Response to Interferon Alfa Therapy in a Patient with HCV-related Arthritis

Among the most frequently submitted questions to The Doctor is in Q and A on HIV and Hepatitis.com are those posed by patients with chronic hepatitis C who are currently on therapy or who have recently completed therapy and who are experiencing symptoms of arthritis. They frequently inquire whether the arthritic symptoms result from their therapeutic regimen of interferon/peginterferon + ribavirin or whether HCV infection causes them.

This issue is partially addressed in the following summary of a case report recently published in the Medical Science Monitor:

Extrahepatic manifestations associated with Hepatitis C virus (HCV) such as arthritis, vasculitis, and cryoglobulinemia are well known. However, HCV-related arthritis in the absence of clinical, biochemical and histological evidence of liver disease is not commonly seen, according to the authors. This article deals with such a case and its response to interferon therapy.

The authors present the case of a 32-year-old Filipino male who presented with bilateral symmetrical painful swelling of multiple joints including, hands, elbows, shoulders, and knees.

Serum rheumatoid factor, antinuclear antibodies and a comprehensive work-up for rheumatologic disorders were all negative.

Both initially and subsequently, serological tests for hepatitis A, B, and autoimmune liver diseases, Wilson’s disease, hemochromatosis, syphilis, human immunodeficiency virus (HIV) and cryoglobulinemia were negative, initially and subsequently. However, the hepatitis C antibody test was positive and hepatitis C viral RNA was detected in high titers [emphasis added—Ed].

The joint symptoms did not improve despite therapy with nonsteroidal anti-inflammatory drugs and a short course of prednisone prescribed earlier by his primary care physician. The patient then requested and was subsequently treated with standard interferon alfa-2b (Intron A or Roferon A).

According to the authors, the patient responded rapidly to the interferon therapy with “significant and sustained improvement in joint symptoms and disappearance of hepatitis C viral RNA from his serum.”

The authors conclude, “HCV arthritis should be considered in the differential diagnosis of seronegative arthritis of undetermined etiology even in the setting of normal liver chemistries.”

Commentary

The end result in this individual case was a good one, as the authors describe it, but not all patients with HCV-related arthritis experience a “significant and sustained improvement” in their symptoms after initiating anti-HCV therapy. In the present case study, it appears that the patient received standard interferon alfa monotherapy (use of ribavirin is not mentioned). 

More data on the relationship between hepatitis C, arthritis and interferon therapy are required in order to help guide physician and patient decision-making about how best to alleviate and overcome severe arthritic symptoms related to chronic hepatitis C.

07/13/05

Reference
A Akhtar and Allen Funnyé^. Hepatitis C virus associated arthritis in absence of clinical, biochemical and histological evidence of liver disease – responding to interferon therapy. Medical Science Monitor 11(7): CS37-39. 2005.

Recommended Reading

E Zukerman, D Yeshurun and I Rosner. Hepatitis C virus-related arthritis: characteristics and response to therapy with interferon alpha. Clin Exp Rheumatol 18(5): 579-584. Sep-Oct 2000.

Y Bayraktar and others. A comparison of the prevalence of autoantibodies in individuals with chronic hepatitis C and those with autoimmune hepatitis: the role of interferon in the development of autoimmune diseases. Hepatogastroenterology 44(14):417-25. March-April 1997.

E Bon and others. Rheumatic manifestations of chronic hepatitis C and response to the treatment with interferon alpha-2b [article in French; abstract in English]. Rev Rhum Ed Fr  61(7-8): 497-504. 1994.  

L E Wilson and others. Autoimmune disease complicating antiviral therapy for hepatitis C virus infection. Seminars in Arthritis Rheumatism 32(3):163-73. December 2002.

F Lunel and P Cacoub. Treatment of autoimmune and extra-hepatic manifestations of HCV infection [article in French; abstract in English]. Annales de Medicine Interne 151(1): 58-64. February 2000.   

M R Lovy and others. Hepatitis C infection presenting with rheumatic manifestations: a mimic of rheumatoid arthritis. Journal of Rheumatology 23(6):979-983. June 1996.   

M C Jendro, J L Hulsemann and H Zeidler. Hepatitis C virus in rheumatic diseases [article in German; abstract in English]. Zeitschrift der Rheumatologie 56(5): 276-286. October 1997.

Intron A - (Recombinant Interferon Alfa-2b) MONOTHERAPY

Intron A Drug Summary (Monotherapy)