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Hepatitis C infection presenting with rheumatic manifestations: a mimic of RA

  [ 18 votes ]   [ Discuss This Article ]
www.ProHealth.com • June 10, 1996


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 or 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.

Lovy MR, Starkebaum G, Uberoi S




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