title: Outcome of hepatitis E virus infection in patients with inflammatory arthritides treated with immunosuppressants: a French retrospective multicenter study.
abstract: The clinical presentation and outcome of hepatitis E virus (HEV) infection in inflammatory rheumatic diseases are unknown. We aimed to investigate the severity of acute HEV infection and the risk of chronic viral replication in patients with inflammatory arthritides treated with immunosuppressive drugs. All rheumatology and internal medicine practitioners belonging to the Club Rhumatismes et Inflammation in France were sent newsletters asking for reports of HEV infection and inflammatory arthritides. Baseline characteristics of patients and the course of HEV infection were retrospectively assessed by use of a standardized questionnaire. From January 2010 to August 2013, we obtained reports of 23 cases of HEV infection in patients with rheumatoid arthritis (n = 11), axial spondyloarthritis (n = 5), psoriatic arthritis (n = 4), other types of arthritides (n = 3). Patients received methotrexate (n = 16), antitumor necrosis factor α agents (n = 10), rituximab (n = 4), abatacept (n = 2), tocilizumab (n = 2), and corticosteroids (n = 10, median dose 6 mg/d, range 2-20). All had acute hepatitis: median aspartate and alanine aminotransferase levels were 679 and 1300 U/L, respectively. Eleven patients were asymptomatic, 4 had jaundice. The HEV infection diagnosis relied on positive PCR results for HEV RNA (n = 14 patients) or anti-HEV IgM positivity (n = 9). Median follow-up was 29 months (range 3-55). Treatment included discontinuation of immunosuppressants for 20 patients and ribavirin treatment for 5. Liver enzyme levels normalized and immunosuppressant therapy could be reinitiated in all patients. No chronic infection was observed. Acute HEV infection should be considered in patients with inflammatory rheumatism and elevated liver enzyme values. The outcome of HEV infection seems favorable, with no evolution to chronic hepatitis or fulminant liver failure.
authors: From the Service de Rhumatologie (HB, J-EG, EC, CS, JS), Centre de Référence des Maladies Auto-Immunes Systémiques Rares, C.H.U. de Hautepierre, Strasbourg; Service de Rhumatologie (CL, AC); Service d'Hépato-gastro-entérologie (SF, J-MP); Laboratoire de Virologie (FA, JI), C.H.U. Purpan, Toulouse; Service de Rhumatologie (PC), C.H.U. Henri Mondor, Créteil; Service de Rhumatologie (CH, AM), C.H.U Cochin, Paris; Service d'Immunologie Clinique et Thérapeutique Ostéo-Articulaire (SF, Y-MP), C.H.U. Lapeyronie, Montpellier; Service de Médecine Interne (GL), C.H.R.U. de Lille; Service de Rhumatologie (LM), Institut Calot, Berck-s-Mer; Service de Rhumatologie (AM), C.H. de Saint Brieuc; Service de Médecine Interne et de Rhumatologie (LM), C.H. Pasteur, Colmar; Service de Rhumatologie (BP-P), C.H.U. Bellevue, Saint Etienne; Laboratoire de Virologie (AM-RA), Hôpital Paul Brousse, Villejuif; Service de Rhumatologie (CR), Hôpital de l'Archet 1, Nice; Service de Rhumatologie (MS), C.H.U. de Clermont-Ferrand; Service de Rhumatologie (CV), C.H.U. Pellegrin, Bordeaux; and Service de Rhumatologie (DW), C.H.U. Minjoz, Besançon, France.
authors: Hélène
authors: H
authors: Bauer
authors: Cécile
authors: C
authors: Luxembourger
authors: Jacques-Eric
authors: JE
authors: Gottenberg
authors: Sophie
authors: S
authors: Fournier
authors: Florence
authors: F
authors: Abravanel
authors: Alain
authors: A
authors: Cantagrel
authors: Emmanuel
authors: E
authors: Chatelus
authors: Pascal
authors: P
authors: Claudepierre
authors: Christophe
authors: C
authors: Hudry
authors: Jacques
authors: J
authors: Izopet
authors: Sylvie
authors: S
authors: Fabre
authors: Guillaume
authors: G
authors: Lefevre
authors: Laurent
authors: L
authors: Marguerie
authors: Antoine
authors: A
authors: Martin
authors: Laurent
authors: L
authors: Messer
authors: Anna
authors: A
authors: Molto
authors: Béatrice
authors: B
authors: Pallot-Prades
authors: Yves-Marie
authors: YM
authors: Pers
authors: Anne-Marie
authors: AM
authors: Roque-Afonso
authors: Christian
authors: C
authors: Roux
authors: Christelle
authors: C
authors: Sordet
authors: Martin
authors: M
authors: Soubrier
authors: Claire
authors: C
authors: Veissier
authors: Daniel
authors: D
authors: Wendling
authors: Jean-Marie
authors: JM
authors: Péron
authors: Jean
authors: J
authors: Sibilia
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001168:Arthritis / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D005260:Female; D005602:France; D016751:Hepatitis E / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D012254:Ribavirin