Radiographic aspects in individuals infected by human T-lymphotropic virus type 1 (HTLV-1) with joint pain

Carvalho, João Marcos da Silva; Campos, Eugênia Maria Teixeira de Araújo; Ferreira, José Luiz Nunes; Carvalho, Huliana Mourão; Carneiro Neto, José Abraão; Carneiro, Tássila de Oliveira; Carvalho, Edgar Marcelino

doi:10.1186/s42358-022-00259-y

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Research • Adv. rheumatol. 62 • 2022 • https://doi.org/10.1186/s42358-022-00259-y copy

Radiographic aspects in individuals infected by human T-lymphotropic virus type 1 (HTLV-1) with joint pain

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Joint pain in the absence or with little synovitis is observed in a large percentage of HTLV-1 infected subjects. As the virus infect CD4 +and CD8 +positive, macrophages and B cells an exaggerated production of pro-inflammatory cytokines is detected in these patients. However, the possible association of HTLV-1 infection with autoimmune diseases has not been documented definitively and the clinical characteristics of HTLV-1 associated arthropathy has not been defined. The objective this study is to describe clinic and radiographic features in HTLV-1-infected individuals with complaints of joint pain.

Methods:

Cross-sectional study enrolling HTLV-1-infected individuals with chronic joint pain, aged up to 75 years, both genders and seronegative controls with osteoarthritis. All participants underwent conventional radiography of the hips, knees and ankles.

Results:

Eighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis participated in the study. Polyarticular and symmetrical arthritis prevailed in the HTLV-1 positive group (54%), while oligoarticular and asymmetrical (44%) were more common in controls ( p < 0.05). The frequency of enthesophytes (90%) in HTLV-1-infected patients was greater than in the control group (73%) ( p < 0.05). Radiographic features were similar in HTLV-1 carriers and in patients with probable or definite HTLV-1 associated myelopathy. The presence of enthesophytes in the absence of joint space reduction or osteophytes was only observed in HTLV-1-infected individuals ( p < 0.001). Magnetic resonance imaging of the ankles of five HTLV-1-infected patients and five controls demonstrated a higher frequency of enthesitis, bursitis and osteitis in the HTLV-1 infected group.

Conclusion:

HTLV-1-associated arthropathy is clinically characterized by symmetrical polyarthralgia and the main radiological finding is the presence of enthesophytes in the absence of osteophytes and joint space narrowing.

Keywords:
HTLV-1; HTLV-1-associated arthropathy; Arthralgia; Radiographic aspects

Demographic and clinical features		HTLV-1 + (n = 81)	Control (n = 30)	p
Age (years)		60 (±9) ^a a Mean (Standard Deviation)	59 (±9) ^a a Mean (Standard Deviation)	0.78 ^b b Student’s t test;
Gender
	Female	59 (73%)	25 (83%)	0.32 ^c c Fisher’s exact test
	Male	22 (27%)	5 (17%)	0.32 ^c c Fisher’s exact test
Clinical/neurological status
	Carrier	48 (59%)	-
	Probable HAM/TSP	22 (27.1%)	-
	Definite HAM/TSP	11 (13.5%)	-
Pattern of joint pain				0.0001 ^d d Chi-square test
	Polyarticular and symmetric	44 (54%)	3 (10%)
	Polyarticular and asymmetric	4 (5%)	4 (13%)
	Oligoarticular and symmetric	16 (20%)	4 (13%)
	Oligoarticular and asymmetric	13 (16%)	13 (44%)
	Monoarticular	4 (5%)	6 (20%)
Main joints with pain complaint
	Knees	72 (89%)	27 (90%)	1.00 ^d d Chi-square test
	Hips	31 (38%)	3 (10%)	0.005 ^d d Chi-square test
	Ankles	54 (67%)	12 (40%)	0.004 ^d d Chi-square test

Radiographic findings	HTLV-1 + N = 81	Control N = 30	p ^a a Fisher’s exact test
Joint Space Narrowing in at least one joint	34 (42%)	29 (97%)	0.0001
Osteophytes in at least one joint	46 (57%)	28 (93%)	0.0001
Enthesophytes in at least one joint	73 (90%)	22 (73%)	0.035
Enthesophytes with joint space narrowing or Osteophytes	49/73 (67%)	22/22 (100%)	0.001
Enthesophytes without joint space narrowing and without osteophytes	24/73 (33%)	0

Radiographic Findings	HTLV-1 + N = 81	Control N = 30	p ^a a Fisher’s exact test
Knees
Joint space narrowing	30 (37%)	29 (97%)	0.0001
Osteophyte	46 (57%)	27 (90%)	0,001
Enthesophyte	29 (36%)	9 (30%)	0.6
Hips
Joint space narrowing	8 (10%)	3 (10%)	1.000
Osteophyte	4 (5%)	6 (20%)	0.02
Enthesophyte	46 (57%)	11 (37%)	0.08
Ankles
Joint space narrowing	1 (1%)	5 (17%)	0.005
Osteophyte	9 (11%)	13 (43%)	0.0001
Enthesophyte	69 (85%)	19 (63%)	0.01

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E-mail: rbreumatol@terra.com.br

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[1] * Correspondence: imuno@ufba.br