Wednesday, September 29, 2010

HCV/OTHER MEDICAL PROBLEMS




Chronic hepatitis C infection causes problems for parts of the body beyond the liver. The organs most often affected include the blood vessels, skin, joints, kidneys, thyroid gland, heart and brain. The virus itself has been found in the heart,muscles, nerves and lymphatic system.

Many problems may arise from the cirrhosis, per se. Potential problems from cirrhosis include fluid accumulation in the abdomen, bleeding into the stomach, jaundice, confusion, poor blood clotting, coma, and susceptibility to infection. During the last years many autoimmune manifestations have been correlated with HCV infection, namely sicca syndrome ,chronic polyarthritis, polydermatomyositis, fibromyalgia, autoimmune thyroiditis, lung fibrosis, and diabetes mellitus.
(Curr Opin Rheumatol 2000 Jan;12(1):53-60)

UPPER RIGHT QUADRANT (URQ)
PAIN (SIDE PAIN)
Even though the liver itself contains no
nerve endings, and does not feel pain,
many people with HCV experience a pain
on the upper right side of their body, just
beneath the ribs. It varies from a dull ache
and bruised feeling, to sharp stabbing pain
which is quite different from “gas pains.”
This is thought by some to be “referred
pain” from the swelling of the liver capsule
due to the disease process. This pain may
also be referred to the right shoulder or to
the back between the shoulder blades.

CRYOGLOBULINEMIA
One-third to one-half of people with
chronic hepatitis C infection have
cryoglobulinemia. Cryoglobulinemia is a
condition where antibodies which are attached
to the hepatitis C virus solidify
when cold. Hepatitis C is recognized as the
most common cause of mixed cryoglobulinemia.
Most of the people with cryoglobulinemia
from hepatitis C have had their hepatitis
for a long time or have cirrhosis. People
with higher concentrations of hepatitis C
RNA in their blood do not seem to have a
higher risk of having cryoglobulinemia.
Usually the cryoglobulins are in low concentration
and cause no symptoms.

About 20% of people with hepatitis C and
cryoglobulinemia have symptoms. Symptoms
most often associated with cryoglobulinemia
include mild fatigue, joint pains, or itching.
Occasionally, people with cryoglobulinemia
develop vasculitis (inflammation of the blood
vessels) which can cause purpura (purple skin
lesions), Raynaud’s phenomenon (the hands
turn white, then blue, and then red from constriction
and subsequent dilation of the blood
vessels), or numbness in the hands and feet.
The presence of cryoglobulinemia does not
affect people’s response to interferon. In fact,
some people with vasculitis have improvement
in the vasculitis as their liver tests improve on
interferon.

RHEUMATOID ARTHRITIS-LIKE
SYMPTOMS
Hepatitis C infection can mirror rheumatoid
arthritis symptoms. 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
rheumatoid factor. In such patients, gammaglutamyl
aminotransferase, serologic studies
for hepatitis C, and other tests appropriate
for chronic liver disease should be performed.

RHEUMATOLOGIC and AUTOIMMUNE MANIFESTATIONS
Myalgia (muscle pains), fatigue and arthralgias (joint pains) are common manifestations of HCV infection. HCV-related arthritis commonly presents as symmetrical inflammatory arthritis involving small joints. The joints involved in HCV-related arthritis are similar to rheumatoid arthritis (RA). This sometimes makes it difficult to differentiate true RA from HCV patients with positive rheumatoid factor but without RA. HCV-related arthritis is usually non-deforming and there are no bony erosions in the joints. A marker called anti-keratin antibodies has been studied to differentiate true RA from HCV related arthritis. In a recent study, 71 patients who were rheumatoid factor positive were tested for anti-keratin antibodies. Anti-keratin antibodies were detected in 20/33 (60.6%) patients with true RA and only 2/25 (8%) patients with HCV-related arthritis (10). Patients with HCV-related arthritis seldom respond to anti-inflammatory medications, and although there are no controlled trials to address this issue, it has been recommended to treat these patients with combination antiviral therapy of interferon and ribavirin (11).Sjogren’s syndrome (SS), an autoimmune disease characterized by dry eyes and dry mouth has been found in some studies to be more common in HCV infected patients. They differ from primary SS in that they do not have lung and kidney involvment. Thus it is recommended to test for HCV infection in patients with SS or primary SS. A study by El-Serag of 34,000 veterans failed to show a significant association between HCV infection and diabetes, SS, or autoimmune thyroid disease (9).

Interferon therapy of HCV infection may also trigger the development of autoimmune diseases, the most frequent of which is autoimmune thyroiditis (Hashimoto’s thyroiditis). This may lead transiently to hyperthyroidism, but eventually to hypothyroidism (underactive thyroid) and to the need for life-long thyroid replacement therapy (Bonkovsky & Mehta).

Fibromyalgia
Fibromyalgia is the name for a condition
that typically includes widespread muscle
pain, fatigue and abnormal sleep patterns.
Until a few years ago, doctors called the
condition fibrositis, or muscular rheumatism,
and believed mostly that the condition was “all
in the patient’s head”. Today, fibromyalgia is
recognized by medical organizations as a
genuine and serious problem.
The symptoms of fibromyalgia typically
include pain in many muscles, and around
ligaments and tendons, persistent fatigue, waking
up feeling tired even after a full night’s
sleep, headaches, bouts of constipation and
diarrhea, abdominal pain, painful menstrual
periods, sensitivity to cold, numbness or tingling,
and difficulty exercising.
Symptoms vary widely among patients and
tend to wax and wane over time. An illness,
injury, cold weather or emotional stress may
trigger a fibromyalgia episode or make ongoing
symptoms worse.

Learn about the potential connection between Hepatitis C and fibromyalgia, and find out why it is possible that Hepatitis C infection may act as a trigger for fibromyalgia syndrome.


If you suspect having both conditions, awareness of this link can lead you to seek the expert evaluation and care that may help reduce your symptoms of pain and fatigue .........

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