Hep C and joint pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The hepatitis C virus (HCV) is a significant health problem affecting the liver. More than 4 million Americans are infected with hepatitis C virus.
One of the major problems with hepatitis C virus infections is that 85% of individuals initially infected with this virus will become chronically infected, usually for decades. This has become a major scourge for Baby Boomers and experts now recommend that all Boomers be screened for this.
Once established, chronic hepatitis C virus infection causes chronic hepatitis. This condition can progress to cirrhosis. Patients with cirrhosis can develop liver failure or the complications of cirrhosis, including liver cancer.
Hepatitis C is spread (transmitted) through the blood: infected blood or blood products, transplantation of infected solid organs (e.g., liver, kidney, heart), and the sharing of contaminated needles among intravenous drug users.
Hepatitis C virus can be sexually transmitted. Hepatitis C virus has been isolated in semen, vaginal fluid, and saliva.
Hepatitis C virus infection can also be acquired through occupational exposures. Health care workers in contact with contaminated bloods, fluids, and needles are at an increased risk for hepatitis C virus.
Only about 25% of patients exhibit the characteristic symptoms of acute (rapid onset) hepatitis. These symptoms include fatigue, muscle aches, poor appetite, and low-grade fever. Rarely, jaundice also occurs. However, most patients (about 75%) experience minimal symptoms.
Several systemic conditions are associated with chronic hepatitis C. The most common is cryoglobulinemia. This condition is due to the presence of abnormal antibodies, called cryoglobulins, that come from hepatitis C virus stimulation of lymphocytes (white blood cells). These antibodies deposit in small blood vessels, causing inflammation of the vessels (vasculitis) in tissues throughout the body. For example, the skin, joints, and kidneys may be involved.
Patients with cryoglobulinemia have symptoms including weakness, joint pain or swelling, a raised, purple skin rash usually in the lower portion of the legs, swelling of the legs and feet due to loss of protein in the urine from the kidney involvement, and nerve pain. In addition, these patients may develop Raynaud's phenomenon, where the fingers and toes turn color (white, then purple, then red) and become painful when exposed to the cold.
The diagnosis of cryoglobulinemia is made by a special test in the laboratory to detect the cryoglobulins in blood. Also, finding inflammation of small blood vessels in tissue biopsies supports the diagnosis of cryoglobulinemia. Symptoms of cryoglobulinemia often resolve with successful treatment of the hepatitis C virus infection.
B-cell non-Hodgkin's lymphoma, a cancer of the lymph tissue, has also been associated with chronic hepatitis C virus. The cause is thought to be the excessive stimulation by the hepatitis C virus of B-lymphocytes, which results in the abnormal reproduction of the lymphocytes.
In addition, up to 25% of hepatitis C virus patients have autoimmune antibodies such as anti-nuclear antibody, anti-smooth muscle antibodies, and rheumatoid factor.
Hepatitis C can cause a symmetric inflammatory arthritis that is often accompanied by a positive rheumatoid factor thus being confused with rheumatoid arthritis. There are no nodules with hepatitis C nor does it cause erosive joint changes.
Patients with rheumatoid arthritis can also have hepatitis C, which makes treatment decisions difficult, particularly when the use of biologics is entertained.
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