PMID- 20051757
OWN - NLM
STAT- MEDLINE
DCOM- 20100422
LR  - 20100106
IS  - 1536-7355 (Electronic)
IS  - 1076-1608 (Linking)
VI  - 16
IP  - 1
DP  - 2010 Jan
TI  - Refractory polyarticular gouty arthritis as a manifestation of immune 
      reconstitution inflammatory syndrome.
PG  - 40-2
LID - 10.1097/RHU.0b013e3181c78ddc [doi]
AB  - Immune reconstitution inflammatory syndrome (IRIS) describes the initial clinical 
      deterioration some patients manifest upon initiation of effective antiretroviral 
      therapy (ART) for HIV infection. In this report we describe a case of IRIS 
      manifesting as polyarticular gout, a previously unreported rheumatological 
      manifestation of IRIS. A 53-year-old HIV-infected man with a history of 
      intermittent attacks of gout and an initial CD4 count of 112 cells/microL and a 
      viral load of >100,000 copies/mL presented to our institution with severe, 
      refractory, polyarticular gout approximately 4 weeks after initiating ART. At 
      this point, the patient demonstrated significant gains in his CD4 counts (103 
      cells/microL) and a greater than 3 log decline in his HIV-1- viral load. This 
      episode was prolonged lasting for approximately 10 weeks and required 
      hospitalization for the management of pain and control of inflammation. The 
      temporal associations of this attack with the initiation of ART and the observed 
      immunologic reconstitution make IRIS a clinical possibility.Monosodium urate 
      crystals through their interactions with interleukin 1- beta, and neutrophilic 
      synovitis play a critical role in the pathophysiology of gout. Defects in both 
      neutrophil and macrophage function and imbalances in the cytokine milieu are 
      documented in HIV infected patients. The introduction of ART results in 
      restoration of neutrophil and macrophage function, declines in levels of the 
      anti-inflammatory cytokine IL-10, and increases in levels of proinflammatory 
      cytokines including IL-1 beta, which may provide the necessary milieu for the 
      precipitation of attacks of severe polyarticular gout in the context of ART 
      initiation.
FAU - Sebeny, Peter J
AU  - Sebeny PJ
AD  - Division of Infectious Diseases, National Naval Medical Center, Bethesda, MD 
      20889, USA.
FAU - Keith, Michael P
AU  - Keith MP
FAU - Love, Kathleen M
AU  - Love KM
FAU - Dwyer, Terrence X
AU  - Dwyer TX
FAU - Ganesan, Anuradha
AU  - Ganesan A
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - J Clin Rheumatol
JT  - Journal of clinical rheumatology : practical reports on rheumatic & 
      musculoskeletal diseases
JID - 9518034
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Anti-Retroviral Agents/*therapeutic use
MH  - Arthritis, Gouty/*etiology
MH  - HIV Infections/*drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*complications
MH  - Male
MH  - Middle Aged
EDAT- 2010/01/07 06:00
MHDA- 2010/04/23 06:00
CRDT- 2010/01/07 06:00
PHST- 2010/01/07 06:00 [entrez]
PHST- 2010/01/07 06:00 [pubmed]
PHST- 2010/04/23 06:00 [medline]
AID - 00124743-201001000-00013 [pii]
AID - 10.1097/RHU.0b013e3181c78ddc [doi]
PST - ppublish
SO  - J Clin Rheumatol. 2010 Jan;16(1):40-2. doi: 10.1097/RHU.0b013e3181c78ddc.