Prevalence of rheumatologic manifestations of chronic hepatitis C virus infection among Egyptians

Abstract

Chronic hepatitis C virus (HCV) viremia has been known to provoke a plethora of autoimmune syndromes referred to as extrahepatic manifestations of chronic HCV infection. Aim of the current study was to assess the prevalence of rheumatologic manifestations among Egyptians with hepatitis C infection and its' association with cryoglobulin profile. The current research represents a cross-sectional study where patients with chronic HCV infection attending the outpatient clinic of the National Hepatology and Tropical Medicine Research Institute over a period of 1 year were interviewed. Patients with decompensated liver disease, on interferon therapy, having end-stage renal disease or coexisting viral infection like hepatitis B surface antibody positive patients were all excluded from the research. Laboratory investigations as well as serological assay including cryoglobulin profile, rheumatoid factor, antinuclear antibody, HCV-PCR were performed. Three hundred and six patients having chronic HCV infection were interviewed in this research. The overall estimated prevalence of rheumatologic manifestations in the current research was 16.39%, chronic fatigue syndrome 9.5%, sicca symptoms 8.8%, arthralgia 6.5%, fibromyalgia 1.9%, myalgia 1.3%, arthritis 0.7%, cryoglobulinemic vasculitis 0.7%, autoimmune hemolytic anemia 0.7%, thrombocytopenia 0.7%. Xerophthalmia was significantly present in male population (p = 0.04), whereas fibromyalgia, cryoglobulinemic vasculitis, arthritis, and autoimmune hemolytic anemia were significantly present in female population under study (p < 0.05). In chronic HCV genotype 4 infection, the prevalence of rheumatologic manifestations was 16.3% with chronic fatigue syndrome and sicca symptoms being the most common with no significant correlation to the degree of elevation of liver disease or viral load.

Hepatitis C virus-associated arthropathy and rheumatoid arthritis

“…In agreement with our study, Mohammed et al [22] showed that 22.7% of patients with HCV-associated arthropathy had arthritis, whereas Bassyouni et al [16] and Orge et al [23] reported that 55 and 47%, respectively, of patients with HCVassociated arthropathy complained of polyarthritis. In agreement with our study, Mohammed et al [22] showed that 22.7% of patients with HCV-associated arthropathy had arthritis, whereas Bassyouni et al [16] and Orge et al [23] reported that 55 and 47%, respectively, of patients with HCVassociated arthropathy complained of polyarthritis.…”

“…These findings were similar to those of Bassyouni et al [16] and Mohammed et al [22]. The mean alanine aminotransferase and aspartate aminotransferase were higher in HCV patients with arthropathy than in HCV patients without arthropathy and RA patients.…”

“…Other studies by Rivera et al [3], Mohammed et al [22], and Bassyouni et al 2009 [16] have reported higher percentages (57.1, 67.8, and 45%) of patients with HCV-associated arthropathy in whom three or more joint areas were affected. Other studies by Rivera et al [3], Mohammed et al [22], and Bassyouni et al 2009 [16] have reported higher percentages (57.1, 67.8, and 45%) of patients with HCV-associated arthropathy in whom three or more joint areas were affected.…”

The Significance of Articular Hand Manifestations in Chronic HCV Patients

“…In addition to hepatic complications, hepatitis C virus (HCV) infection is reported to predispose to extrahepatic disorders involving renal, dermatologic, hematologic and rheumatologic systems [3,4,5] . Articular involvement in HCV infection is a frequent complication varying from 4 to 23% and the clinical picture of HCV related arthropathy varies widely, ranging from polyarthralgia to monoarticular or oligoarticular intermittent arthritis and symmetric chronic polyarthritis [4,5,6] . HCV associated arthritis in contrast to RA has a benign course, typically not deforming and not associated with…”

Viral arthritides

“…Indeed, symptomatic arthralgia has been estimated to occur in 6.5-19% of patients [30][31][32]. Hepatitis C can cause two distinct types of arthritic symptoms: the more common rheumatoid arthritis-like polyarthritis of the small joints but without …”