RESEARCH - Hepatitis C virus-related arthritis: characteristics and response to therapy with INF-alpha

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Clin Exp Rheumatol. 2000 Sep-Oct;18(5):579-84.

Hepatitis C virus-related arthritis: characteristics and response to therapy

with interferon alpha.

Zuckerman E, Keren D, Rozenbaum M, Toubi E, Slobodin G, Tamir A, Naschitz

JE, Yeshurun D, Rosner I.

Department of Internal Medicine A, B'nai Zion Medical Center, Bruce

Rappaport Faculty of Medicine, Technion, Israel Institute of Technology,

Haifa, Israel.

OBJECTIVE: To characterize hepatitis C virus (HCV)-related arthropathy and

to evaluate the response to treatment with interferon-alpha (INF-alpha).

METHODS: We studied 28 HCV-infected patients with arthritis. All patients

underwent complete clinical, laboratory and radiological evaluation,

including assessment and follow-up by a rheumatologist. Twenty-five patients

were treated with INF-alpha for a median period of 12 months. RESULTS: All

patients were HCV-RNA positive (genotype 1b in 65%). The mean duration of

arthropathy-related symptoms prior to the diagnosis of HCV infection was 12

months. 19 patients (68%) had symmetric polyarthritis and 19 (68%) had

morning stiffness > or = 60 min. None of the patients had erosive disease or

subcutaneous nodules. 12 (43%) had detectable cryoglobulin (mean cryocrit:

3.6 +/- 3.5%), 17 (61%) had rheumatoid factor (RF) (median titer: 1:80), and

only 15 (54%) had elevated ESR. 14 patients (50%) had > or = 4 ACR (American

College of Rheumatology) criteria for the diagnosis of rheumatoid arthritis

(RA), 9 of whom were mistakenly diagnosed and previously treated as RA

patients. Only 3 patients had a satisfactory response to previous treatment

with anti-inflammatory or disease modifying drugs. Complete or partial

response of arthritis-related symptoms in INF-alpha treated patients was

observed in 44% and 32%, respectively. Cryoglobulin became undetectable in 9

of 12 patients. However, a complete biochemical and virological

end-of-treatment response was achieved in only 8 (36%) and 5 patients (20%),

respectively.

CONCLUSION: HCV arthropathy should be considered in the

differential diagnosis of any patient with arthritis, even in the absence of

liver disease. Treatment with interferon-alpha may lead to substantial

clinical improvement of HCV-related arthritis even without a complete

biochemical or virological response.

PMID: 11072597

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

ct & list_uids=11072597

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