Chronic Hepatitis C Virus Infection Is Associated with the Development of Rheumatoid Arthritis: A Nationwide Population-Based Study in Taiwan

Su, Fu Hsiung; Wu, Chien-Sheng; Sung, Fung Chang; Chang, Shih Ni; Su, Chien‐Tien; Shieh, Ying‐Hua; Yeh, Chih‐Ching

doi:10.1371/journal.pone.0113579

Cited by 26 publications

(22 citation statements)

References 28 publications

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“…Five studies were identified which evaluated the risk of developing rheumatoid arthritis in HCV‐infected patients (N = 18 234); three of those studies also included a control group . Two studies were from Japan, one study was from Korea, and two from Taiwan.…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: extrahepatic manifestations in chronic hepatitis C virus‐infected patients in East Asia

Younossi

Henry

Ong³

et al. 2019

Aliment Pharmacol Ther

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Background: Although the prevalence of extrahepatic manifestations of chronic hepatitis C virus (HCV) infection has been reported from Western countries, their prevalence in East Asian countries is not well known. Aim:To perform a systematic review to quantify the prevalence of selected extrahepatic manifestations of HCV among patients from East Asia.Methods: Medline, CINAHL, EMBASE, Cochrane and country-specific databases were reviewed according to standard guidelines for meta-analyses. Only articles with patients from East Asian countries were included. Results:After review, 34 articles were selected (Japan = 9; China = 5, Korea = 3, Taiwan = 16, multiple countries = 1) with 646 228 subjects, 66 436 with HCV.Mean age for HCV-infected patients was 56 years (range 41-72 years), 50% were male (range 26%-73%). The pooled prevalence of type 2 diabetes in East Asian HCV patients was 19.0% (95% confidence interval 15.6%-22.9%) (n = 19 studies) with an increased risk when compared to non-HCV: odds ratio (OR) 1.58 (1.28-1.94). The prevalence of chronic kidney disease in HCV was 9.2% (5.0%-16.2%) (n = 7 studies), also with a significantly increased risk: OR=1.98 (1.41-2.77). Pooled prevalence of cardiovascular disease in HCV was 8.6% (3.5%-19.9%) (n = 6 studies), also with an increased risk: OR = 1.55 (1.21-1.98). The prevalence of lichen planus in HCV was 8.9% (3.6%-20.6%) (n = 6 studies) while the prevalence of rheumatoid arthritis was 4.5% (0.6%-25.7%) (n = 4 studies). Conclusions:These data show increased risk of developing extrahepatic manifestations in East Asian patients with HCV. Both hepatic and extrahepatic manifestations of the infection should be used to accurately determine the total burden of the disease in the region.

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Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: extrahepatic manifestations in chronic hepatitis C virus‐infected patients in East Asia

Younossi

Henry

Ong³

et al. 2019

Aliment Pharmacol Ther

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“…This high rate of RF seropositivity in patients with chronic HCV infection presents diagnostic and therapeutic difficulties for the clinician. In addition, one nationwide population‐based study in Taiwan revealed that chronic HCV infection is associated with RA development . Therefore, the presence of RF is of little value in distinguishing between RA and HCV‐associated arthritis, especially because a high‐positive RF level is given a score of 3 in the 2010 classification criteria for RA.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictive value of high‐positive rheumatoid factor and anti‐citrullinated protein antibody levels in nonarthritic patients with chronic hepatitis C infection

et al. 2018

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Aim:In order to increase diagnostic sensitivity for early disease in rheumatoid arthritis (RA), new classification criteria were approved in 2010 by the American College of Rheumatology and the European League Against Rheumatism. One of the criteria, a high-positive rheumatoid factor (RF) or anti-citrullinated protein antibody (ACPA) level, was given a high score of 3. However, the increased prevalence of RF in patients with chronic hepatitis C virus (HCV) infection markedly diminishes the diagnostic specificity of serum RF for RA in these patients. There are no published data on the prevalence and predictive value of high-positive RF and ACPA; thus, we investigated high-positive RF and ACPA levels in nonarthritic patients with chronic HCV infection. Method:Anti-citrullinated protein antibody and total RF were determined in serum from nonarthritic patients with chronic HCV infection (all had HCV RNA viremia). Result:In 271 HCV-infected patients, positive RF, positive ACPA, high-positive RF, and high-positive ACPA were detectable in 47.2%, 1.1%, 8.9% and 1.1%, respectively. In these patients, fatty liver was an independent factor for high-positive RF. Conclusion:In contrast to RF, ACPA is not increased in HCV infection. High-positive RF is not unusually present in nonarthritic patients with chronic HCV infection.ACPA may have improved value for the diagnosis of RA in this patient population.In patients with HCV infection, fatty liver may be a risk factor for high-positive RF. K E Y W O R D Santi-ACPA, hepatitis C virus, rheumatoid factor known to induce autoantibodies. 19-21 Cacoub et al 22 studied a large, single-center group of 1202 patients who had chronic HCV infection and reported that female sex, increasing age, and extensive liver fibrosis were risk factors for the presence of extrahepatic symptoms.Age was not statistically different between HCV-infected patients with or without RF in our study, although a previous study reported that 10%-25% of those aged >70 years had a positive RF test. 23 HCV viral load did not differ between RF-positive/negative groups. Ramos et al 24 found no difference in RF activity between those with different serum HCV RNA levels. In addition, Riccio et al 25 reported a decreased RF titer in non-responders receiving combined therapy with PEG-INF alpha-2b and ribavirin. They suggested that INF plus ribavirin counteract the exaggerated immune response, independent of viral outcome. In other words, RF titer did not correlate with viral load in HCV patients. The prevalence of high-positive RF was not unusual. Fatty liver by US was more common in the high-positive RF group than in the non-high-positive group. Bank et al 26 studied 23 patients with NAFLD and found a frequency of positive RF of 13%. The pathogenesis of NAFLD is not completely understood; however, Kugelmas et al 27 found that tumor necrosis factor-α, interleukin (IL)-8, and IL-6 concentrations were significantly elevated in patients with biopsyproven nonalcoholic steatohepatitis. These findings imply that inflammatory cyt...

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“…As a result, anti-citrullinated protein antibody could ensure enhanced clinical significance in implementation in clinical diagnosis of rheumatoid arthritis in the current and previously similar research studies [2,6] In great harmony with the current research study results a prior research has shown that female study subjects revealed a greater prevalence of positive rheumatoid factor. This could be justified in correlation to gender-sex hormonal serum levels that could trigger autoantibodies production [3,7].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, some illnesses e.g. chronic hepatitis C virus infection can clinically present with an extrahepatic symptom and signs profile mimicking rheumatoid arthritis [3,4].…”

Section: Introductionmentioning

confidence: 99%

Predictive Clinical Value of Rheumatoid Factor and Anti-Citrullinated Protein Antibodies as Diagnostic Tools in Cases with Non-Arthritic Chronic Hepatitis C Viral Disease

2018

JCEI

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Background: Rheumatoid arthritis is a chronic immunological disease that causes destruction and deformity of joints. Chronic hepatitis C infection cases could develop rheumatic like clinical presenting profile. Raised rheumatoid factor in chronic HCV infection considerably reduces the diagnostic privilege of rheumatoid factor for rheumatoid arthritis coexisting with HCV infection. Aim of the work: To determine the value of anti-citrullinated protein antibody levels in cases having chronic HCV infection in comparison to rheumatoid factor. Methodology: The research team recruited 150 non-arthritic study subjects having chronic hepatitis C virus infection rheumatoid factor and anti-citrullinated protein antibody levels were assayed for all study subjects for statistical analysis. Results: Rheumatoid factor +ve study subjects had statistically significantly more frequent within female gender. (p value=0.027) Rheumatoid factor high +ve cases had statistically significantly had more frequent fatty liver and higher platelets than on high RF +ve cases. (P value =0.020, <0.038 consecutively) Conclusion: HCV cases with joint involvement were not implemented in the current research study that prevented statistical estimation of the sensitivity of anti-citrullinated protein antibody for arthritis in this cohort. Racial and ethnic differences should be put in consideration in future research studies that are recommended to be multi centric in fashion.

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Chronic Hepatitis C Virus Infection Is Associated with the Development of Rheumatoid Arthritis: A Nationwide Population-Based Study in Taiwan

Cited by 26 publications

References 28 publications

Systematic review with meta‐analysis: extrahepatic manifestations in chronic hepatitis C virus‐infected patients in East Asia

Systematic review with meta‐analysis: extrahepatic manifestations in chronic hepatitis C virus‐infected patients in East Asia

Prevalence and predictive value of high‐positive rheumatoid factor and anti‐citrullinated protein antibody levels in nonarthritic patients with chronic hepatitis C infection

Predictive Clinical Value of Rheumatoid Factor and Anti-Citrullinated Protein Antibodies as Diagnostic Tools in Cases with Non-Arthritic Chronic Hepatitis C Viral Disease

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