Rheumatological manifestations in a patient with hiv in regular use of antiretroviral therapy

Different studies demonstrate an association between autoimmune phenomena and rheumatic disorders with human immunodeficiency virus (HIV) infection, with reports of musculoskeletal involvement in up to 72% of cases, in addition to increasing the risk for bone mineralization disorders.Spondyloarthritis is among the most prevalent joint manifestations in the population of HIV-infected patients, with the most prevalent conditions being: arthralgias (45%), reactive arthritis (5-10%), psoriatic arthritis and HIV-associated arthritis (< 10%), the latter may be similar to rheumatoid arthritis (RA).Its triggering mechanisms have not yet been clarified and the clinical course is usually more severe.Some studies also showed an association of these patients using antiretroviral therapy (ART) with higher rates of hyperuricemia when compared to healthy individuals with similar risk factors. CASE REPORTMale, 70 years old, diagnosed with acquired immunodeficiency syndrome in 1986, being started on ART since then, with an undetectable viral load.He developed a condition of chronic inflammatory polyarthralgia in the proximal interphalangeal (PIP), metacarpophalangeal (MCP) and wrists, bilaterally, with morning stiffness.Physical examination showed thickening of the 3 rd right PIP and bilateral 2 nd and 3 rd MCP, in addition to Heberden and Bouchard's nodules, and diagnostic hypotheses of HIV-related arthritis, RA and osteoarthritis (OA) of the hands were performed.Laboratory tests showed negative anti-CCP and rheumatoid factor, 5.7 uric acid and X-ray of the hands with hooked osteophyte in the 3 rd left MCP, bone sclerosis, reduction of the interarticular space in the 2 nd and 3 rd MCP bilateral and rhizarthrosis.Therapy with hydroxychloroquine and prednisone was initiated and subsequently associated with sulfasalazine due to the refractoriness.Bone mineral densitometry showed osteoporosis and lumbar spine X-ray with L1 fracture, and alendronate was started.A joint ultrasound was performed which showed synovitis and osteodegenerative process in the 3 rd MCP on the right and on the left synovitis with power Doppler grade I in the 2 nd MCP associated with significant osteophytosis and the presence of intrasynovial calcified tophi in the 2 nd and 3 rd MCP, with a new hypothesis of microcrystalline disease being performed, probable tophaceous gout, in addition to secondary OA. CONCLUSIONRheumatological manifestations are significantly prevalent in the population living with HIV and using ART, presenting a clinical picture and evolution different from the general population, requiring greater attention to differential diagnoses and individualized treatment.