A case-control study of the association of toxoplasmosis with antirheumatic therapy in rheumatoid arthritis | [Anaesthesia, Pain and Intensive Care • 2024]

Author(s):

1. Rabie G. Abdullah: Department of Pharmacology, College of Pharmacy, University of Duhok,Duhok, Kurdistan Region,Iraq

2. Souzan H. Eassa: Department of Basic Sciences, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq; Molecular and Microbiology Division, School of Medicine, University of Kurdistan Hewlêr, Erbil, Iraq

3. Fouad K. Mohammad: Department of Physiology, Biochemistry, and Pharmacology, College of Veterinary Medicine, University of Mosul, Mosul, Iraq; College of Nursing, American University of Kurdistan, Duhok, Kurdistan Region, Iraq

Abstract:

Background & Objective: Toxoplasmosis is a globally prevalent opportunistic zoonotic infection. Rheumatoid arthritis (RA) is an autoimmune disease which is manifested as joint inflammation, pain, stiffness, and swelling. The patients may contract toxoplasmosis, especially when receiving antirheumatic immunosuppressive therapy. However conflicting results have been reported on toxoplasmosis in RA patients. We aimed to evaluate Toxoplasma gondii positivity and associated risk factors in patients with RA in Duhok province, Iraq, and to assess the role of antirheumatic therapy in toxoplasmosis and the possibility of its reactivation. Methodology: This case-control study was carried out in Duhok, Kurdistan Region, Iraq, from February 2022 to June 2023. A total of 88 RA patients, with and without concurrent antirheumatic therapy, were recruited. The diagnosis of RA was according to the 2010 American College of Rheumatology/European League. RA-patients were categorized into three groups: Group 1 - no-therapy (n = 14); Group 2 - conventional therapy (n = 49) and Group 3 - biologics in combination with conventional medications (n = 25). Healthy subjects (n = 61) were also selected as controls. Plasma samples obtained from the participants were screened for T. gondii infection using Human anti-Toxoplasma gondii antibody IgG. IgG positive samples were tested utilizing human anti-Toxoplasma gondii antibody IgM ELISA Kit and the avidity T. gondii IgG ELISA kit was used to determine the state of infection. Results: Of the 88 RA patients, with or without antirheumatic therapy, 76 (86.36%) were females and 12 (13.64%) were males. Patients on therapy (n = 74) received several conventional antirheumatic drugs of which methotrexate was the most frequently used one (86.36%). Among biological therapies, etanercept, a TNF-alpha inhibitor, was mostly used (13.51%). The toxoplasmosis was significantly less in the older age group (> 50 y) compared to individuals under 30 y. Gender had no significant effect. Toxoplasma IgG positivity was found to be significantly higher in the three groups of RA patients in comparison with healthy controls. Further assessment of anti-Toxoplasma IgM positivity and Toxoplasma IgG avidity results to identify the state of T. gondii infection in anti-Toxoplasma IgG positive subjects revealed that the frequency of reactivation of toxoplasmosis in RA patient groups was not significantly different from that of the control counterparts. Conclusion: The study showed higher seroprevalence of anti-Toxoplasma antibodies in patients with RA irrespective of therapy; therefore, we could consider toxoplasmosis interaction with RA in the pathogenesis of both diseases. This seroprevalence was higher in younger age groups, but with no significant role of gender, duration of disease, duration of therapy and its type. No significant difference was noted in rates of reactivation of latent T. gondii infection among RA patients and healthy controls.

Page(s): 674-680

DOI: 10.35975/apic.v28i4.2510

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 28, Issue: 4, Year: 2024

Keywords:

Rheumatoid arthritis , autoimmune disease , Toxoplasma gondii , Antirheumatic drugs , Toxoplasma seroprevalence , Toxoplasma IgG avidity

References:

[1] Dámek F,Swart A,Waap H,Jokelainen P,Le Roux D,Deksne G .2023 .Systematic review and modelling of agedependent prevalence of Toxoplasma gondii in livestock, wildlife and felids in Europe. , 12(1) : 97.

[2] . .. [PubMed] DOI: 10.3390/pathogens12010097, : .

[3] .2023 .. , 388(6) : 529-42.

[4] GBD 2021 Rheumatoid Arthritis .1990 .and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. , : 2020.

[5] .2023 .. , 9913(23) : 00211-4.

[6] Abbas KS,Hasan AS,Tareq NL .2023 .Assessment of the impact of different rheumatoid arthritis stages on the quality of life of a sample of Iraqi patients. J Adv Pharm Educ Res, 10(1) : 122-6.

[7] Abdullah RG,Eassa SH,Mohammad FK .2023 .Plasma cholinesterase activity in patients with rheumatoid arthritis and toxoplasmosis. Cureus, 15(12) : .

[8] .2021 .. , 10(11) : 3017.

[9] Dis Clin North Am Rheum .2022 .. , 03(3) : 679-89.

[10] .2017 .. , 37(5) : 785-90.

[11] Hosseininejad Z,Sharif M,Sarvi S,Amouei A,Hosseini SA,Nayeri Chegeni T .2018 .Toxoplasmosis seroprevalence in rheumatoid arthritis patients: a systematic review and meta-analysis. PLoS Negl Trop Dis, 12(6) : .

[12] Dong W,Zhong Q,Gu YL,Liang N,Zhou YH,Cong XM .2023 .Is Toxoplasma gondii infection a concern in individuals with rheumatic diseases? Evidence from a case-control study based on serological diagnosis. Microb Pathog, 182 : 106257.

[13] Hill B,Wyatt N,Ennis D .2020 .Cerebral Toxoplasmosis in a rheumatoid arthritis patient on immunosuppressive therapy. Cureus, 12(6) : .

[14] Durieux MF,Lopez JG,Banjari M,Passebosc-Faure K,Brenier-Pinchart MP .2022 .Toxoplasmosis in patients with an autoimmune disease and immunosuppressive agents: a multicenter study and literature review. PLoS Negl Trop Dis, 16(8) : .

[15] Salih JM,Mero WMS,Eassa SH .2020 .Seroprevalence and some demographic factors associated with Toxoplasma gondii infection among male population in Duhok Province/Iraq. , 17 : 0431-6.

[16] Kasim HF,Salih HM,Eassa SH .2020 .Adherence to biologic drugs among patients with immune mediated inflammatory diseases in Duhok Governorate. Duhok Med, 14(1) : 63-6.

[17] Kuba RH,Zghair KH,Alosami MH .2023 .Detection of toxoplasma antibodies and TNF-α in rheumatoid arthritis patients treated with methotrexate. Iraqi J Sci, 55(4A) : 1535-40.

[18] Aletaha D,Neogi T,Silman AJ,Funovits J,Felson DT,Bingham CO .2010 .rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis, 69(9) : 1580-8.

[19] Antwi E,Groenwold RH,Browne JL,Franx A,Agyepong IA,Koram KA .2017 .Development and validation of a prediction model for gestational hypertension in a Ghanaian cohort. -012670, 7(1) : .

[20] Hammer Ø,Harper DAT,Ryan PD .2001 .PAST: paleontological statistics software package for education and data analysis. Palaeontol Electron, 4(1) : 1.

[21] El-Sayed NM,Kishik SG,Fawzy RM .2016 .The current status of Toxoplasma gondii infection among Egyptian rheumatoid arthritis patients. Asian Pac J Trop Med, 6 : 797-801.

[22] İnal A,Taş D. . .Toxoplasma gondii seroprevalence in rheumatoid arthritis patients treated with biological agents. , : .

[23] Al-Oqaily MA,Al-Ubaidi IK .2017 .Prevalence of toxoplasmosis in Iraqi rheumatoid arthritis patients and detection levels of MCP-1 and TGF-β chemokines during infection. Int J Sci Nature, 8(4) : 824-9.

[24] Dreaj HA,Hathal HD .2022 .Seropositivity of Toxoplasma gondii antibodies in rheumatoid arthritis patients under treatment with TNF-α Antagonists. Biomedicine, 42(2) : 314-7.

[25] Fischer S,Agmon-Levin N,Shapira Y,Porat Katz BS,Graell E,Cervera R .2013 .Toxoplasma gondii: bystander or cofactor in rheumatoid arthritis. Immunol Res, 56(2-3) : 287-92.

[26] Massoori L,Molazadeh M,Rezaei N,Alizadeh S,Hassanpour H,Badirzadeh A .2021 .Development of rheumatoid arthritis by toxoplasmosis in Iranian patients. J Kerman Univ Med Sci, 10(4) : 412-419.

[27] Tian A-L,Gu YL,Zhou N,Cong W,Li GX,Elsheikha HM .2017 .Seroprevalence of Toxoplasma gondii infection in arthritis patients in eastern China. Infec Dis of Pov, 6(1) : 153.

[28] Abdul Ameer Jaber K .2021 .Comparisons of Toxoplasma gondii prevalence in rural and urban areas by serological methods in Al-Najaf province. Iraq. Arch Razi Inst, 356315(6) : 1695-701.

[29] Tamimi NS,Al-Lami SAD,Abbas SF .2023 .Validation of a questionnaire for assessment of Iraqi domestic cat's behavior. Ann Roman Soc Cell Biol, 27(1) : 282-8.

[30] .2014 .Innate immunity to Toxoplasma gondii infection. Nature Rev Immunol, 14(2) : 109-21.

[31] Listing J,Gerhold K,Zink A .2013 .The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatology (Oxford), 52(1) : 53-61.

[32] Teimouri A,Mohtasebi S,Kazemirad E,Keshavarz H . .Role of Toxoplasma gondii IgG avidity testing in discriminating between acute and chronic toxoplasmosis in pregnancy. J Clin Microbiol. 2020 Aug, 24(9) : 20.

[33] Rajput R,Denniston AK,Murray PI .2017 .False negative toxoplasma serology in an immunocompromised patient with PCR positive ocular toxoplasmosis. Ocul Immunol Inflamm, 26(8) : 1200-2.

[34] Jean-Pierre V,Miozzo J,Fricker-Hidalgo H,Garnaud C,Robert MG,Pelloux H .2022 .Serological diagnosis of toxoplasmosis: evaluation of the commercial test recomLine Toxoplasma IgG immunoblot (Mikrogen) based on recombinant antigens. Parasite, 29 : 52.

Citations

Downloads

Views