Hepatitis C–associated arthritis

Abstract

Rheumatologic complications of hepatitis C virus (HCV) infection are common and include mixed cryoglobulinemia, vasculitis, sicca symptoms, myalgia, arthritis, and fibromyalgia. The prevalence of cryoglobulinemia in Sweden and Germany is much lower compared with data from southern Europe. Viral, genetic, or environmental factors may be responsible for such a difference in prevalence. There is no single clinical picture of arthritis in patients with HCV infection. There is a well-defined picture of arthritis associated with the presence of mixed cryoglobulinemia that consists of an intermittent mono- or oligoarticular, nondestructive arthritis affecting large and medium-size joints. Involvement of salivary and lacrimal glands is common in HCV-infected subjects, but HCV antigens are not detected in affected glands. HCV-infected subjects express a high prevalence of a variety of autoantibodies, usually in low titers. The clinical significance of most of these autoantibodies is not clear. The prevalence and titer of these autoantibodies are unaffected by interferon-alpha therapy. Several studies have attempted to assess whether HCV infection may be involved in the etiopathogenesis of rheumatic and autoimmune diseases. The results of most of these studies do not support the idea that HCV infection may play a pathogenic role in the development of systemic lupus erythematosus, antiphospholipid syndrome, or leukocytoclastic vasculitis. Experience treating patients with HCV-associated arthritis is limited and treatment remains controversial. No major therapeutic trials in HCV-associated arthritis were reported in the past 2 years.

Disease Characteristics and Treatment Patterns in Veterans With Rheumatoid Arthritis and Concomitant Hepatitis C Infection

“…Therefore, the higher DAS28 scores among HCV-positive patients may not necessarily represent greater inflammatory burden. However, the observation of higher patient-reported outcomes in this group is impor- higher rates of myalgias (16%) (19,21) and a higher incidence of fibromyalgia reported between 5-19% (22). Posttraumatic stress disorder (PTSD) is more frequent in HCVpositive veterans compared to HCV-negative veterans (23) and our group has previously shown that RA patients with PTSD have higher self-reported pain, patient global assessment scores, and tender joint counts, contributing to higher DAS28 scores (24).…”

Rheumatic Manifestations in Viral Hepatitis

“…У пациентов с хронической инфекцией вГС диагно-стируют различные ревматические болезни -РА, псориа-тическую артропатию, СКВ и др. [37,38]. Т.М.…”

Mixed cryoglobulinemia

“…As observed for HCV infection, the prevalence of other virus-related MC seems to show a variable prevalence among patient's series from different geographical areas [86]. Moreover, a number of clinicoepidemiological studies revealed a heterogeneous distribution of different HCV-related extra hepatic manifestations, including some autoimmune disorders such as 'primary' Sjogren's syndrome [87][88][89][90][91][92][93][94][95][96][97][98].…”

“…Cryoglobulinemic syndrome may share a number of etiopathogenetic events and clinical features with both autoimmune diseases such as autoimmune hepatitis, Sjö-gren's syndrome, and polyarthritis, and B-cell lymphomas [3,11,12,25,28,[85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100]. Therefore, a differential diagnosis should be carefully done in all patients with MC syndrome (Fig.…”

“…Cryoglobulinemic syndrome can represent a crossroads between some autoimmune diseases (autoimmune hepatitis, Sjögren's syndrome, polyarthritis, glomerulonephritis, thyroiditis, type 2 diabetes, etc.) and malignancies (B-cell lymphomas, hepatocellular carcinoma) [3,11,12,25,28,[87][88][89][90][91][92][93][94][95][96][97][98]. It is possible to observe in Differential diagnosis between mixed cryoglobulinemia and other autoimmune-lymphoproliferative disorders in the setting of HCV infection the same patient a slow progression from mild HCV-associated hepatitis to various extrahepatic manifestations (arthralgias, sicca syndrome, Raynaud's phenomenon, RF positivity, etc.…”