Arthritis in patients with chronic hepatitis C virus infection.

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Arthritis in patients with chronic hepatitis C virus infection.

J, -Monforte A, Pineda A, Millan Nunez-Cortes J.

Instituto Provincial de Rehabilitacion, Internal Medicine Department,

Hospital General Universitario Gregorio Maranon, Madrid, Spain.

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OBJECTIVE: To describe the clinical picture of arthritis in patients

with chronic infection by hepatitis C virus (HCV). METHODS: Two

patient populations were studied. Patients with arthritis and

evidence of serum elevation of alanine aminotransferase (ALT) at the

consultation were checked for HCV infection. A second group of 303

consecutive patients with rheumatoid arthritis (RA) were also checked

for the presence of HCV antibodies. All patients attended the

outpatient rheumatology unit of a tertiary care teaching hospital.

Chronic HCV infection was determined by the presence of viral RNA in

serum. A group of 315 first-time blood donors served as controls.

RESULTS: Twenty-eight patients with arthritis and chronic HCV

infection were identified. Seven fulfilled criteria for RA, psoriatic

arthritis was found in one patient, systemic lupus erythematosus in

one, gout in 2, chondrocalcinosis in 2, osteoarthritis in 7, and

tenosynovitis in one. In 7 patients with a clinical picture of

intermittent arthritis, a definitive diagnosis could not be made. In

these patients, mixed cryoglobulinemia was present in 6/7 (86%),

whereas mixed cryoglobulinemia was found in 6/21 (28%) of the other

patients. Among patients with RA, 23 (7.6%) had HCV antibodies, and

active infection by HCV was found in 7 (2.3%) patients. The

prevalence of HCV antibodies in a blood donor population was 0.95%,

significantly different (p<0.001; 95% CI 0.03, 0.10) compared to

patients with RA. The distribution of antibodies determined by

recombinant immunoblot analysis was similar (p = NS) between RA

patients and blood donors with HCV antibodies. CONCLUSION: There is

not a single clinical picture of arthritis in patients with chronic

HCV infection. There is a well defined picture of arthritis

associated with the presence of mixed cryoglobulinemia that consists

of an intermittent, mono or oligoarticular, nondestructive arthritis

affecting large and medium size joints. Although a high prevalence of

HCV antibodies is suspected in patients with RA, its occurrence may

be coincidental and its interpretation is difficult to determine from

the data in this study.

PMID: 9972979 [PubMed - indexed for MEDLINE]

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