Background Hepatitis C virus (HCV) infection is a global health problem, Egypt has the highest prevalence rate reach 20%. HCV infection is associated with extrahepatic manifestations including rheumatic autoimmune manifestations, on the other hand; there is growing interest in the impact of HCV on Egyptian rheumatoid arthritis patients (RA).
Objectives The aim of this work was to determine the prevalence of HCV infection in a cohort of patients with RA, and to identify the impact of its presence on the pattern of RA disease, disease activity, functional assessment & radiological damage.
Methods 110 RA patients fulfilled the ACR 1987 revised criteria for the classification of RA were included. Disease activity was assessed using the disease activity score 28 (DAS28) and Functional disability was assessed by the Modified Health Assessment Questionnaire (MHAQ). The following laboratory tests were done; 1-Rheumatoid Factor (RF) was assayed with immunonephelometry test. 2- anti-citrullinated protein antibody (ACPA) was measured using the microparticle enzyme immunoassay (MEIA) method. 3-ANA was done using indirect immunofluorescence. 4-HCV infection was diagnosed by HCV-antibody using MEIA test and detection of quantitative HCV-RNA using reverse transcriptase polymerase chain reaction. Plain radiographs for both hands, wrists and feet were taken for each patient (in postero-anterior view) and radiological damage was assessed by a Modified Larsen's score.
Results Ninety seven patients were females (88.2%) and 13 were males (11.8%) with mean age (44.6±12.7) and disease duration (7.92±6.56 years). HCV antibody was detected in 22 out of 110 RA patients (20%). Positive HCV RNA by PCR was present in 14 RA patients (12.7%). HCV-Ab positive patients were significantly older, more frequently male and had a longer disease duration than HCV-Ab negative patients (P<0.05). Regarding pattern of arthritis; all patients included in this study had symmetric polyarthritis but HCV-Ab positive patients had significantly more frequent deformities, higher MHAQ scores (P<0.05) and also significantly higher ESR than HCV-Ab negative ones (p<0.05). Regarding extraarticular manifestations in RA patients; HCV-Ab positive RA patients had significantly more frequent vasculitis (in the form of palpable purpura & mononeuritis multiplex), (P<0.05) and hepatomegaly (P<0.05) and significantly higher frequency of bronchial asthma (P<0.05) than HCV-Ab negative patients. However, there were no differences in DAS28 and modified Larsen's score, RF, ACPA and ANA frequencies were detected between both groups (P>0.05).
Conclusions A high prevalence of HCV infection is present among Egyptian RA patients which reflects the high prevalence of HCV infection in Egypt, so routine screening for HCV infection in Egyptian RA patients is recommended. Moreover, HCV infection in RA patients is associated with significant disability and comorbidities in form of bronchial asthma, hepatomegaly and vasculitis.
Disclosure of Interest None declared
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