Rheumatologic manifestations during chronic viral hepatitis C

Abstract

Introduction: Chronic hepatitis C (CHC) is assimilated to a systemic disease because of its multiple extrahepatic manifestations particularly rheumatological.
Aim: To determine the prevalence and the characteristics of rheumatological manifestations (RM) associated with CHC.
Methods: a retrospective study including all patients suffering from CHC followed over a period of 11 years (2002 – 2012) at the department of gastroenterology B at La Rabta hospital. Were excluded all patients co-infected by hepatitis B virus or by human immunodefficiency virus and those having decompensated cirrhosis. Different RM were collected and analyzed according to the epidemiological, clinico-biological, immunological, virological and histological data of the CHC.
Results: two hundred and four patients affected by CHC were included, meanly aged by 52 years [22- 66 years]. The sex-ratio was 0,46. RM were noted in 76 patients (37,25%) dominated by inflammatory polyarthralgia of big joints (88,15%). Non erosive arthritis was observed in a woman, myalgia was noted in 11 cases (14,47%) among them, 2 appeared under antiviral treatment. Dryness syndrome was observed in 17 cases (22,36%). RM were associated to other extrahepatic manifestations of CHC in 69,7% of cases, notably to mixed cryoglobulinemia (MC) (60%) and to non specific antinuclear antibodies (21,6%). A partial to total amelioration of RM was noted in most patients under antiviral treatment often associated to symptomatic measures. In univariate analysis, only female sex and presence of MC were significantly correlated to the presence of RM. 
Conclusion: RM occur frequently inCHC and are dominated by arthralgia, myalgia and dryness syndrome. Authentic arthritis are uncommon and constitute a diagnostic problem particularly when they inaugurate the disease. MC is the immunological factor the most associated with RM. MR treatment remains mainly antiviral.