A reexamination of the relationship between active rheumatoid arthritis and the acquired immunodeficiency syndrome

Abstract

Three patients with rheumatoid arthritis (RA) that remitted with the development of the human immunodeficiency virus (HIV) infection have been described in the literature, and this has contributed to the belief that RA and HIV infection or the acquired immunodeficiency syndrome (AIDS) cannot coexist. However, a computerized MEDLINE literature search revealed reports of 4 patients who did have active RA and AIDS or HIV infection, as well as other case reports of symmetric polyarthritis compatible with RA in patients with HIV infection. Each of the patients whose RA remitted had received standard disease‐modifying antirheumatic drug therapy, and 1 of the 3 had a normal T helper: T suppressor ratio at the time of remission. Of the 4 previously reported patients with active RA and AIDS or HIV infection, all had decreased numbers of T helper lymphocytes. The present report describes a fifth patient with both RA and AIDS and reviews the data concerning the coexistence of these 2 diseases. It appears that active RA may indeed coexist with AIDS. It remains to be seen under what settings HIV may have a diseasemodifying effect in RA. These issues have important implications regarding the pathogenesis and therapy of RA, especially in terms of the role of CD4+ lymphocytes and anti‐CD4 monoclonal antibody therapy.

Rheumatic manifestations of human immunodeficiency virus infection

“…This association is controversial, however, as cases that remit receive disease-modifying antirheumatic drugs. RA patients who still have active disease and radiologic progression, despite an immunosuppressive state of HIV infection, have also been described [70,71].…”

Protective Role of Infections and Vaccinations on Autoimmune Diseases

“…One should mention, however, the transient improvement of nephrotic syndrome during measles infection [37], as well as the improvement of myasthenia gravis (MG) or more controversially of RA in HIV infected patients [38][39][40]. Arguments supporting the above hypothesis are derived from epidemiological studies developed from three sets of observations: (1) allergic and autoimmune diseases are more common in developed than in underdeveloped countries; (2) the incidence of these diseases selectively increases in these countries; (3) there is a negative correlation between occurrence of these diseases and socioeconomical factors or frequency of some infections.…”

Pathogenesis of rheumatoid arthritis

“…Einzelbeobachtungen im Sinne einer Involvierung von T-Zellen zeigen, daB bei RA-Patienten, die sich mit dem HI-Virus infiziert harten, mit zunehmender Pro~edienz der HIVErkrankung und damit abfallenden TZellzahlen die rheumatoide Arthritis klinisch immer stummer wurde [2]. In jª Vergangenheit wurden allerdings weitere Kasuistiken bekannt, in denen dieser Zusammenhang nicht gesehen wurde [52]. In einer eleganten Studie konnte sogar die Progredienz der erosiven Ver~inderungen auch im Endstadium der HIV-Erkrankung bei sehr niedrigen T-Zell-Zahlen dokumentiert werden 82].…”