car accident, hep c, RA flare

[grevay]

I was diagnosed with RA seven years ago and was prescribed Plaquenil. I received much relief and continued doing well. About 9 months after I was in a car accident, resulting in cervical stenosis and a long course of PT I had severe flares for which I was prescribed prednisone for several months (May, 2007). My rheumatologist was concered about my liver functioning and diagnosed hepatitis c after a blood test. I began treatment for hcv (January, 2008), my flares subsided, however during the latter part of the 6 months of hcv treatment, the flares increased and I was in considerable pain. I was prescribed prednisone in dosages ending at 20 mg. for 3 months. The prednisone provided minimal relief, and I was weaned off the prednisone, and put on sulfazine. In September, 2008 I was prescribed Enbrel and finally Methotrexate (January, 2009). I have received much relief with the current medications (I continue to take Plaquenil as well). My question is, is it possible that my car accident and resulting injury caused my RA flares? Finally is there any literature or research that addresses the relationship between hcv treatment and RA, as well as RA flares and stress?

[alagirl]

about your other question, I see a lot of arthritis info that says flares can be caused by stress, physical trauma, bacteria, etc.  I haven't found the actual studies though, but it makes sense to me that when the immune system would go into overdrive when under stress.

[LI_Lady]

I was diagnosed with RA & didn't realize the connection with my hep C until after developing neuropathy....as a result of cryoglobulenemia.  I was very lucky in that I treated the HCV successfully, but I was warned prior to starting treatment that it could aggravate the RA and the neuropathy.

The only RA med I take now is sulfazine. I was on Plaquenil at first, but then developed eye problems so was taken off it. I'm sure you were told you must have regular ophthalmic exams.  I'm surprised that you're MD prescribed Methotrexate  and Enbrel since mine won't permit me to try either due to my liver issues.

When I get very bad, I take Prednisone & I wish I could continue on it.  It was the best med I've found for RA.  I felt like Superwoman!

I am now 18 months off HCV treatment.  My last test was in May and I am still negative!  I was undetectable just a few weeks into treatment and remained so the entire time.

I am so sorry that I did not treat the hep sooner.  I truly believe I could have avoided all my current medical issues had I done so.  My husband also suffers from HCV and cryo and had a kidney transplant a little over a year ago.  Just because you don't "feel" sick with hep, it's there and it can disable you years down the road.

[kickboxingmom]

Some Interferon RA Articles
by alagirl , May 08, 2008 10:46PM
http://www.****: more than just an antiviral

Proteins such as interferons and interleukins are known as cytokines. Interferon (IFN) has a broad range of effects; it can affect anti-cancer cells, antibody producing B-cells and also cause the production of other cytokines. As IFN can affect many cells in a variety of ways, dysfunction within the IFN system may cause disturbances in other parts of the immune system. There are reports of disturbances in immune function with several autoimmune disorders including rheumatoid arthritis, hepatitis B, diabetes, immune deficiencies, multiple sclerosis and Lupus (SLE: systemic lupus erythematosus).

Defects of the IFN system in these disorders have been noted to involve both IFN alpha and gamma. Often the highest levels of IFN in the blood are found when the severe episodes of autoimmune diseases occur. In experiments with mice who have an autoimmune disorder, injections of IFN seem to worsen the disorder and shorten lifespan. Thus, it is even possible that IFN itself may be the cause of some of the immune dysfunction in autoimmune disorders. This may also be the case in lupus. The defects in the immune system of people with Lupus include: (1) increased blood levels of IFN alpha; (2) a decreased sensitivity to the effects of IFN; and (3) a reduced ability to produce IFN.



1: J Okla State Med Assoc. 1994 May;87(5):228-30.Links
Rheumatoid arthritis: a complication of interferon therapy.Nadir F, Fagiuoli S, Wright HI, Nadir A, Hopp E, Gavaler J, Van Thiel DH.
Oklahoma Transplantation Institute, Baptist Medical Center of Oklahoma, Oklahoma City 73112.

A case report of rheumatoid arthritis developing during alpha-interferon therapy of chronic hepatitis C is reported. The rheumatoid arthritis was severe, being non-responsive to the use of nonsteroidal anti-inflammatory drugs, and persisted despite discontinuation of the interferon therapy. The literature relative to this case suggesting an association between rheumatoid arthritis and interferon therapy is presented. This case suggests that interferon therapy may precipitate subclinical rheumatoid arthritis in an individual without pre-existing clinical arthritis.

PMID: 8051581 [PubMed - indexed for MEDLINE]


http://****

N. Sekiguchi, S. Kawauchi, T. Furuya, N. Inaba, K. Matsuda, S. Ando, M. Ogasawara, H. Aburatani, H. Kameda, K. Amano, et al.
Messenger ribonucleic acid expression profile in peripheral blood cells from RA patients following treatment with an anti-TNF-{alpha} monoclonal antibody, infliximab
Rheumatology, April 14, 2008; (2008) ken083v2.
[Abstract] [Full Text] [PDF]

http://www****

New onset of rheumatoid arthritis during interferon
P-1B treatment in a patient with multiple sclerosis:
comment on the case report by Jabaily and Thompson


Good morning.Nice to meet you.Here's an article that alagirl posted not to long ago.I thought it may help.

[FloridaMouse]

I have RA.  I actually became symptomatic while I was on treatment the first time. I got my first flares 2 months before I finished my 48 week course.  The answer to your question is yes, treatment can indeed aggravate RA flares and can speed up the progression of the disease.

I am currently taking Humira, Celebrex and periodic taper down doses of Prednisone (along with tramadol for pain).  I was on methotrexate as well until last month when I was pulled off it by Shands at the University of Florida due to the fact that my liver disease has now progressed to early cirrhosis.

By the way have you had a Anti-CCP test done for your RA?  It's a test that apparently was  put in use to assist with the diagnosis and prognosis for people with RA.   It can predict with 95% accuracy whether or not a person has the erosive form (deforming) of RA.  I just had one done and go the results on Monday.  I do have the errosive form but the biologic drugs such as Enbrel, Humira,  Remicade and Orencia are supposed to help slow that progression down.  

Lastley, there are some studies out that suggest that the biologic/TNF blockers for RA actually enhance the effects of interferon.  Unfortunately this didn't hold true in my case.

Mouse

[JennyPenny]

I can't answer your questions about RA and the effects of stress. However, I can tell you that hepatitis c, both the virus itself, as well as the treatment, can exacerbate any autoimmune disease. Having the virus causes a patients immune system to be constantly fighting and this can make the body start to attack itself  which is a hallmark of autoimmune diseases. I hope you feel better soon.