Hepatitis C Infection Presenting with Rheumatic Manifestations

August 2, 1996
Disease Presentation; "Hepatitis C Infection Presenting with Rheumatic Manifestations/ A Mimic of Rheumatoid Arthritis."

Hepatitis Weekly via Individual Inc. : According to the authors' abstract of an article published in Journal of Rheumatology,

OBJECTIVE:
To describe the clinical features of a group of patients presenting with rheumatic manifestations who were subsequently determined to have hepatitis C infection.

METHODS:
A case study of 19 consecutive patients referred to private practitioners in Tacoma and Federal Way, Washington, because of polyarthritis, polyarthralgia, or positive rheumatoid factor (RF) who were subsequently found to have hepatitis C. Patients were tested for hepatitis C when they met the following screening criteria: abnormal liver biochemical studies or history of transfusion, jaundice, or hepatitis.

RESULTS:
Risk factors for hepatitis C infection were present in 14 patients, including transfusions (8) or intravenous drug use (6). Eight patients gave a history of previous jaundice or hepatitis predating their articular complaints by intervals ranging from 3 mos to 23 yrs. Liver biochemical tests were normal in 6 patients. Serologic evidence of hepatitis B or human T lymphotrophic virus type II was present in 3 of 19 and 2 of 14 patients, respectively. Carpal tunnel syndrome (8 patients), palmar tenosynovitis (7 patients), fibromyalgia (6 patients), and nonerosive, nonprogressive arthritis typified the articular manifestations. Fifteen patients fulfilled diagnostic criteria for rheumatoid arthritis (RA). Three patients had small vessel skin vasculitis. The arthritis responded well to treatment with low dose prednisone and hydroxychloroquine.

CONCLUSION:
Hepatitis C infection can present with rheumatic manifestations indistinguishable from RA. The predominant clinical findings include palmar tenosynovitis: small joint synovitis, and carpal tunnel syndrome. Risk factors such as transfusions and IV drug abuse or a history of hepatitis or jaundice should be included in the history of present illness of any patient with acute or chronic polyarthritis or unexplained positive RF. In such patients, gammaglutamyl aminotransferase, serologic studies for hepatitis C, and other tests appropriate for chronic liver disease should be performed."

The corresponding author for this study is: MR Lovy, 2420 South Union 150, Tacoma, WA 98405 USA.
For subscription information for this journal contact the publisher: J Rheumatol Publ Co, 920 Yonge St, Suite 115, Toronto on M4W 3C7, Canada.
AUTHORS: Lovy, M.R.; Starkebaum, G.; Uberoi, S.
SOURCE: Journal of Rheumatology, June 1996;23(6):979-983.

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