Joint affection in chronic active hepatitis c with correlation to liver biopsy and cryoglobulinemia

ABSTRACT

This study was carried out to map, in a cohort of consecutive patients with chronic HCV infection, joint affection with correlation to cryoglobulinemia and with viral activity detected through liver biopsy done for those patients. Thirty three patients with hepatitis C infection were recruited for the study. Laboratory investigations involved determination of erythrocyte sedimentation rate [ESR], IgM rheumatoid factor [RF] and its titer, serum aminotransferases, and alkaline phosphatase concentrations. Cryoglobulines detection was done in their blood. State of viral activity and degree of hepatic fibrosis were detected by doing liver biopsy through [Metavir score]. Thirty three hepatitis C patients [15 males and 18 females] with mean age [SD] 43.5 [10.5] with mean disease duration [SD] of 50.8 [24.1] months were recruited for the study. Three patients were found to fulfill at least 4 out of the 7 ACR classification criteria for rheumatoid arthritis. They were excluded from the study. There is highly significant strong positive correlation between arthritis and cryogolbulinemia. There is non significant week negative correlation between arthritis and Metavir score -A liver biopsy. There is significant difference between cryoglobulins-positive and -negative patients as regard arthritis. Rheumatological manifestations constitute part of the extra hepatic manifestations of hepatitis C infection, so that sector of patients may have criteria sufficient for RA classification. Cryoglobulinemia plays an important role in association of arthritis/arthralgia in HCV infection patients. HCV, Hepatitis C virus ; MC, mixed cryoglobulinemia ; ALT, alanine aminotransferase; RTPCR, reverse transcriptase-polymerase chain reaction ; RF, rheumatoid factor; RA rheumatoid arthritis; ACR, American College of Rheumatology; ESR, erythrocyte sedimentation rate; SD, slandered deviation