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Background:Interferon-α (IFN-α) is known for its antiviral and antiproliferative effects, used mainly for the treatment of chronic hepatitis C infection [1]. Immunomodulatory effects have been reported in patients treated with IFN-α, including hematological, immunological, rheumatological and dermatological disorders [2]. In fact, IFN-α may lead to the induction or exacerbation of autoimmune diseases such as psoriasis, systemic lupus erythematosus, and rarely rheumatoid arthritis (RA).Objectives:We report the case of a Caucasian who developed anticyclic citrullinated peptide antibody (anti-CCP)-positive RA following treatment of chronic hepatitis C infection with pegylated IFN-α2a.Methods:A 57-year-old women was diagnosed of chronic hepatitis C infection after detection of abnormal liver function. She has a genotype Ib with a high viral load: RNA was 100,000 UI/ml. Liver histology showed advanced fibrosis and portal fibrosis (A3 F4 according to metavir score). A history of blood transfusion was found. The patient was placed on a 24-week course of PEGylated -IFN-α2a 180 µg weekly and a 1000 mg daily dose of ribavirin. After two months of antiviral treatment, she developed symmetrical polyarthritis, with pain and edema in the wrists, elbows, shoulders and metacarpophalangeal joints, associated with prolonged morning stiffness. The musculoskeletal examination was notable for active synovitis of the proximal phalangeal joints, metacarpophalangeal joints, wrists, elbows. Distal interphalangeal joints were spared. She had no musculoskeletal symptoms prior to antiviral therapy. Review of systems was otherwise unremarkable. X-ray showed no remarkable findings. Ultrasonography of the hands revealed diffuse synovitis as well as tenosynovitis of the ulnar extensor tendons in both wrists. Laboratory results revealed a normal C-reactive protein, elevated liver enzymes: ALAT (alanin-aminotransferase) 119,ASAT (aspartat-aminotransferase) 66, Gamma-GT 203 and undetectable cryoglobulins. Anti-CCP was 21 IU/ml (negative < 20 IU/ml), antinuclear antibodies were positive 1280 (negative<160), rheumatoid factor was 192 (normal < 30 IU/ml).A diagnosis of rheumatoid arthritis (RA) was made on the basis of clinical and ultra-sonographic evidence as well as Rheumatoid Factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody positivity. Moreover, an autoimmune thyroiditis was found that evolved into hypothyroidism treated with thyroxine.Results:The patient developed a sustained virological response as evidenced by persistent undetectable HCV RNA and normal aminotransferase activities. Upon completion of a 12-week course of antiviral therapy, The rheumatoid syndrome disappeared after cessation of IFN therapy. By that time, antinuclear antibodies were in a titre of 1 /180, rheumatoid factor and Anti-CCP were negative.Conclusion:The present case suggests that biological agents, affecting the cytokine network, may work as triggering factors for the development of RA in previously predisposed individuals. Screening for RF and anti-CCP may be considered before treating with IFN. In addition, a close surveillance for the occurrence of autoimmune phenomena during and after treatment should be worthy, for early diagnosis and adequate clinical management.References:[1]DARICE YANG,DANIEL ARKFELDandTSE-LING FONG TreatmentforChronic Hepatitis C Infection.DevelopmentofAnti-CCP-positive Rheumatoid Arthritis Following Pegylated Interferon-alpha. J Rheumatol 2010;37;1777Volume 37, no. 8. 2a[2]Okanoue T, Sakamoto S, Itoh Y, Minami M, Yasui K, Sakamoto M, et al. Side effects of high-dose interferon therapy for chronic hepatitis C. J Hepatol 1996;25:283-91.Disclosure of Interests:None declared

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Background:Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.Objectives:The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.Methods:Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.Statistical package for social sciences (SPSS) was used for analysis.Results:The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.Conclusion:The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.References:[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.Disclosure of Interests:None declared

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