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[Rheumatic manifestations of chronic hepatitis C and response to the treatment with interferon alpha-2b]
E Bon1, A Cantagrel, L Moulinier
1Service de Rhumatologie, Hôpital Rangueil, Toulouse.
Insights
Rheumatic symptoms like joint pain can signal chronic hepatitis C infection. Early diagnosis and interferon alpha treatment can effectively resolve these autoimmune manifestations.
Area of Science:
- Rheumatology
- Hepatology
- Immunology
Background:
- Chronic hepatitis C is associated with various autoimmune conditions.
- Rheumatic symptoms can be the primary presentation of hepatitis C infection.
Observation:
- Six patients with hepatitis C presented with prominent joint pain and muscle aches.
- Immunological abnormalities including rheumatoid factors, antinuclear antibodies, and low complement levels were common.
- Cryoprecipitate and sicca syndrome symptoms were noted in several patients.
Findings:
- Hepatitis C virus RNA was detected in most patients.
- Histological examination confirmed chronic hepatitis.
- Interferon alpha treatment led to symptom resolution and normalized liver function and immunological markers in most patients.
Implications:
- Rheumatic symptoms warrant investigation for chronic hepatitis C.
- Hepatitis C-related autoimmune manifestations may improve with antiviral therapy.
- This highlights the importance of a multidisciplinary approach in managing hepatitis C.
Abstract:
Chronic hepatitis C can be responsible for a broad range of autoimmune manifestations, including cryoglobulinemia and Sjögren's syndrome. We report our experience with six patients (five women and one man; mean age 55.6 years) in whom hepatitis C was diagnosed during evaluation of joint symptoms. Polyarthralgia was the main symptom and was often accompanied with myalgia; a polyalgic syndrome was seen in some patients. Isolated cytolysis was consistently found, although, in some instances, liver enzyme elevations were moderate and postdated the onset of the clinical symptoms. The diagnosis of hepatitis C was confirmed by recombinant immunoblot assay (RIBA) in every case. The polymerase chain reaction (PCR) detected hepatitis C virus RNA in five of the six patients. Histological findings were characteristic of chronic hepatitis. All six patients had immunological test abnormalities, which included presence of rheumatoid factors (2 of 6), positive antinuclear antibodies without anti-DNA antibodies (3 of 6) and low serum complement levels (3 of 6). A cryoprecipitate was found in four of the six patients. Four patients reported symptoms of sicca syndrome and two had Chisholm grade III lesions upon examination of salivary gland biopsy specimens. Four patients were given a six-month course of interferon alpha. In three of these four patients, evaluation at the end of the treatment showed abatement or resolution of symptoms, normal liver function tests, unchanged or diminished antinuclear antibody titers, and normal serum complement levels. In the remaining patient, no changes in symptoms or transaminase levels occurred during interferon alpha treatment. In conclusion, rheumatic symptoms can be the most prominent manifestation of chronic hepatitis C.(ABSTRACT TRUNCATED AT 250 WORDS)