Few cases of rheumatoid like arthritis has been recorded with interferon alpha treatment
Is there any published or personal experience about initiating Interferon based regimen with a DAA for HCV patient with rheumatoid arthritis?
There are 3 dimensions to this question1. Does the patient indeed have RA? Over 70% of HCV patients are positive for Rheumatoid factor. HCV itself can cause a form of non erosive arthritis. Cryoglobulinemia , often associated with HCV can present with arthritis. If the patient does not have RA, the arthritis will actually resolve with IFN.
2. Choice of RA therapy on HCV: One needs to avoid methotrexate, lefluniomide and NSAIDs. Hydroxychloroquin and Sulphasalazine might be acceptable DMARDs. In case of choosing biologics, TNF inhibitors are by and large not recommended. Rituximab, though not recommended, is sometimes given as it does have benefial effects on cryoglobulinemia related arthritis of HCV and might cause lesser harm. Abatacept might be an alternative worth exploring.
3. Effect of DAA interferon/ribavirtin on RA: This is a tough one. IFN/ribavirin is known to precipitate autoimmune diseases including RA. 4 cases of RA have been described with IFN therapy. The best I can say is, make your own judgement and monitor patient more frequently.
all the best
Thank you Dr Subramanian
The patient is an established case of RA with failure of Sulphasalazine with 7.5 mg of prednisone, cryoglobulin is negative. We need to clear HCV ( genotype 4 ) before upgrade her RA treatment. unfortunately only sofosbuvir can be offered for her so we have to use it with INF
Why did not you use methotrexate, lefluniomide and Hydroxychloroquin before using INF?
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