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[Hepatitis C virus in rheumatic diseases]
M C Jendro1, J L Hülsemann, H Zeidler
1Abteilung Rheumatologie Medizinische Hochschule Hannover.
Insights
Hepatitis C virus (HCV) infection frequently causes rheumatic conditions like mixed cryoglobulinemia and non-erosive arthritis. Early HCV testing in rheumatology patients is crucial for timely treatment and preventing liver damage.
Area of Science:
- Rheumatology
- Infectious Diseases
- Hepatology
Context:
- Hepatitis C virus (HCV) infection is a significant concern in rheumatology.
- HCV is linked to various rheumatic manifestations, including mixed cryoglobulinemia, Sicca syndrome, fibromyalgia, and thromboembolic events.
- HCV-associated non-erosive polyarthritis can mimic rheumatoid arthritis but has a distinct disease course.
Purpose:
- To outline the clinical and serological indicators for suspecting HCV infection in rheumatological patients.
- To guide the appropriate use of HCV testing within a rheumatology setting.
- To emphasize the importance of identifying HCV in rheumatic patients.
Summary:
- HCV infection presents with diverse rheumatic symptoms, often without elevated liver enzymes.
- Associated autoantibodies include cryoglobulins, rheumatoid factor, ANA, SMA, anti-phospholipid, and anti-thyroid antibodies.
- Specific antibodies like anti-Ro (SSA) and anti-La (SSB) are notably absent in HCV-associated Sicca syndrome.
Impact:
- Early identification of HCV in rheumatic patients prevents iatrogenic hepatitis from hepatotoxic drugs.
- Prompt diagnosis allows for the use of alpha-interferon, a potential virus-eradicating agent.
- Integrating HCV screening into rheumatology practice improves patient management and outcomes.
Abstract:
HCV-infection is an important infectious disease in rheumatology. It is the cause of mixed cryoglobulinemia and other rheumatic manifestations develop frequently during HCV-infection. These comprise: Sicca-syndrome, thromboembolic events associated with anti-cardiolipin antibodies and fibromyalgia. Also associated with HCV-infection is a non-erosive polyarthritis. This synovitis often fulfills the ACR-criteria for rheumatoid arthritis, but the disease course is different with frequent remissions and non-erosive joint involvement. The following autoantibodies are associated with HCV-infection: Cryoglobulins, rheumatoid factor, antinuclear antibodies (ANA), antismooth muscle antibodies (SMA), anti-phospholipid-antibodies and anti-thyroid-antibodies. In HCV-associated sicca-syndrom, antibodies against Ro (SSA) and La (SSB) are not detected. The course of HCV-infection is often occult, without elevation of liver enzymes. We summarize the clinical and serological signs and symptoms when HCV-infection should be suspected and when HCV-testing should be performed in a rheumatological setting. The identification of HCV-infection in rheumatic patients is important to minimize the risk of aggravating hepatitis by prescription of hepatotoxic drugs and because of the availability of alpha-interferon as a potential virus eradicating agent.