Background Hepatitis C (HCV) infection is associated with musculoskeletal manifestations such as chronic widespread pain (CWP), sicca syndrome, polyarthritis and a reduced health-related quality of life (HRQOL). Little data is available on the effect of treatment on these manifestations. This study measured changes in extra hepatic symptoms before and after antiviral treatment in a large UK patient cohort.
– Investigate whether HRQOL and rheumatological symptoms are associated, or improve following antiviral therapy.
– Investigate whether improvement is dependent on sustained viral response (SVR) after treatment.
Methods 118 patients with HCV completed standard antiviral treatment with pegylated interferon and ribavirin and answered the hepatitis quality of life questionnaire (HQLQ) and a survey of symptoms affecting the spine, muscles, bones and joints before treatment and six months after finishing treatment. Outcome measures included presence/absence of CWP according to Manchester criteria, pain-intensity and life-impact scored on a visual analogue scale (VAS), and sicca symptoms using the Vitali questionnaire. Pre and Post treatment results were compared and tested against patient demographic data and serological markers such as presence/absence of sustained viral response (SVR) to treatment and rheumatoid factor.
Results There was a significant improvement in 6 out of 12 HQLQ domains: Physical-functioning, Physical-disability, Social-functioning, Limitations and Health-distress due to hepatitis, and General-health. There was a significant decline in Positive well-being, Health-distress, and Mental-health, and no significant change in Body-pain, Motivation, or Vitality. After treatment there was a significant decline in CWP (26.3% of patients pre-treatment vs. 15.3% post, p=0.015), pain for more than three months (64.4% pre vs. 53.4% post, p=0.041), and agreeing with the statement “I ache all over” (23.7% pre vs. 13.6% post, p=0.029). Having CWP pre-treatment was significantly associated with worse pre-treatment pain intensity (5.7/10 with vs. 2.7/10 without, p>0.001) and Life-impact (5.0/10 vs. 2.1/10, p>0.001), though the average VAS pain scores and number of painful joints did not fall significantly post-treatment. Having CWP pre-treatment was significantly associated with worse scores in all HQLQ domains except Vitality, Health Distress, and Positive well being. A disappearance of CWP post-treatment was significantly associated with improvement in the Body-pain HQLQ domain (15.4 points better if CWP disappears vs. 4.28 better if CWP stays, p=0.037). There was an association between acheiving SVR and improvement in both HQLQ scores, and CWP, but these were not significant. There was a low number of patients with sicca symptoms, which fell without significance post-treatment (12.7% pre vs. 11% post), and was not associated with SVR.
Conclusions Antiviral therapy significantly improves HRQOL and CWP symptoms in HCV patients, independently of SVR. In our sample, CWP was prevalent and demonstrably associated with HRQOL, but not fully accounted for by cryoglobulinaemia. Sicca symptoms were unaffected by treatment. Although a viral role in CWP cannot be deduced by these results, the impact of antiviral therapy on physical and social aspects of HRQOL is positive regardless.
Disclosure of Interest None Declared
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