Prevalence and impact of chronic hepatitis C virus infection on the clinical manifestations and disease activity among patients suffering from systemic lupus erythematosus

To study the prevalence of anti-HCV antibodies among patients suffering from systemic lupus erythematosus [SLE] as well as to determine the impact of chronic HCV infection on the clinical manifestations and disease activity. Ninety-eight consecutive SLE patients presented to the rheumatology department, Cairo University Hospitals were included in the study. All patients were screened for anti-HCV antibodies using a 3rd generation enzyme-linked immune-sorbent assay [ELISA]. Patients with positive anti-HCV were tested for the presence of HCV-RNA by polymerase chain reaction [PCR]. Patients were classified into two groups; HCV/SLE and non-HCV/SLE according to the presence or absence of anti-HCV antibodies. Twenty/98 patients [20.4%] were positive for HCV antibody. Eight/98 patients [8.2%] had active viremia. SLE patients with positive anti-HCV antibodies tend to be older in age and having a longer SLE duration than non-HCV/SLE Patients. HCV/SLE patients had significantly lower mucocutaneous manifestations [p < 0.05] and higher cardiac manifestations and fundus abnormalities [p < 0.04, p < 0.01 respectively] than non-HCV/SLE patients. There was no statistical difference between the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] score between both groups. Patients with HCV/SLE were less frequently on oral steroids than patients with non-HCV/SLE HCV antibodies and active HCV viremia were found in 20.4% and 8.2% respectively among SLE patients. SLE with positive anti-HCV antibodies tend to be older in age and having longer SLE disease duration, lower mucocutaneous and higher cardiac manifestations and fundus abnormalities. Concomitant chronic HCV infection has no adverse impact on SLEDAI

Thrombotic thrombocytopenic purpura associated with chronic HCV infection

Thrombotic thrombocytopenic purpura is a potentially lethal microvascular thrombotic disorder. In this study, we report a 32 years old woman who suffered from undifferentiated vasculitis with marked improvement on steroids and cyclophosphamide. Two years later, hepatitis C virus infection was discovered. Decision for interferon therapy was not recommended at this stage and the patient remained stable for the following 7 years. In January 2009, pegylated interferon and ribavirin were started due to worsening of her hepatitis; the treatment was stopped after 12 weeks due to the absence of any virologic response. Fourteen months later, she developed severe uncontrolled thrombotic thrombocytopenic purpura that led eventually to her death. We report this rare case of thrombotic thrombocytopenic purpura that may directly be related to chronic HCV infection rather than to interferon therapy

Bone densitometry in patients with rheumatoid arthritis

Rheumatoid arthritis [RA] is a chronic inflammatory disease, with symmetric polyarthritis. There are two types of osteoporosis [OP] associated with RA; periarticular and systemic. Generalized OP in RA patients is believed to be associated with increased production of inflammatory cytokines. The aim of the present work is to evaluate the bone mineral density [BMD] and the frequency of reduced bone mass in RA patients. The influence of different variables related to the patient, the disease and the medications on BMD in RA patients were also assessed. This study was conducted on 100 adult RA patients [88 females and 12 males] and 100 healthy age and sex matched controls. The mean age of patients and controls were 36.11 +/- 9.279 and 35.87 +/- 9.32 years, respectively. The mean disease duration was 5.46 +/- 5.366 years. All the patients were subjected to full history taking, full general and locomotor examination and laboratory investigations. Bone densitometry was performed by dual X-ray absorptiometry equipment in the lumbar spine [LS] femoral neck [FN] and distal third of radius. Two RA groups were analyzed, patients receiving corticosteroids [n= 19] and patients not receiving corticosteroids [n= 81]. At the LS 36% of patients had osteopenia and 9% had osteoporosis compared to 1% of controls had osteopenia [P=0.001], At FN 28% of patients had osteopenia and 3% had osteoporosis while all controls were normal [P=0.001], at radius 24% of patients had osteopenia and 13% had osteoporosis and all the controls were normal [P<0.001]. Considering disease activity, our study showed that DAS 28 is a significant predictor of low BMD by using multilinear regression analysis in both hip [P = 0.049] and radius [P = 0.022], also by Pearson correlation, DAS 28 was found to have negative correlation with BMD at radius [P= 0.023 r = -0.228]. Mean BMD showed no significant differences among corticosteroid users and non users at LS, FN and the radius.[P =0.644, 0.107 and 0.401 respectively], however, cumulative dose of corticosteroids showed significant negative correlation with BMD at hip [P= 0.039 r= - 0.206]. Body mass index [BMI] showed a positive statistically significant correlation with BMD at lumbar spine [r-0.265; P = 0.008] the hip [r- 0.362; P = 0.000] and distal third of radius [r = 0.250; P = 0.012]. There is increased frequency of reduced BMD in RA patients indicating that disease related factors [Rheumatoid factor and Disease activity score DAS 28], as well as patients related factors [age, BMI] and cumulative dose of corticosteroids were found to be associated with the reduction of BMD