Among the most frequently submitted questions to The Doctor is in Q and A on HIV and Hepatitis.com are those posed by patients with chronic hepatitis C who are currently on therapy or who have recently completed therapy and who are experiencing symptoms of arthritis. They frequently inquire whether the arthritic symptoms result from their therapeutic regimen of interferon/peginterferon + ribavirin or whether HCV infection causes them.

This issue is partially addressed in the following summary of a case report recently published in the Medical Science Monitor:

Extrahepatic manifestations associated with Hepatitis C virus (HCV) such as arthritis, vasculitis, and cryoglobulinemia are well known. However, HCV-related arthritis in the absence of clinical, biochemical and histological evidence of liver disease is not commonly seen, according to the authors. This article deals with such a case and its response to interferon therapy.

The authors present the case of a 32-year-old Filipino male who presented with bilateral symmetrical painful swelling of multiple joints including, hands, elbows, shoulders, and knees.

Serum rheumatoid factor, antinuclear antibodies and a comprehensive work-up for rheumatologic disorders were all negative.

Both initially and subsequently, serological tests for hepatitis A, B, and autoimmune liver diseases, Wilson’s disease, hemochromatosis, syphilis, human immunodeficiency virus (HIV) and cryoglobulinemia were negative, initially and subsequently. However, the hepatitis C antibody test was positive and hepatitis C viral RNA was detected in high titers [emphasis added—Ed].

The joint symptoms did not improve despite therapy with nonsteroidal anti-inflammatory drugs and a short course of prednisone prescribed earlier by his primary care physician. The patient then requested and was subsequently treated with standard interferon alfa-2b (Intron A or Roferon A).

According to the authors, the patient responded rapidly to the interferon therapy with “significant and sustained improvement in joint symptoms and disappearance of hepatitis C viral RNA from his serum.”

The authors conclude, “HCV arthritis should be considered in the differential diagnosis of seronegative arthritis of undetermined etiology even in the setting of normal liver chemistries.”

Commentary

The end result in this individual case was a good one, as the authors describe it, but not all patients with HCV-related arthritis experience a “significant and sustained improvement” in their symptoms after initiating anti-HCV therapy. In the present case study, it appears that the patient received standard interferon alfa monotherapy (use of ribavirin is not mentioned).

More data on the relationship between hepatitis C, arthritis and interferon therapy are required in order to help guide physician and patient decision-making about how best to alleviate and overcome severe arthritic symptoms related to chronic hepatitis C.

A Akhtar and Allen Funnyé. Hepatitis C virus associated arthritis in absence of clinical, biochemical and histological evidence of liver disease – responding to interferon therapy. Medical Science Monitor 11(7): CS37-39. 2005.