The intersection of virology and rheumatology is gaining increased attention as new therapeutic approaches create complex interactions between these traditionally distinct fields. Dr. Leonard H. Calabrese, Professor of Medicine and Vice Chair at Cleveland Clinic Lerner College of Medicine, emphasizes the critical importance of understanding these relationships in modern rheumatology practice.
Viral Arthritis in Clinical Practice
"Viral forms of arthritis still need to be kept in mind. Generally speaking, these are self-limiting, non-erosive and nondestructive, but they may catch us off guard and we may misdiagnose these," explains Dr. Calabrese. He particularly emphasizes the importance of considering viral etiologies in returning travelers presenting with rheumatic symptoms, highlighting the need for a comprehensive differential diagnosis.
Impact of Viral Infections on Treatment
The relationship between viral infections and rheumatic diseases presents multiple clinical challenges. Various viruses, including parvovirus and travel-related infections such as arboviruses and Zika virus, can trigger arthritic manifestations. Of particular concern is the potential for biologic therapies to reactivate latent viral infections, specifically HIV, hepatitis B, and hepatitis C.
Screening Protocols and Management Strategies
"When we use biologics, we have black box warnings for the use of B cell depleting agents and hepatitis B reactivation," Dr. Calabrese notes. This underscores the crucial need for comprehensive viral screening before initiating immunosuppressive therapy. While some viral infections like hepatitis C can be cured, others such as hepatitis B and HIV require ongoing management despite available treatments that can effectively suppress viral activity.
Future Perspectives
Dr. Calabrese will further explore these topics at the 2024 Congress of Clinical Rheumatology (CCR) West meeting in San Diego, where he will present on the multi-faceted role of viral infections in rheumatology. This presentation promises to provide valuable insights into the evolving understanding of viral-rheumatic disease interactions and their implications for clinical practice.
