RESEARCH - Rheumatologic manifestations of chronic hepatitis C infection

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Joint Bone Spine. 2006 Sep 25; [Epub ahead of print]

Rheumatologic manifestations of chronic hepatitis C infection.

Rheumatology Department and INSERM ERI-18, Avicenne Teaching Hospital

(AH-HP) and Paris 13 University, 125, rue de Stalingrad, 93009 Bobigny,

France.

The many rheumatologic manifestations associated with chronic hepatitis C

virus (HCV) infection include arthralgia, myalgia, arthritis, vasculitis,

and sicca syndrome. Arthralgia is the most common extrahepatic manifestation

and may indicate mixed cryoglobulinemia or an adverse reaction to interferon

therapy. HCV arthritis unrelated to cryoglobulinemia is far less common but

constitutes an independent entity. The picture may mimic rheumatoid

arthritis (RA), particularly as rheumatoid factor is present in 50-80% of

cases. Tests are usually negative for antibodies to cyclic citrullinated

peptides (anti-CCP), which may help to differentiate the two conditions. The

management of HCV arthritis is empirical and poorly standardized. Although

low-dose glucocorticoid therapy, hydroxychloroquine, and methotrexate have

been used successfully in several patients, little is known about their

hepatic safety profile. Arthritis associated with cryoglobulinemia usually

responds to antiviral treatment. Sicca syndrome is common in patients with

chronic HCV infection and shares similarities with primary Sjogren syndrome,

suggesting that HCV infection may deserve to be included among the causes of

secondary Sjogren syndrome. HCV-associated vasculitis is usually related to

cryoglobulinemia, although a few cases of polyarteritis nodosa-like disease

affecting the medium-sized vessels have been reported. Other conditions

reported in patients with chronic HCV infection include fibromyalgia,

systemic lupus erythematosus (SLE), antiphospholipid syndrome, and

osteosclerosis.

PMID: 17056293

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=17056293

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