• How does liver damage occur in hepatitis C infection?

    The presence of HCV in the liver triggers the human immune system, which leads to inflammation. Over time, prolonged inflammation may cause scarring. Extensive scarring in the liver is called cirrhosis. When the liver becomes cirrhotic, the liver fails to perform its normal functions and this leads to serious complications and even death.

    How is hepatitis C virus spread?

    HCV is spread most efficiently through inadvertent exposure to infected blood.The most common route of transmission is a needle shared among users of illicit drugs. 
Accidental needle-sticks in healthcare workers also have transmitted the virus.HCV also can be passed from mother to unborn child. A small number of cases are transmitted through sexual intercourse. Finally, there have been some outbreaks of HCV when instruments or sharp tool have been re-used without appropriate cleaning between patients.

    Who get hepatitis rheumatic diseases?

    Hepatitis associated rheumatic disorders affect individuals of all ages, ethnicities and genders who have the HCV virus.Hepatitis C virus infection and rheumatic disorders are both common in the Middle East and share many clinical and immunological manifestations, raising diagnostic problems.

    What are the symptoms of hepatitis rheumatic diseases?

    Multiple joint pain or swelling (polyarthritis)was the most common rheumatic manifestation (35%) in the cases, followed by skin lesions/rash (cutaneous vasculitis) (15%). Kidney diseases (Glomerulonephritis) were uncommon.

    Two subsets of the disease have been identified:

    (1)  Multiple joint affected involving small joints that resembles rheumatoid arthritis, but is usually milder.

    (2)  Single or little joint involvement that shows an intermittent course and is frequently associated with the presence of cryoglobulins in serum.

    Do I need to do blood tests?

    Immunological abnormalities included serum rheumatoid factor, cryoglobulins, and one or more autoimmune antibodies are useful for diagnosis. Hepatitis C virus RNA is used to determine virus activity.

    What are the treatment options for these conditions?

    Hydroxychloroquine, low doses of corticosteroids and NSAIDs are frequently administered to patients with hepatitis associated arthritis diseases.

    Use of antiviral drugs (Interferon plus ribavirin) shows good results, but interferon can induce or worsen autoimmune disorders. For this reason, in our opinion, this approach should be prescribed only when required by the coexistent liver disease.

    On the basis of the poor available data, the administration of biological (anti-TNF-α) agents seems safe in HCV patients, but the usually non-aggressive course of hepatitis associated diseases does not justify their use as a current therapy.

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