prednisone equivalent. Despite immunosuppression, patients with CDR exhibited increased levels of specific anti-T. cruzi and anti-SAPA antibodies, which decreased after anti-parasitic treatment. CDR is possible in rheumatologic patients, especially after receiving high doses of corticosteroids. Since CDR symptoms may mimic rheumatic disease activity, monitoring of Chagas disease is highly recommended before, during and after immunosuppression. Key Points • Chagas disease reactivation (CDR) in the context of rheumatological treatment was associated to high doses of corticosteroids. • CDR was associated with an increase in anti-T. cruzi antibodies despite the immunosuppressive treatment. • Suspecting and anticipating CDR is mandatory in this patient population to diagnose and treat it.
在接受风湿病治疗（RT）的风湿病患者中，恰加斯病再激活（CDR）的证据很少。本研究旨在筛查和随访接受 RT 的合并恰加斯病的风湿病患者，以检测 CDR，并描述 CDR 与特定 RT 之间的可能关系。这是一项在 2018 年至 2020 年间进行的观察性、纵向、前瞻性、连续研究。纳入的患者在随访期间接受了临床和实验室检查，以评估 CDR 的临床表现。采用 Strout 法和聚合酶链反应（PCR）进行直接血液寄生虫学检查，以诊断 CDR。还通过间接免疫荧光法（IFA）和酶联免疫吸附试验（ELISA）（总 IgG 和 Anti-SAPA）评估抗 T. cruzi 特异性抗体的动态变化。共纳入 51 例患者（86%为女性），其中以类风湿性关节炎为主（57%），最常见的 RT 为经典 DMARDs（86.3%）和皮质类固醇（61%）。6 例（11.7%）患者发生 CDR，均为 Strout 法和 PCR 阳性。2 例曾诊断为 CDR 的患者出现 CD 症状再激活（发热、乏力、关节痛、肌痛）。尽管存在免疫抑制，但所有发生 CDR 的患者在接受治疗前均接受了超过≥20mg/天的泼尼松等效剂量。尽管存在免疫抑制，但发生 CDR 的患者特异性抗 T. cruzi 和 Anti-SAPA 抗体水平升高，经抗寄生虫治疗后下降。在接受风湿病治疗的患者中，CDR 是可能发生的，尤其是在接受大剂量皮质类固醇治疗后。鉴于 CDR 症状可能与风湿病活动相似，强烈建议在免疫抑制治疗前、治疗中和治疗后监测恰加斯病。重点 • 风湿病治疗中恰加斯病再激活（CDR）与大剂量皮质类固醇有关。 • 尽管进行了免疫抑制治疗，CDR 仍与抗 T. cruzi 抗体增加有关。 • 在这种患者人群中，必须怀疑和预测 CDR，以诊断和治疗它。
