Rheumatoid-like Arthritis Associated with Hepatitis C

Rheumatoid arthritis is a clinical entity whose etiology is unknown, although an infectious cause has been suggested. We describe three patients diagnosed to have a rheumatoid arthritis-like disease that was chronic but nonerosive and unresponsive to nonsteroidal anti-inflammatory drugs. The patients were females aged 30, 69 and 70 years who had morning stiffness of more than 30 minutes and symmetric polyarthritis for periods of 4, 6, and 20 months, respectively. A laboratory screening revealed minunal liver enzyme elevations, whereas acute phase reactants were consistent with systemic inflammation, and the presence of rheumatoid factor and cryoglobulins was detected. Serology was positive for hepatitis C virus antigens. Liver biopsies revealed hepatitis and early cirrhosis. Alpha-interferon therapy was associated with clinical improvement of arthritis in two cases. It is suggested that hepatitis C infection may be associated with rheumatoid-like arthritis.