Fatigue does not correlate with the degree of hepatitis or the presence of autoimmune disorders in chronic hepatitis C infection

[Guest guest]

TITLE: Fatigue does not correlate with the degree of

hepatitis or the

presence of autoimmune disorders in chronic hepatitis

C infection.

BACKGROUND: Fatigue is probably the most commonly

reported symptom in

chronic hepatitis C virus (HCV) infection. It is

unclear whether

fatigue is

related to the severity of underlying liver disease or

other autoimmune

disorders often described with chronic HCV infection.

OBJECTIVE: To quantify fatigue in terms of its impact

on quality of

life in

a homogeneous cohort and examine its relationship to

the status of

liver

disease or associated autoimmunity.

METHODS: The Fatigue Impact Scale (FIS) questionnaire

(Fisk et al. Clin

Infect Dis 1994; 18:S79-S83), a recently validated

psychometric tool

for

assessing patients' perceptions of the functional

limitations

attributable

to fatigue (40 statements; three subscales: physical,

cognitive and

psychological; maximum score = 160), was applied to a

cohort of Irish

women

who were PCR-positive for HCV genotype 1b via

inoculation with

contaminated

anti-D products in 1977. RIBA-positive, PCR-negative

patients (n = 20)

and

healthy age-matched women (n = 50) served as controls.

The degree of

hepatitis was assessed using the Knodell histological

activity index

(HAI)

score on previous liver biopsies. Clinical and

laboratory evidence of

cryoglobulinaemia, Sjogren's syndrome, connective

tissue diseases,

autoimmune thyroid disease and glomerulonephritis was

sought.

RESULTS: The mean FIS score of the 66 PCR-positive

women (mean 78+/-36;

range 7-153) was significantly higher than in

age-matched controls

(mean

31+/-24, range 0-78, P<0.001) but not statistically

different from that

of

the RIBA-positive, PCR-negative group. The FIS score

did not correlate

with

the HAI score (median HAI = 4; range 2-9; Pearson's

correlation

coefficient

r=0.01, P=0.9). Significant levels of cryoglobulins

were detected in 10

(15.2%). The sicca complex was diagnosed in six

patients, three of whom

had

associated cryoglobulinaemia. Thyroid antibodies,

anti-nuclear

antibody,

rheumatoid factor, antimitochondrial antibody and

anti-smooth muscle

antibody were detected in 15.2%, 6%, 4.5%, 4.5% and

1.5%, respectively.

There was no significant difference in the FIS score

between the groups

with

autoimmune diseases and those without. The FIS score

of the nine

patients

previously treated with interferon was not

statistically different from

the

untreated group (P=0.39).

CONCLUSION: The perceived functional impact of fatigue

on quality of

life is

significantly higher in patients with chronic HCV

genotype 1b infection

compared to healthy controls. However, it is unrelated

to the degree of

hepatitis and cannot be accounted for by the

co-existence of autoimmune

disorders alone.

AUTHOR: Goh J, Coughlan B, Quinn J, O'Keane JC, Crowe

J, Department of

Hepatology, Mater Misericordiae Hospital and

University College Dublin,

Ireland.

SOURCE: Eur J Gastroenterol Hepatol 1999

Aug;11(8):833-8

__________________________________________________

[Guest guest]

TITLE: Fatigue does not correlate with the degree of

hepatitis or the

presence of autoimmune disorders in chronic hepatitis

C infection.

BACKGROUND: Fatigue is probably the most commonly

reported symptom in

chronic hepatitis C virus (HCV) infection. It is

unclear whether

fatigue is

related to the severity of underlying liver disease or

other autoimmune

disorders often described with chronic HCV infection.

OBJECTIVE: To quantify fatigue in terms of its impact

on quality of

life in

a homogeneous cohort and examine its relationship to

the status of

liver

disease or associated autoimmunity.

METHODS: The Fatigue Impact Scale (FIS) questionnaire

(Fisk et al. Clin

Infect Dis 1994; 18:S79-S83), a recently validated

psychometric tool

for

assessing patients' perceptions of the functional

limitations

attributable

to fatigue (40 statements; three subscales: physical,

cognitive and

psychological; maximum score = 160), was applied to a

cohort of Irish

women

who were PCR-positive for HCV genotype 1b via

inoculation with

contaminated

anti-D products in 1977. RIBA-positive, PCR-negative

patients (n = 20)

and

healthy age-matched women (n = 50) served as controls.

The degree of

hepatitis was assessed using the Knodell histological

activity index

(HAI)

score on previous liver biopsies. Clinical and

laboratory evidence of

cryoglobulinaemia, Sjogren's syndrome, connective

tissue diseases,

autoimmune thyroid disease and glomerulonephritis was

sought.

RESULTS: The mean FIS score of the 66 PCR-positive

women (mean 78+/-36;

range 7-153) was significantly higher than in

age-matched controls

(mean

31+/-24, range 0-78, P<0.001) but not statistically

different from that

of

the RIBA-positive, PCR-negative group. The FIS score

did not correlate

with

the HAI score (median HAI = 4; range 2-9; Pearson's

correlation

coefficient

r=0.01, P=0.9). Significant levels of cryoglobulins

were detected in 10

(15.2%). The sicca complex was diagnosed in six

patients, three of whom

had

associated cryoglobulinaemia. Thyroid antibodies,

anti-nuclear

antibody,

rheumatoid factor, antimitochondrial antibody and

anti-smooth muscle

antibody were detected in 15.2%, 6%, 4.5%, 4.5% and

1.5%, respectively.

There was no significant difference in the FIS score

between the groups

with

autoimmune diseases and those without. The FIS score

of the nine

patients

previously treated with interferon was not

statistically different from

the

untreated group (P=0.39).

CONCLUSION: The perceived functional impact of fatigue

on quality of

life is

significantly higher in patients with chronic HCV

genotype 1b infection

compared to healthy controls. However, it is unrelated

to the degree of

hepatitis and cannot be accounted for by the

co-existence of autoimmune

disorders alone.

AUTHOR: Goh J, Coughlan B, Quinn J, O'Keane JC, Crowe

J, Department of

Hepatology, Mater Misericordiae Hospital and

University College Dublin,

Ireland.

SOURCE: Eur J Gastroenterol Hepatol 1999

Aug;11(8):833-8

__________________________________________________