Olivieri Ignazio, Palazzi Carlo, Padula Angela
Lucania Department of Rheumatology, San Carlo Hospital, Contrada Macchia Romana, Potenza 85100, Italy.
Rheum Dis Clin North Am. 2003 Feb;29(1):111-22. doi: 10.1016/s0889-857x(02)00097-2.
Arthritis is one of the several autoimmune disorders induced by HCV infection. There is not a specific clinical pattern of HCV-related arthritis, but two nonerosive subsets have more frequently been described: a RA-like polyarthritis and a less common mono-oligoarthritis involving medium-sized and large joints, often showing an intermittent course. This latter form is associated with the presence of serum cryoglobulins. Because of its variable characteristics, HCV-related arthritis must be considered in the differential diagnosis of many patients having inflammatory joint involvement. Antikeratin antibodies and possibly IgA RF can be useful in distinguishing between RA and HCV-related RA-like polyarthritis. In fact, these tests are highly specific in RA patients. In any case, the search for HCV antibodies should be more widely performed in the diagnostic approach to rheumatic diseases. An association between PsA and HCV infection has been described in the literature, but the authors were unable to confirm these data. Nonsteroidal anti-inflammatory drugs, hydroxychloroquine, and low doses of corticosteroids are the cornerstones of the treatment of HCV-related arthritis. An etiologic therapy with alpha-interferon and ribavirin is useful when required by hepatic or systemic involvement; such therapy could also be considered in selected cases of isolated arthritis that are unresponsive to other drugs. Few case reports described the onset of polyarthritis after the administration of alpha-interferon for HCV-related chronic hepatitis. This topic should be more accurately studied in the future to exclude a spurious association between the two events.
关节炎是由丙型肝炎病毒（HCV）感染诱发的几种自身免疫性疾病之一。HCV相关性关节炎没有特定的临床模式，但有两种非侵蚀性亚型被更频繁地描述：类风湿关节炎（RA）样多关节炎和较少见的累及中大型关节的单寡关节炎，通常呈间歇性病程。后一种形式与血清冷球蛋白的存在有关。由于其特征多变，在许多有炎症性关节受累的患者的鉴别诊断中必须考虑HCV相关性关节炎。抗角蛋白抗体以及可能的IgA类风湿因子（RF）有助于区分RA和HCV相关性RA样多关节炎。事实上，这些检测在RA患者中具有高度特异性。无论如何，在风湿病的诊断方法中应更广泛地检测HCV抗体。文献中描述了银屑病关节炎（PsA）与HCV感染之间的关联，但作者无法证实这些数据。非甾体抗炎药、羟氯喹和低剂量皮质类固醇是HCV相关性关节炎治疗的基石。当肝脏或全身受累需要时，使用α干扰素和利巴韦林进行病因治疗是有用的；在对其他药物无反应的孤立性关节炎的特定病例中也可考虑这种治疗。很少有病例报告描述在使用α干扰素治疗HCV相关性慢性肝炎后发生多关节炎。这个问题在未来应该更准确地研究，以排除这两个事件之间的虚假关联。
