Human T-Cell Leukaemia Virus Type 1-Associated Myelopathy in Patients with Rheumatoid Arthritis: A Case Series Highlighting Functional Disability and Diagnostic Challenges

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ID: 331539
2026
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Abstract
OBJECTIVES: Although rheumatoid arthritis (RA) and human T-cell leukaemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) occasionally coexist, their clinical characteristics and impact on patient outcomes remain poorly elucidated. METHODS: We conducted a retrospective case series of five patients with RA complicated by HAM/TSP (HAM-RA) enrolled in the HTLV-1 Positive Rheumatoid Arthritis Miyazaki Registry. Data on clinical characteristics, disease course, functional status, quality of life and HTLV-1-associated parameters were reviewed. Age- and sex-matched patients with HTLV-1-positive RA and HTLV-1-negative RA served as comparison groups. RESULTS: All patients were women, (median age, 67 years). HAM/TSP preceded RA onset in two patients, whereas RA developed first in three. Neurological disability substantially differed, with Osame Motor Disability Scores of 2-11; three patients necessitated wheelchair use. Despite comparable RA disease activity, patients with HAM-RA demonstrated worse physical function and health-related quality of life than matched controls. Patients with HAM-RA tended to have higher HTLV-1 proviral loads (PVLs) than those with HTLV-1-positive RA without HAM/TSP. CONCLUSIONS: HAM/TSP may develop before or after RA onset and cause substantial functional disability despite satisfactory control of arthritis. Knowledge of HTLV-1 infection status may facilitate consideration of HAM/TSP and timely neurological evaluation. Considering the high PVL in patients with HAM-RA and its association with elevated adult T-cell leukaemia/lymphoma (ATL) risk, cautious long-term monitoring for ATL development may be warranted.
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Authors Masayuki Murai, Kunihiko Umekita, Risa Kudo, Masatoshi Kimura, Chihiro Iwao, Kosho Iwao, Takeshi Kawaguchi, Motohiro Matsuda, Shunichi Miyauchi, Yayoi Hashiba, Toshihiko Hidaka, Taiga Miyazaki
Journal modern rheumatology
Year 2026
DOI
10.1093/mr/roag087
URL
https://doi.org/10.1093/mr/roag087
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