Management of hepatitis C virus-related arthritis

Abstract

In recent years, hepatitis C virus-related arthritis (HCVrA) has been recognised as an autonomous rheumatic disorder. Two subsets of the disease have been identified: a polyarthritis involving small joints that resembles rheumatoid arthritis, but is usually milder, and a mono-oligoarthritis that shows an intermittent course and is frequently associated with the presence of cryo-globulins in serum. Few data about HCVrA treatment are reported in the literature. As a consequence, the therapeutic approach for this disorder is still largely empirical. Hydroxychloroquine, low doses of corticosteroids and NSAIDs are frequently administered to patients with HCVrA, but some authors describe an incomplete relief of symptoms, especially in the rheumatoid-like subset. Intake of low doses of corticosteroids and NSAIDs is more effective in subjects belonging to the mono-oligoarthritis group. Use of antiviral drugs (IFN plus ribavirin) shows good results, but IFN can induce or worsen autoimmune disorders. For this reason, in our opinion, this approach should be prescribed only when required by the coexistent liver disease. On the basis of the poor available data, the administration of anti-TNF-alpha agents seems safe in HCV patients, but the usually non-aggressive course of HCVrA does not justify their use as a current therapy.

A closer look at pain and hepatitis C: Preliminary data from a veteran population

“…However, treatment focusing on relieving the pain associated with joint inflammation without worsening liver damage caused by HCV has been recommended [45]. Medical treatment may involve the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients who do not have a cirrhotic process, cyclooxygenase inhibitors, corticosteroids, disease-modifying antirheumatic drugs, and antiviral therapies [45][46]. Medications such as methotrexate or immunosuppressants have not been recommended, at least as an initial effort, given their toxic effect on the liver [47].…”

“…The potential impact of substance abuse and other conditions on this population of patients should be carefully examined. Additionally, well-executed studies are needed to determine which medical treatments optimally reduce pain symptoms and/or treat HCV without interfering with liver health or exacerbating pain [45][46]. Such studies will help providers choose treatment courses that maximize efficacy while minimizing detrimental effects on functioning.…”

Rheumatic Manifestations in Viral Hepatitis

“…Описано две формы артрита, ассо-циированного с ВГС: более часто встречающийся аутоим-мунный рецидивирующий олигоартрит при криоглобули-немии и полиартрит, возникающий без криоглобулинемии, как неспецифическое воспалительное проявление хрониче-ского вирусного процесса. В последнем варианте он близок к РА, но отличается более мягким течением [38,39,44,45].…”

“…Потенциально многие противоревматические препараты гепатотоксичны, поэтому их применение требует особой осторожности. Известно, что иммуносупрессивная терапия может усиливать репликацию вируса и усугублять заболевание печени [3,45,50].…”

The Symptom Experience of HIV/HCV-Coinfected Adults

“…joint pain (Palazzi, Olivieri, Cacciatore, Pennese, & D'Amico, 2005), irritability and fatigue (Lang et al, 2006) have been reported. What remains unclear is the actual symptom burden associated with HIV/HCV co-infection.…”