Rivera J, García-Monforte A, Pineda A, Millán Núñez-Cortés J
Instituto Provincial de Rehabilitación, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
J Rheumatol. 1999 Feb;26(2):420-4.
To describe the clinical picture of arthritis in patients with chronic infection by hepatitis C virus (HCV).
Two patient populations were studied. Patients with arthritis and evidence of serum elevation of alanine aminotransferase (ALT) at the consultation were checked for HCV infection. A second group of 303 consecutive patients with rheumatoid arthritis (RA) were also checked for the presence of HCV antibodies. All patients attended the outpatient rheumatology unit of a tertiary care teaching hospital. Chronic HCV infection was determined by the presence of viral RNA in serum. A group of 315 first-time blood donors served as controls.
Twenty-eight patients with arthritis and chronic HCV infection were identified. Seven fulfilled criteria for RA, psoriatic arthritis was found in one patient, systemic lupus erythematosus in one, gout in 2, chondrocalcinosis in 2, osteoarthritis in 7, and tenosynovitis in one. In 7 patients with a clinical picture of intermittent arthritis, a definitive diagnosis could not be made. In these patients, mixed cryoglobulinemia was present in 6/7 (86%), whereas mixed cryoglobulinemia was found in 6/21 (28%) of the other patients. Among patients with RA, 23 (7.6%) had HCV antibodies, and active infection by HCV was found in 7 (2.3%) patients. The prevalence of HCV antibodies in a blood donor population was 0.95%, significantly different (p<0.001; 95% CI 0.03, 0.10) compared to patients with RA. The distribution of antibodies determined by recombinant immunoblot analysis was similar (p = NS) between RA patients and blood donors with HCV antibodies.
There is not a single clinical picture of arthritis in patients with chronic HCV infection. There is a well defined picture of arthritis associated with the presence of mixed cryoglobulinemia that consists of an intermittent, mono or oligoarticular, nondestructive arthritis affecting large and medium size joints. Although a high prevalence of HCV antibodies is suspected in patients with RA, its occurrence may be coincidental and its interpretation is difficult to determine from the data in this study.
描述丙型肝炎病毒（HCV）慢性感染患者的关节炎临床表现。
研究了两组患者。对就诊时有关节炎且血清丙氨酸氨基转移酶（ALT）升高证据的患者进行HCV感染检查。另一组303例连续的类风湿关节炎（RA）患者也接受了HCV抗体检测。所有患者均在一家三级护理教学医院的门诊风湿病科就诊。通过血清中病毒RNA的存在来确定慢性HCV感染。一组315名首次献血者作为对照。
确定了28例有关节炎和慢性HCV感染的患者。7例符合RA标准，1例为银屑病关节炎，1例为系统性红斑狼疮，2例为痛风，2例为软骨钙质沉着症，7例为骨关节炎，1例为腱鞘炎。7例有间歇性关节炎临床表现的患者无法做出明确诊断。在这些患者中，6/7（86%）存在混合性冷球蛋白血症，而其他患者中6/21（28%）存在混合性冷球蛋白血症。在RA患者中，23例（7.6%）有HCV抗体，7例（2.3%）患者存在HCV活动性感染。献血人群中HCV抗体的患病率为0.95%，与RA患者相比有显著差异（p<0.001；95%CI 0.03，0.10）。通过重组免疫印迹分析确定的抗体分布在有HCV抗体的RA患者和献血者之间相似（p=无显著性差异）。
慢性HCV感染患者不存在单一的关节炎临床表现。存在一种与混合性冷球蛋白血症相关的明确关节炎表现，其特征为间歇性、单关节或寡关节、非破坏性关节炎，累及大、中关节。虽然怀疑RA患者中HCV抗体患病率较高，但其出现可能是巧合，且根据本研究的数据难以确定其解释。
