title: Rheumatoid arthritis following PEG-interferon-alfa-2a plus ribavirin treatment for chronic hepatitis C: a case report and review of the literature.
abstract: BACKGROUND
  The combination of Pegylated Interferon-alpha (PEG-IFN-α) and ribavirin is the current standard of care for the treatment of HCV infection. Unfortunately, IFN-α may lead to the induction or exacerbation of autoimmune diseases, such as psoriasis, thyroiditis, systemic lupus erythematosus and, rarely, rheumatoid arthritis (RA).
  
  
  METHODS
  We report the case of a man affected with chronic hepatitis C (CHC) due to HCV genotype 3a infection, who developed RA after a complete course of PEG-IFN-α and ribavirin. Nine weeks after cessation of antiviral treatment, the patient developed symmetrical polyarthritis, with pain and edema in the wrists, knees, shoulders and metacarpophalangeal joints; magnetic resonance imaging detected initial bone erosions with juxta-articular osteopenia in wrist, knee and hand joints. Anti-cyclic citrullinated peptide (anti-CCP) antibodies were positive.
  
  
  CONCLUSIONS
  Autoimmune diseases, including RA, may occur when treating chronic hepatitis C with PEG-IFN-α and ribavirin; therefore, a close surveillance for the occurrence of autoimmune phenomena should be suggested in the setting of HCV management.
authors.affiliation: Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Via Palermo 636, 95125, ARNAS Garibaldi Nesima, Catania, Italy. cacopardobruno@inwind.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Cacopardo
authors.forename: Francesco
authors.initials: F
authors.lastname: Benanti
authors.forename: Marilia Rita
authors.initials: MR
authors.lastname: Pinzone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nunnari
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D001323:Autoantibodies / Q000096:biosynthesis*; D004359:Drug Therapy, Combination; D005838:Genotype; D016174:Hepacivirus / Q000145:classification / Q000187:drug effects / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000037:antagonists & inhibitors; D011092:Polyethylene Glycols / Q000009:adverse effects*; D012367:RNA, Viral / Q000145:classification / Q000235:genetics*; D011994:Recombinant Proteins / Q000009:adverse effects; D012254:Ribavirin / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D001323:Autoantibodies; D016898:Interferon-alpha; D010456:Peptides, Cyclic; D012367:RNA, Viral; D011994:Recombinant Proteins; C487763:cyclic citrullinated peptide; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a