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Fibromyalgia (FM)-associated hepatitis C virus infection

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The objective was to determine whether there might be an
association between hepatitis C virus (HCV) chronic infection
and fibromyalgia (FM). We determined the prevalence of HCV
infection in 112 FM patients, in comparison with matched
rheumatoid arthritis (RA) patients from the out-patient clinic
of a teaching tertiary care general hospital. Furthermore, we
looked for evidence of FM in 58 patients diagnosed with
chronic hepatitis due to HCV, compared with matched surgery
clinic patients, HCV antibodies were determined by
enzyme-linked immunosorbent assay (ELISA) and recombinant
immunoblot assay (RIBA). Serum RNA of HCV (HCV-RNA) was
determined by polymerase chain reaction. In the group of FM
patients, HCV antibodies were found by ELISA in 17 (15.2%)
patients and in six (5.3%) of the RA controls (P < 0.05). RIBA
was positive in 16 and indeterminate in one of the FM
patients. Serum HCV-RNA was found in 13 of these FM patients.

In eight (47%) FM patients, alanine aminotransferase (ALT) was
normal, although HCV-RNA was detected in four (50%) of them.
In the group of patients with chronic hepatitis due to HCV,
all patients had HCV antibodies and the presence of HCV-RNA in
serum. Within these patients, 31 (53%) had diffuse
musculoskeletal pain, while six (10%) fulfilled FM diagnostic
criteria. In the control group, 13/58 (22%) had diffuse
musculoskeletal pain (P < 0.001), whereas only one female
patient (1.7%) fulfilled FM criteria (P < 0.05). Serum ALT was
51.7 +/- 38.4 in FM patients, whereas it was 122 +/- 76.3 in
patients with HCV chronic hepatitis but without FM (P <
0.001). There were no statistical differences in autoimmune
markers between patients with and without FM.

These data suggest that there exists an association between FM and
active HCV infection in some of our patients. FM is not associated
with liver damage or autoimmune markers in these patients. HCV
infection should be considered in FM patients even though ALT
elevations were absent.

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