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Fibromyalgia-associated hepatitis C virus infection
J Rivera1, A de Diego, M Trinchet
1Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Insights
This study found a link between fibromyalgia and active hepatitis C virus infection. Healthcare providers should consider HCV testing for fibromyalgia patients, even without elevated liver enzymes.
Area of Science:
- Hepatology
- Rheumatology
- Infectious Diseases
Background:
- Fibromyalgia (FM) and chronic hepatitis C virus (HCV) infection are prevalent conditions.
- Potential associations between autoimmune diseases and viral infections are areas of ongoing research.
Purpose of the Study:
- To investigate the association between chronic hepatitis C virus (HCV) infection and fibromyalgia (FM).
- To determine the prevalence of HCV in FM patients compared to rheumatoid arthritis (RA) patients.
- To assess FM symptoms in patients with chronic HCV infection.
Main Methods:
- Compared HCV prevalence in 112 FM patients versus matched RA controls.
- Evaluated FM in 58 chronic HCV patients versus matched controls.
- Utilized ELISA, RIBA for HCV antibodies, and PCR for HCV-RNA.
- Assessed alanine aminotransferase (ALT) levels and autoimmune markers.
Main Results:
- HCV antibodies were more prevalent in FM patients (15.2%) than RA controls (5.3%).
- HCV-RNA was detected in 13 FM patients, with normal ALT in 50% of these.
- Chronic HCV patients showed higher rates of diffuse musculoskeletal pain (53%) and FM criteria fulfillment (10%) compared to controls.
Conclusions:
- An association exists between fibromyalgia and active hepatitis C virus infection.
- Fibromyalgia in this context was not linked to liver damage or autoimmune markers.
- HCV infection should be considered in fibromyalgia patients, irrespective of ALT levels.
Abstract:
The objective was to determine whether there might be an association between hepatitis C virus (HCV) chronic infection and fibromyalgia (FM). We determined the prevalence of HCV infection in 112 FM patients, in comparison with matched rheumatoid arthritis (RA) patients from the out-patient clinic of a teaching tertiary care general hospital. Furthermore, we looked for evidence of FM in 58 patients diagnosed with chronic hepatitis due to HCV, compared with matched surgery clinic patients, HCV antibodies were determined by enzyme-linked immunosorbent assay (ELISA) and recombinant immunoblot assay (RIBA). Serum RNA of HCV (HCV-RNA) was determined by polymerase chain reaction. In the group of FM patients, HCV antibodies were found by ELISA in 17 (15.2%) patients and in six (5.3%) of the RA controls (P < 0.05). RIBA was positive in 16 and indeterminate in one of the FM patients. Serum HCV-RNA was found in 13 of these FM patients. In eight (47%) FM patients, alanine aminotransferase (ALT) was normal, although HCV-RNA was detected in four (50%) of them. In the group of patients with chronic hepatitis due to HCV, all patients had HCV antibodies and the presence of HCV-RNA in serum. Within these patients, 31 (53%) had diffuse musculoskeletal pain, while six (10%) fulfilled FM diagnostic criteria. In the control group, 13/58 (22%) had diffuse musculoskeletal pain (P < 0.001), whereas only one female patient (1.7%) fulfilled FM criteria (P < 0.05). Serum ALT was 51.7 +/- 38.4 in FM patients, whereas it was 122 +/- 76.3 in patients with HCV chronic hepatitis but without FM (P < 0.001). There were no statistical differences in autoimmune markers between patients with and without FM. These data suggest that there exists an association between FM and active HCV infection in some of our patients. FM is not associated with liver damage or autoimmune markers in these patients. HCV infection should be considered in FM patients even though ALT elevations were absent.