Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Intestinal Microsporidiosis: High Risk in Rheumatic Diseases Patients under Anti-TNF Therapy Combined with Methotrexate.

Aikawa3,  Nadia E., Twardowsky5,  Aline O., Carvalho5,  Jozelio, Silva4,  Clovis, Silva2,  Ivan, Medeiros5,  Ana, Goncalves5,  Carla

Faculdade Medicina, Sao Paulo, Brazil
Rheumatology Division (CEDMAC) and Infectology Division, Faculdade de Medicina da Universidade de Sao Paulo
Rheumatology Division (CEDMAC) and Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
Rheumatology Division (CEDMAC) and Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de Sao Paulo
Rheumatology Division (CEDMAC), Faculdade de Medicina da Universidade de Sao Paulo

Background:

Microsporidiosis are among the most frequent opportunistic intestinal diseases in immunocompromised subjects. However, there are scarce studies regarding the relevance of microsporidia and other intestinal parasites in high risk rheumatic diseases patients.

Purpose:

To evaluate microsporidiosis and other intestinal pathogenic parasites in patients with rheumatic diseases under disease modifying anti-rheumatic drugs (DMARDs) and biological agents therapies and to investigate possible associations between these parasitoses, disease activity and drugs.

Methods:

98 consecutive rheumatic diseases patients [47 rheumatoid arthritis (RA), 31 ankylosing spondylitis (AS), 11 psoriatic arthritis (PsA) and 9 juvenile idiopathic arthritis (JIA)] and 92 socio-economic-matched healthy controls were enrolled. Stool parasitological analysis and culture were performed in all participants. Three stool samples from each subject were collected in different days. Stools were evaluated using microscopic examination for detection of pathogenic protozoan oocysts, cysts, helminthic eggs and larvae. GRAM-Chromotrope for Microsporidium and intestinal Coccidia, Leishman staining for Blastocystis hominis and fecal leukocytes, Kinyoun procedure and capture-ELISA for Cryptosporidium sp., Cyclospora cayetanensis and Isospora belli, and Kato-Katz for Schistosoma mansoni were also performed. Clinical manifestations, disease activity data and treatments were also analyzed.

Results:

The mean of current age (44.2±14.3 vs. 43.75±14.29 years, p=0.8155), frequencies of Caucasian race and socio-economic classes were comparable in patients and controls (p>0.05). Of note, the frequency of microsporidia was significantly higher in rheumatic diseases compared to controls (36% vs. 4%, p<0.0001), as well as in RA (32% vs. 4.4%, p<0.0001), EA (45% vs. 4%, p<0.0001), PsA (40% vs. 4%, p<0.0001) and JIA patients (56% vs. 4%, p=0.0002). Regarding the other pathogenic parasites, only Giardia lamblia was more often observed in EA patients versus controls (9.7% vs. 0%, p=0.0149). The frequency of methotrexate/anti-TNF therapy was higher in patients with pathogenic parasites compared to those without these parasitosis (77% vs. 54%, p=0.0249), in spite of similar mean duration of anti-TNF therapy in both groups (12.3 ± 9.9 vs. 15 ± 11.1months, p= 0.2231) and disease activity parameters (p>0.05). Gastrointestinal symptoms occurred in a similar frequency in patients with and without pathogenic parasitosis (p>0.05) and none had disseminated disease. All patients and controls were treated with albendazole for microsporidia infection and metronidazole for giardiasis.

Conclusion:

We have identified that microsporidiosis is a frequent opportunistic infection in rheumatic diseases patients under concomitant methotrexate and anti-TNF treatment regardless of the gastrointestinal symptoms and therefore investigation for microsporidia is highly recommended for early diagnosis. This drug combination seems to play an important role in host defense probably by inhibiting inflammatory mediators.

To cite this abstract, please use the following information:
Aikawa, Nadia E., Twardowsky, Aline O., Carvalho, Jozelio, Silva, Clovis, Silva, Ivan, Medeiros, Ana, et al; Intestinal Microsporidiosis: High Risk in Rheumatic Diseases Patients under Anti-TNF Therapy Combined with Methotrexate. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :539
DOI: 10.1002/art.28308

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