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

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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


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


Lovy MR, Starkebaum G, Uberoi S

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