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Arthritis with Common Variable Immunodeficiency

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Arthritis with Common Variable Immunodeficiency

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Common variable immunodeficiency is an immune disorder that occurs due to the low protein level that fights against infections. Read the article to know more.

Written by

Dr. Preetha. J

Medically reviewed by

Dr. Naval Mendiratta

Published At January 6, 2022
Reviewed AtSeptember 19, 2023

Introduction

While arthritis and CVID are two separate medical conditions, they can sometimes occur together. In some cases, individuals with CVID may experience joint pain and inflammation, which can lead to arthritis. This is thought to be due to the immune system’s dysfunction in CVID, which can cause chronic inflammation throughout the body, including the joints.

What Is a Common Variable Immune Deficiency?

Common Variable Immune Deficiency (CVID) is the dysfunction of the immune system typically caused due to a mutation in a gene or genes. It can cause recurrent bacterial and rarely viral infections and is characterized by low protective antibodies (immunoglobulins) and a higher risk of infections. People who have a common variable immune deficiency cannot make antibodies against agents that can cause infection.

In the vast majority of common variable immune deficiency cases, the causes are unknown. But it has been identified that genetic mutation is the cause of 10 % of people with CVID. Therefore it is believed to occur due to the combination of both environmental and genetic factors. But the ecological factors are unclear.

Common symptoms of common variable immunodeficiency are:

  • Chronic cough.

  • Fever.

  • Ear pain.

  • Diarrhea.

  • Weight loss.

  • Nausea or vomiting.

  • Runny nose.

  • Food nutrient deficiencies.

  • Swollen glands or lymph nodes.

  • Cough with yellow, green, or brown phlegm or mucus.

  • Wheezing or other breathing issues.

Common variable immunodeficiency is the most commonly occurring primary immunodeficiency in adulthood. It presents a wide range of clinical manifestations that often include non-infectious complications and heightened susceptibility to infections.

These versatile manifestations can make it difficult to differentiate between other infections resulting in a diagnostic delay and undertreatment with increased mortality and morbidity. The autoimmune reaction occurs in about 30 % of CVID patients, and it is an emerging cause of morbidity and mortality in these types of patients. CVID patients have a higher risk of getting autoimmune diseases. The treatment for CVID includes Ig (immunoglobulin) replacement therapy. It can help to stop the cycle of recurrent infections.

What Are the Possible Complications of CVID?

To avoid complications from CVID, they must be managed promptly and correctly as they may lead to the most severe conditions. CVID affects anyone above the age of 2 years, but it is often diagnosed only in their 30s or 40s. Since it is diagnosed at a later stage, there are chances that the complications might have been developed already due to recurrent infections.

The following are the possible complications of CVID:

  • Bronchiectasis: Bronchiectasis, which is an obstructive lung disease, can be caused by recurrent lung infections or pneumonia. This can cause a permanent widening of the bronchi and the bronchioles in the lungs, which could complicate the treatment for CVID.

  • Cancers: People with CVID have a higher risk of developing cancer, especially lymphoma. Cancer risk, including those involving the immune system cells, called non-Hodgkin lymphoma, stomach, and other gastrointestinal regions, is also commonly seen in people with CVID.

  • Poor Response to Vaccines: Since the immune system is impaired in people with CVID, some vaccines cannot develop adequate immunity. This will make them unable to create the immunoglobulins required for long-lasting immunity. Therefore, some live vaccines are contraindicated in people with this condition. But still, since the T-cell response is often normal, some immunity can still be gained from vaccines.

  • Granulomas: Lung infections can lead to granulomas, which occur in 10 % to 20 % of cases. In CVID, granulomas (lumps of inflamed tissues) are typically seen in the lungs or lymph nodes but rarely in the skin, spleen, brain, bone marrow, gastrointestinal tract, and kidney.

  • Life Expectancy: Some particular CVID complications can be associated with a lower life expectancy.

What Is Arthritis?

Pain and swelling in one or more joints can occur due to arthritis. Stiffness and joint pain is the most common symptom of arthritis, which can worsen with age. Arthritis is not a single disease, but it is an umbrella term for multiple conditions that affect the joints in the whole body. Arthritis can occur gradually or suddenly. The other symptoms of arthritis may include redness, warmth, swelling, and decreased range of motion in the affected joints.

What Is Arthritis with CVID?

Arthritis is a life-threatening complication in common variable immunodeficiency (CVID) patients. The severity of symptoms can vary among people with CVID. CVID can increase the risk of getting digestive disorders, autoimmune disorders, blood disorders, and cancer in an individual. It can be inherited, or a person can develop it during their lifetime.

About 1 to 10% of people with CVID will have joint symptoms like rheumatoid arthritis. The symptoms of arthritis with CVID may include pain, joint swelling, stiffness, and deformity. In some instances, arthritis can be due to an infection of the joints or unrelated to the autoimmune process.

Immune disorders in CVID patients are rheumatoid arthritis, Sjogren's syndrome (a chronic autoimmune disease that affects the salivary glands and the tear glands), and systemic lupus erythematosus (an autoimmune disease that includes skin rash, erosion of joints, or even kidney failure).

Children and young adults with this arthritis-associated CVID syndrome typically present recurrent infections. Patients with polyarthralgia (pain in several joints in the body) and fever for several months might develop recurrent respiratory and gastrointestinal tract infections and pernicious anemia. These patients also have a higher risk of autoimmune diseases.

How to Diagnose Arthritis with CVID?

Arthritis with CVID can be diagnosed by performing immunological studies. These tests will show decreased levels of IgM (immunoglobulin M), IgG (immunoglobulin G), complete IgA (immunoglobulin A) deficiency, increased percentage of CD8 lymphocytes, and a reduced ratio of CD4:CD8 (ratio of T-helper cells and killer cells).

How to Treat Arthritis with CVID?

To treat arthritis with CVID, sufficient administration of the following agents is helpful as it results in the remission of arthritis.

  • Intravenous immunoglobulin substitution.

  • Antibiotics.

  • Anti-inflammatory drugs.

A few months later, if hand radiograms are performed in patients with arthritis-associated CVID, it can show narrowing of the intra-articular space (space inside a joint between two bones) in the right radiocarpal metacarpophalangeal joints (between the metacarpal bones and the proximal phalanges of the fingers) along with multiple bone cysts and erosions. These erosions present are indicative of rheumatoid arthritis. Arthritis can present primary immunodeficiency in adults, especially with recurrent infections or autoimmune diseases. These patients require more advanced diagnostic procedures and the therapeutic cooperation of different specialists.

Conclusion

Despite the challenges of managing arthritis in individuals with CVID, with proper care and management, the affected individuals can lead fulfilling lives with minimal impact on their quality of life.

Frequently Asked Questions

1.

Is Rheumatoid Arthritis Considered an Immunodeficiency Disease?

Rheumatoid arthritis is indeed an autoimmune disease. The immune system fights against other foreign harmful organisms in a healthy person, but in the case of an autoimmune disease, it targets the healthy cells of the body. In this disease, healthy tissues that are present in the joints get attacked by the immune system. This condition can also lead to problems that are associated with the eyes, heart, lungs, and skin.

2.

What Food Is Bad for Arthritis?

Arthritis is nothing but inflammation in joints. This can occur due to factors such as diet. Foods that are high in fat, refined grains, and sugar have been known to be associated with an increase in inflammation. Some of the common foods that are advised against arthritis are high-fat dairy, salt, red meat, fried foods, sweetened or carbonated beverages, alcohol, canned foods, and foods that contain gluten.

3.

How to Cure Rheumatoid Arthritis Permanently?

There has not been any permanent cure for rheumatoid arthritis. But there have been studies that indicate the suspension of symptoms in patients who have been diagnosed early and treated early with Disease-Modifying Antirheumatic Drugs (DMARDs). In addition, many management methods are available for symptoms such as pain and discomfort.

4.

How Can We Get Rid of Arthritis in Fingers?

Arthritis in fingers has been known to be associated with immense discomfort accompanied by swelling and pain. There are certain self remedies and medications that can help to overcome these inconveniences. Exercises that focus on making the finger stronger such as thumb and finger bends, easy squeezes, thumbs up, and finger lifts, help in reducing the pain and improve the strength of the fingers. Home remedies like heat or cold application can help in reducing the swelling. NSAIDs (non-steroidal anti-inflammatory disease) can help in relieving pain but are used as only temporary relief.

5.

How to Strengthen the Immune System for Arthritis?

Certain food habits can help in managing the symptoms of rheumatoid arthritis as well as improve our immunity against it. They include:
- Omega-3 fatty acids from fish, healthy fats from avocados and nuts, whole-grain bread, fruits, and vegetables. Vegetables rich in antioxidants such as berries, raisins, and spinach should be taken.
- Calcium and vitamin D is important for good bone health as rheumatoid arthritis can cause osteoporosis.
- Indulge in exercises that strengthen the bones and avoid a sedentary lifestyle.

6.

Does Common Variable Immune Deficiency Cause Pain?

Common variable immunodeficiency is associated with autoimmune disorders affecting the blood cells, causing:
- Decreased white blood cell count or platelets.
- Anemia.
- Arthritis.
- Endocrine disorders.
- Painful swollen joints in the ankle, knee, elbow, or wrist.
- Gastrointestinal problems, abdominal pain, etc.

7.

What Are the Symptoms of Arthritis?

The symptoms of arthritis are:
- Stiffness in the joints.
- Pain in the joints.
- Low energy.
- Difficulty in breathing.
- Blurred vision.
- Itchy skin.
- Dryness in the eyes.

8.

Is Arthritis an Overactive Immune System?

Arthritis is the inflammation of the joint that is caused by an overactive immune system. It simultaneously affects all the joints of the body. This form of arthritis is much less common than osteoarthritis, which is seen mostly at the later stages of life.

9.

What Type of Arthritis Affects the Immune System?

Autoimmune arthritis is the name of arthritis where the immune system attacks itself. Rheumatoid arthritis is a common example of autoimmune arthritis. When this happens, it results in the inflammation of the joint, which results in:
- Pain.
- Stiffness.
- Mobility problems.

10.

Which Arthritis Causes the Highest Pain?

The most painful type of arthritis is rheumatoid arthritis because it affects joints, organs, and other surrounding tissues. It is an inflammatory, autoimmune disease that attacks normal healthy cells causing painful swelling of the joints throughout the body.
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Dr. Naval Mendiratta
Dr. Naval Mendiratta

Rheumatology

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