Current treatment of hepatitis C-associated rheumatic diseases

Review
Current treatment of hepatitis C-associated rheumatic diseases

Clodoveo Ferri^*, Marco Sebastiani, Alessandro Antonelli, Michele Colaci, A Manfredi and Dilia Giuggioli

* Corresponding author: Clodoveo Ferri clferri@unimo.it   

Arthritis Research & Therapy 2012, 14:215 doi:10.1186/ar3865
Published: 25 June 2012

            
Abstract (provisional)

Hepatitis C virus (HCV) is both hepatotropic and lymphotropic virus responsible for a great number of hepatic and extrahepatic immune-system disorders, the so-called HCV syndrome. The HCV-associated rheumatic diseases are characterized by frequent clinico-serological overlapping; therefore a correct classification of the single patient is necessary before the therapeutical decisions. These latter are particularly difficult because of the coexistence of viral infection and complex autoimmune alterations. In this context, mixed cryoglobulinemia syndrome (MCs) represents the prototype of virus-related autoimmune-lymphoproliferative diseases. The MCs can be treated at different levels by means of etiological treatment with antivirals (peg-interferon-alpha plus ribavirin) aimed at HCV eradication and/or pathogenetic/symptomatic treatments directed to both immune-system alterations and vasculitic process (rituximab, cyclophosphamide, steroids, plasmapheresis, etc.). In clinical practice, the therapeutic strategy should be modulated according to severity/activity of MCs and possibly tailored on the single patient's conditions. Cryoglobulinemic skin ulcers may represent a therapeutical challenge, which should be managed by means of both local and systemic treatments. HCV-associated arthritis should be differentiated from the simple comorbidity of HCV infection and classical rheumatoid arthritis. It may be treated with low dosage of steroids and/or hydroxychloroquine; the use of biologics (rituximab) may be considered in more severe variants. Primary Sjogren's syndrome is rarely associated to HCV infection, while sicca syndrome and myalgia are frequently detectable in hepatitis C patients, with or without cryoglobulinemic vasculitis. Osteosclerosis is a rare disorder described in adults with HCV infection; clinically, it is characterized by nonspecific, often diffuse bony pain and tenderness over involved bones due to periosteal stretching, in the absence of joint swelling or motion limitation. In few cases reported to date, symptomatic treatments may provide some benefit; interestingly, one patient recently described showed a clear-cut improvement of bone sclerosis after antiviral therapy. Other autoimmune rheumatic disorders (fibromyalgia, poly/dermatomyositis, polyarteritis nodosa, etc.) have been reported as potentially associated to HCV infection in patients' populations from different countries, suggesting the role of genetic and/or environmental co-factors. The therapeutical approach to these disorders should be balanced (immunosuppressors/antivirals or both) according to patient's evaluation of hepatic, virological, and immunological findings.

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