Hepatitis C infection presenting with rheumatic manifestations: a mimic of rheumatoid arthritis.

[Guest guest]

Hepatitis C infection presenting with rheumatic manifestations: a

mimic of rheumatoid arthritis.

Lovy MR, Starkebaum G, Uberoi S.

Division of Rheumatology, University of Washington, Seattle, USA.

OBJECTIVE: To describe the clinical features of a group of patients

presenting with rheumatic manifestations who were subsequently

determined to have hepatitis C infection. METHODS: A case study of 19

consecutive patients referred to private practitioners in Tacoma and

Federal Way, Washington, because of polyarthritis, polyarthralgia, or

positive rheumatoid factor (RF) who were subsequently found to have

hepatitis C. Patients were tested for hepatitis C when they met the

following screening criteria: abnormal liver biochemical studies or

history of transfusion, jaundice, or hepatitis. RESULTS: Risk factors

for hepatitis C infection were present in 14 patients, including

transfusions (8) or intravenous drug use (6). Eight patients gave a

history of previous jaundice or hepatitis predating their articular

complaints by intervals ranging from 3 mos to 23 yrs. Liver

biochemical tests were normal in 6 patients. Serologic evidence of

hepatitis B or human T lymphotrophic virus type II was present in 3

of 19 and 2 or 14 patients, respectively. Carpal tunnel syndrome (8

patients), palmar tenosynovitis (7 patients), fibromyalgia (6

patients), and nonerosive, nonprogressive arthritis typified the

articular manifestations. Fifteen patients fulfilled diagnostic

criteria for rheumatoid arthritis (RA). Three patients had small

vessel skin vasculitis. The arthritis responded well to treatment

with low dose prednisone and hydroxychloroquine. CONCLUSION:

Hepatitis C infection can present with rheumatic manifestations

indistinguishable from RA. The predominant clinical findings include

palmar tenosynovitis, small joint synovitis, and carpal tunnel

syndrome. Risk factors such as transfusions and IV drug abuse or a

history of hepatitis or jaundice should be included in the history of

present illness of any patient with acute or chronic polyarthritis or

unexplained positive RF. In such patients, gammaglutamyl

aminotransferase, serologic studies for hepatitis C, and other tests

appropriate for chronic liver disease should be performed.

PMID: 8782126 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

cmd=Retrieve & db=PubMed & list_uids=8782126 & dopt=Abstract