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Management of hepatitis c virus-related arthritis.

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    BioDrugs 2001;15(9):573-84 Management of hepatitis c virus-related arthritis. Zuckerman E, Yeshurun D, Rosner I. Liver Unit, Department of Internal Medicine A,
    Message 1 of 1 , Nov 27, 2001
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      BioDrugs 2001;15(9):573-84

      Management of hepatitis c virus-related arthritis.

      Zuckerman E, Yeshurun D, Rosner I.

      Liver Unit, Department of Internal Medicine A, Bnai
      Zion Medical Center, Haifa, Israel.

      Hepatitis C virus (HCV) infection is often associated
      with extrahepatic manifestations among which
      arthropathy is common, affecting up to 20% of
      HCV-infected individuals. This arthropathy is to be
      distinguished from the more superficially prominent
      myalgias and fatigue. HCV-related arthritis is
      commonly presented as rheumatoid-like, symmetrical
      inflammatory polyarthritis involving mainly small
      joints, or, less commonly, as mono- or oligoarthritis,
      usually of the large joints. HCV arthritis usually
      runs a relatively benign course that, in contrast to
      'true' rheumatoid arthritis (RA), is typically
      non-deforming and is not associated with articular
      bony erosions. In addition, unlike 'classic' RA,
      erythrocyte sedimentation rate is elevated only in
      about half of the patients and subcutaneous nodules
      are absent. In about two-thirds of the affected
      individuals morning stiffness may be severe, resolving
      after more than an hour. Several pathogenetic
      mechanisms may be involved: HCV arthritis may be part
      of the syndrome of mixed cryoglobulinaemia, or may be
      directly or indirectly mediated by HCV. Such possible,
      but yet not proven, mechanisms include direct invasion
      of synovial cells by the virus eliciting local
      inflammatory response, cytokine-induced disease or
      immune complex disease, particularly in genetically
      susceptible individuals. The diagnosis of HCV
      arthritis in patients with positive rheumatoid factor
      and chronic inflammatory polyarthritis may be
      difficult. Positive HCV antibody and HCV RNA, and the
      absence of bony erosions, subcutaneous nodules and
      antikeratin antibodies, may be useful in
      distinguishing between HCV-related arthritis and RA.
      The optimal treatment of HCV-related arthritis has not
      yet been established. Concerns may be raised regarding
      the use of immunosuppressive or potentially
      hepatotoxic drugs. However, it may be suggested that
      once the diagnosis of HCV-associated arthritis is
      made, combination antiviral treatment with
      interferon-alpha and ribavirin should be initiated as
      part of the therapeutic armamentarium. Low dose oral
      corticosteroids, nonsteroidal anti-inflammatory drugs,
      hydroxychloroquine or sulfasalazine in addition to the
      antiviral therapy can be used to control
      arthritis-related symptoms. Some patients may need
      long term anti-inflammatory treatment in various
      combinations, along with antiviral therapy. In
      patients with severe, disabling or life-threatening
      cryoglobulinaemia-related symptoms refractory to
      antiviral or anti-inflammatory treatment, high dose
      corticosteroids (including pulse therapy) and/or
      plasmapheresis may be needed.

      PMID: 11580301 [PubMed - in process]

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