The case for hepatitis C arthritis

doi:10.1016/j.semarthrit.2003.12.006

Seminars in Arthritis and Rheumatism

Volume 33, Issue 6, June 2004, Pages 375-387

https://doi.org/10.1016/j.semarthrit.2003.12.006 Get rights and content

Abstract

Objective

To present the data available supporting the existence of an arthropathy associated with hepatitis C infection.

Methods

The MEDLINE database was searched for “arthritis” intersecting with “hepatitis C” in addition to the authors’ investigations and experience on this subject.

Results

Arthritis, not otherwise explained, has been noted in 2% to 20% of hepatitis C virus (HCV) patients. This arthritis is rheumatoid-like in two thirds of the cases and a waxing/waning oligoarthritis in the rest. Cryoglobulinemia alone does not explain the arthritis, and there is difficulty in differentiating it from rheumatoid arthritis. The arthropathy is nonerosive/nondeforming. Whereas nonsteroidal anti-inflammatory drugs, low-dose corticosteroids, and hydroxychloroquine may be helpful, conventional treatment of arthritis may be problematic in the context of viral hepatitic arthropathy. Antiviral therapy is most effective, even without viral clearance, but rheumatic complications may ensue.

Conclusions

HCV arthropathy should be considered in the differential diagnosis of new-onset arthritis.

Section snippets

Methods

A survey of the literature pertaining to arthritis in the context of hepatitis C was undertaken. The MEDLINE database was searched between 1989 and June 2003 for key words “hepatitis C” intersecting with “arthritis.” In addition, other articles and abstracts of work presented at scientific congresses relevant to the topic at hand were reviewed and brought to bear. Except for the earliest descriptions of arthritis in association with hepatitis C, case reports were largely ignored, and the work

Discussion

Since 1989, data have been steadily accumulating in support of the existence of a distinct chronic arthritis in association with chronic HCV infection. Although this arthritis may be difficult to distinguish from other common chronic arthropathies, most notably RA, it is important to consider this arthropathy in the differential diagnosis of every newly presenting oligo- or polyarthritis. Because of significant differences in treatment strategies between RA and HCV arthropathy, future research

Itzhak Rosner, MD: Director of Rheumatology, Bnai Zion Medical Center, Senior Clinical Lecturer, Technion-Faculty of Medicine, Haifa, Israel

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Citation Excerpt :
These manifestations range from non-specific symptoms such as fatigue to autoimmune and lymphoproliferative disorders. HCV-associated inflammatory arthritis has been described in several reports [4]. This form of arthritis can be difficult to distinguish from rheumatoid arthritis (RA), given that ~40–75% of patients with chronic HCV infection have a positive rheumatoid factor (RF) [5–8].
The objectives of this study were to determine the prevalence of hepatitis C virus–associated inflammatory arthritis, to describe its clinical and immunologic correlates, and to identify features that are characteristic of arthritis in chronic hepatitis C.
Participants with chronic hepatitis C infection enrolled in a population-based cohort study in Alaska and who had not received anti-viral treatment for hepatitis C were recruited. In a cross-sectional study, we assessed joint symptoms and signs, performed autoantibody and cytokine testing, and abstracted medical records for features of hepatitis C and arthritis.
Of the 117 enrolled participants, 8 (6.8%) had hepatitis C-associated arthritis. The participants with arthritis were younger than those without (median age: 45 vs. 52, p = 0.02). Rheumatoid factor was commonly present among patients with hepatitis C-associated arthritis. The only studied autoantibody found more commonly in patients with HCV arthritis than those without arthritis was anti-nuclear antibody (63% vs. 23%, p = 0.026). The only joint symptom significantly more common in hepatitis C arthritis was self-reported joint swelling (75% vs. 26%, p = 0.007). Features of fibromyalgia were more common and functional status was worse in those with arthritis than those without. No cytokines differed in patients with and without arthritis. There were no associations of arthritis or autoantibodies with liver-related outcomes.
In this study of a cohort of individuals with chronic HCV infection, HCV-associated arthritis was present in less than 10%. Few serologic features distinguished participants with or without arthritis, but self-reported joint swelling was more common in those with arthritis.

View all citing articles on Scopus

Itzhak Rosner, MD: Director of Rheumatology, Bnai Zion Medical Center, Senior Clinical Lecturer, Technion-Faculty of Medicine, Haifa, Israel

Michael Rozenbaum, MD: Assistant Director of Rheumatology, Bnai Zion Medical Center, Senior Clinical Lecturer, Technion-Faculty of Medicine, Haifa, Israel

Elias Toubi, MD: Director, Clinical Immunology, Bnai Zion Medical Center, Senior Clinical Lecturer, Technion-Faculty of Medicine, Haifa, Israel

Aharon Kessel, MD: Senior Physician, Clinical Immunology, Bnai Zion Medical Center, Haifa, Israel

Jochanan E. Naschitz, MD: Director, Internal Medicine A, Bnai Zion Medical Center, Associate Professor of Medicine, Technion-Faculty of Medicine, Haifa, Israel

Eli Zuckerman, MD: Director, Hepatology Unit, Bnai Zion Medical Center, Senior Clinical Lecturer, Technion-Faculty of Medicine, Haifa, Israel.

View full text

The case for hepatitis C arthritis

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Methods

Discussion

J Hepatol

Semin Arthritis Rheum

J Hepatol

Am J Gastroenterol

Semin Arthritis Rheum

J Hepatol

Hum Immunol

Semin Arthritis Rheum

Semin Arthritis Rheum

Blood

Blood

Gastroenterolgy

Blood

Gastroenterology

Am J Med Sci

Lancet

Clin Ther

An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis

Science

Hepatitis C virus infection and vasculitis

Arthritis Rheum

Extrahepatic manifestations related to hepatitis C virus

Pathol Biol

Hepatitis C, a multifaceted disease. Review of extra-hepatic manifestations

Ann Intern Med

Hepatitis C virus in rheumatic diseases

Z Rheumatol

Fibromyalgia-associated hepatitis C virus infection

Br J Rheumatol

Fibromyalgia in hepatitis C virus infection. Another infectious disease relationship

Arch Intern Med

Extrahepatic manifestations of chronic hepatitis C

Arthritis Rheum

Extrahepatic manifestations associated with hepatitis C virus infection. A prospective multicenter study of 321 patients. The GERMIVIC. Groupe d’Etude et de Recherche en Medecine Interne et Maladies Infectieuses sur le virus de l’Hepatite C

Medicine

Arthritis in patients with chronic hepatitis C virus infection

J Rheumatol

Hepatitis C infection presenting with rheumatic manifestationsA mimic of rheumatoid arthritis

J Rheumatol

HCV- related arthritisCharacteristics and response to therapy with interferon alfa

Clin Exp Rheumatol

Hepatitis C virus related polyarthritis11 cases

Arthritis Rheum

Epidemic outbreak of non-A, non-B hepatitis in a plasmapheresis center. Clinical observations and a four-year follow-up of patients

Infection

Development of rheumatoid arthritis after hepatitis C virus infection

Arthritis Rheum

Development of rheumatoid arthritis after chronic hepatitis caused by hepatitis C virus infection

Intern Med

Rheumatoid-like arthritis associated with HCV

J Clin Rheumatol

Rheumatic manifestations of chronic hepatitis C and response to the treatment with interferon alpha 2b

Rev Rhum Ed Fr

Polyarthritis associated with hepatitis C virus infection

Br J Rheumatol

A case of hepatitis C virus (HCV)-associated arthritis. Quantitative analysis of HCV RNA of the synovial fluid and the serum

Br J Rheumatol