Considering Viral Infections in Patients With Rheumatic Disease, with Leonard Calabrese, DO

Virology and rheumatology, although seemingly separate fields, are being increasingly linked as new therapies create interactions between them and researchers find more and more links between fields.

“Viral forms of arthritis still need to be kept in mind. Generally speaking, these are self-limiting. They are non-erosive and nondestructive, but they may catch us off guard and we may misdiagnose these,” Leonard H. Calabrese, DO, Professor of Medicine and Vice Chair, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, told HCPLive. “We also like to think about arthritis in the returning traveler, or people with rheumatic symptoms, and after they've traveled, they come to see us... we keep that in mind in our differential diagnosis.”

Calabrese will be giving a talk on the multi-faceted role of viral infections in the field of rheumatology at the 2024 Congress of Clinical Rheumatology (CCR) West meeting, held in San Diego, California, on September 26-29.

In this conversation, Calabrese emphasized that viral infections can often be implicated in the etiology of rheumatic diseases and affect the treatment and management of patients with rheumatic disease. Some diseases that may cause forms of arthritis to emerge include parvovirus, as well as viruses that a patient might become infected with after traveling abroad, such as arboviruses or Zika virus. Other viruses may be reactivated by biologic therapies, including HIV, hepatitis B, and hepatitis C, making it important to screen for these viruses. Lastly, comorbid viruses such as Herpes zoster, may also interact with therapies.

"Comorbid viral infections [are] really important to keep in mind. While hepatitis B, hepatitis C, and HIV are what we refer to as de-accelerating infections, we have treatments. We can cure Hepatitis C, we can't cure Hepatitis B, and we can't cure HIV, but we have suppressed it, and the actual infection rates are going down... When we use biologics, we have black box warnings for the use of B cell depleting agents and hepatitis B reactivation. So, we need to understand that patients going on to immunosuppressive therapies with targeted therapies need to be screened for hepatitis C, hepatitis B, and HIV,” Calabrese said.

Relevant disclosures for Calabrese include AbbVie, AstraZeneca, Bristol Myers Squibb, Galvani, Genentech, GlaxoSmithKline, Janssen, Novartis, Regeneron, Sanofi and UCB. Quotes have been edited for clarity.

REFERENCE

Calabrese LH. Viral Infections in Rheumatic Disease 2024: Etiology Management and Prevention. Presented at: 2024 CCR West Meeting; San Diego, California; September 26-29.