HCV/OTHER MEDICAL PROBLEMS

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HCV/OTHER MEDICAL PROBLEMS

Chronic hepatitis C infection causesproblems for parts of the body beyond theliver. The organs most often affected includethe blood vessels, skin, joints, kidneys,thyroid gland, heart and brain. Thevirus itself has been found in the heart,muscles, nerves and lymphatic system.Many problems may arise from the cirrhosis,per se. Potential problems from cirrhosisinclude fluid accumulation in the abdomen,bleeding into the stomach, jaundice,confusion, poor blood clotting, coma, andsusceptibility to infection., During the last years many autoimmunemanifestations have been correlatedwith HCV infection, namely sicca syndrome,chronic polyarthritis, polydermatomyositis,fibromyalgia, autoimmune thyroiditis,lung fibrosis, and diabetes mellitus.(Curr Opin Rheumatol 2000 Jan;12(1):53-60)UPPER RIGHT QUADRANT (URQ)PAIN (SIDE

PAIN)Even though the liver itself contains nonerve endings, and does not feel pain,many people with HCV experience a painon the upper right side of their body, justbeneath the ribs. It varies from a dull acheand bruised feeling, to sharp stabbing painwhich is quite different from “gas pains.â€This is thought by some to be “referredpain†from the swelling of the liver capsuledue to the disease process. This pain mayalso be referred to the right shoulder or tothe back between the shoulder blades.CRYOGLOBULINEMIAOne-third to one-half of people withchronic hepatitis C infection havecryoglobulinemia. Cryoglobulinemia is acondition where antibodies which are attachedto the hepatitis C virus solidifywhen cold. Hepatitis C is recognized as themost common cause of mixed cryoglobulinemia.Most of the people with cryoglobulinemiafrom hepatitis C have had

their hepatitisfor a long time or have cirrhosis. Peoplewith higher concentrations of hepatitis CRNA in their blood do not seem to have ahigher risk of having cryoglobulinemia.Usually the cryoglobulins are in low concentrationand cause no symptoms.About 20% of people with hepatitis C andcryoglobulinemia have symptoms. Symptomsmost often associated with cryoglobulinemiainclude mild fatigue, joint pains, or itching.Occasionally, people with cryoglobulinemiadevelop vasculitis (inflammation of the bloodvessels) which can cause purpura (purple skinlesions), Raynaud’s phenomenon (the handsturn white, then blue, and then red from constrictionand subsequent dilation of the bloodvessels), or numbness in the hands and feet.The presence of cryoglobulinemia does notaffect people’s response to interferon. In fact,some people with vasculitis have improvementin the

vasculitis as their liver tests improve oninterferon.RHEUMATOID ARTHRITIS-LIKESYMPTOMSHepatitis C infection can mirror rheumatoidarthritis symptoms. The predominantclinical findings include palmar tenosynovitis:small joint synovitis, and carpal tunnel syndrome.Risk factors such as transfusions andIV drug abuse or a history of hepatitis or jaundiceshould be included in the history of presentillness of any patient with acute orchronic polyarthritis or unexplained positiverheumatoid factor. In such patients, gammaglutamylaminotransferase, serologic studiesfor hepatitis C, and other tests appropriatefor chronic liver disease should be performed.

From HCV Advocate

RHEUMATOLOGIC and AUTOIMMUNE MANIFESTATIONS

Myalgia (muscle pains), fatigue and arthralgias (joint pains) are common manifestations of HCV infection. HCV-related arthritis commonly presents as symmetrical inflammatory arthritis involving small joints. The joints involved in HCV-related arthritis are similar to rheumatoid arthritis (RA). This sometimes makes it difficult to differentiate true RA from HCV patients with positive rheumatoid factor but without RA. HCV-related arthritis is usually non-deforming and there are no bony erosions in the joints. A marker called anti-keratin antibodies has been studied to differentiate true RA from HCV related arthritis. In a recent study, 71 patients who were rheumatoid factor positive were tested for anti-keratin antibodies. Anti-keratin antibodies were detected in 20/33 (60.6%) patients with true RA and only 2/25 (8%) patients with HCV-related arthritis (10). Patients with HCV-related arthritis seldom respond to anti-inflammatory

medications, and although there are no controlled trials to address this issue, it has been recommended to treat these patients with combination antiviral therapy of interferon and ribavirin (11).Sjogren’s syndrome (SS), an autoimmune disease characterized by dry eyes and dry mouth has been found in some studies to be more common in HCV infected patients. They differ from primary SS in that they do not have lung and kidney involvment. Thus it is recommended to test for HCV infection in patients with SS or primary SS. A study by El-Serag of 34,000 veterans failed to show a significant association between HCV infection and diabetes, SS, or autoimmune thyroid disease (9).Interferon therapy of HCV infection may also trigger the development of autoimmune diseases, the most frequent of which is autoimmune thyroiditis (Hashimoto’s thyroiditis). This may lead transiently to hyperthyroidism, but eventually to hypothyroidism (underactive thyroid) and to

the need for life-long thyroid replacement therapy (Bonkovsky & Mehta). FibromyalgiaFibromyalgia is the name for a conditionthat typically includes widespread musclepain, fatigue and abnormal sleep patterns.Until a few years ago, doctors called thecondition fibrositis, or muscular rheumatism,and believed mostly that the condition was “allin the patient’s headâ€. Today, fibromyalgia isrecognized by medical organizations as agenuine and serious problem.The symptoms of fibromyalgia typicallyinclude pain in many muscles, and aroundligaments and tendons, persistent fatigue, wakingup feeling tired even after a full night’ssleep, headaches, bouts of constipation anddiarrhea, abdominal pain, painful menstrualperiods, sensitivity to cold, numbness or tingling,and difficulty exercising.Symptoms vary widely among patients andtend to wax and wane over time. An illness,injury, cold weather or emotional stress

maytrigger a fibromyalgia episode or make ongoingsymptoms worse.Learn about the potential connection between Hepatitis C and fibromyalgia, and find out why it is possible that Hepatitis C infection may act as a trigger for fibromyalgia syndrome.If you suspect having both conditions, awareness of this link can lead you to seek the expert evaluation and care that may help reduce your symptoms of pain and fatigue ......... Continue Reading.Source

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