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. 2023 Nov;42(11):3123-3129.
doi: 10.1007/s10067-023-06722-5. Epub 2023 Jul 28.

Clinical features and predictors of osteoarticular manifestations in common variable immunodeficiency

Monia Ben Khaled  1   2 , Amani Merdassi  3   4 , Samia Rekaya  3   4 , Ilhem Ben Fraj  3   4 , Takwa Lamouchi  3   4 , Ikram Zaiter  3   4 , Ridha Kouki  3   4 , Mohamed Bejaoui  3   4 , Fethi Mellouli  3   4 , Monia Ouederni  3   4
Affiliations

Clinical features and predictors of osteoarticular manifestations in common variable immunodeficiency

Monia Ben Khaled et al. Clin Rheumatol. 2023 Nov.

Abstract

Introduction: This study aimed to assess osteoarticular manifestations in patients with common variable immunodeficiency (CIVD) and to identify the predictive factors.

Methods: This was a retrospective and prognostic study conducted in the pediatrics: immuno-hematology and stem cell transplantation department, including patients who fit the definition of CVID. A Cox model analysis was used to identify predictive factors.

Results: A total of 36 patients were enrolled. Osteoarticular involvement was noted in 15 patients (42%) with a cumulative incidence of 90% after a median follow-up of 25 years. Non-infectious manifestations were reported in 14 patients (39%). The cumulative risk of inflammatory or autoimmune osteoarticular etiology was 74%. Well-characterized rheumatic diseases were retained in six patients and unlabeled autoimmune or inflammatory mechanism in five cases. Bone mineral density revealed osteoporosis in six cases leading to a cumulative risk of degenerative complications of 72%. The cumulative incidence of infectious complications was 17%. In multivariate analysis, predictors of osteoarticular complications were low body weight (HR = 8.67, CI: 1.496-50.278, p = 0.01) and hepatomegaly at diagnosis (HR = 6.2, CI: 1.537-25.075, p = 0.01). Reduced CD4 cells rate < 600 cells/mm3 and hepatomegaly were predictors of autoimmune or inflammatory complications, while chronic diarrhea and iron deficiency were associated with degenerative manifestations.

Conclusions: Osteoarticular manifestations have emerged as a real health problem for CVID patients. Risk increases with low body weight, hepatomegaly, chronic diarrhea, iron deficiency, and CD4 cells rate under 600 cell/mm3. Elucidating the mechanisms of these complications in CVID is important for developing preventive strategies. Key Points • This retrospective and prognostic study described the clinical characteristics of osteoarticular manifestations in 36 patients with CVID to ensure better recognition and understanding of this association by clinicians. • Identification of predictive factors of osteoarticular complications according to its etiology is crucial to establish appropriate, optimal and early management of patients at risk.

Keywords: Arthralgia; Arthritis; Autoimmunity; Common variable immunodeficiency; Complications; Osteoporosis.

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