Study of Rheumatological Manifestations of Hepatitis C In Chronic Haemodialysis Patients

Abstract

HCV is a major health problem, it is the main cause of transfusion-associated hepatitis and is also seen in intravenous drug abuse, organ transplant , hemodialysis patients and health care workers. In addition to hepatitis, cirrhosis and HCC and several extra-hepatic manifestations have been reported in the natural history of HCV infection. According to different studies, 40-74% of patients infected with HCV might develop at least one extra-hepatic manifestations during the course of the disease. A significant proportion of these extrahepatic manifestations disorders are rheumatological in nature. Musculoskeletal manifestations and autoimmune markers are common in HCV infection and systemic autoimmune diseases. Experimental, virologic, and clinical evidence has demonstrated a close association between hepatitis C virus infection and cryoglobulinemia syndrome, with hepatitis C virus-associated rheumatoid like manifestations being indistinguishable in most cases from the primary form rheumatoid arthritis. With respect to rheumatoid arthritis, patients with hepatitis C virus-related polyarthritis and positive rheumatoid factor may fulfill the classification criteria for rheumatoid arthritis. Recent data are available on the use of new immunosuppressive and biologic agents (mainly mycophenolate mofetil, anti-tumor necrosis factor agents, and rituximab) in patients with hepatitis C virus infection and autoimmune manifestations. The aim of this study was to analyze the frequency of rheumatological manifestations in chronic prevalent haemodialysis egyptian patients with HCV infection. This study was performed on 40 CKD patients on regular renal HD and they were divided into two groups: Group I: consists of 20 patients with CKD and positive for anti-HCV antibodies on prevalent haemodialysis. Group II: consists of 20 patients with CKD and negative for anti-HCV antibodies on prevalent haemodialysis. Full patient assessment was done for all groups including thorough history taking, physical examinations, and some hematological examinations.

We found that:- • The prevalence of purpra( 5%) was approximately similar in CKD subjects with HCV positive antibodies or HCV negative antibodies. • The prevalence of musculoskletal manifestaions (arthralgia and myalgia) (25%) , arthritis (10%) cryoglobulinemia ( 15%), serum hypocomplementemia C3 (20%) , hypocomplementemia C3 (25%), and positive rheumatoid factor ( 30%) are significantly higher among end stage renal subjects on prevalent haemodialysis with positive HCV than those with negative HCV