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Rheumatic Hand Manifestations Observed in Chronic HCV

Hepatitis C virus infection prompted hand manifestations among Egyptian patients, according to study data. 

“Patients infected with HCV might develop at least one extra hepatic manifestation in 40% to 74% of cases during the course of the disease; rheumatologic manifestations are among the most frequent,” the researchers wrote. “Hand manifestations in the form of arthralgia and arthritis are the main extra hepatic manifestations in patients with HCV affecting mainly the metacarpophalangeal joints, wrists and proximal interphalangeal joints. However, the decision of treatment may be difficult and hazardous as patients with [rheumatoid arthritis] require more aggressive therapy.”

Researchers recruited 297 patients (54.2% male) with HCV from the National Hepatology and Tropical Medicine Research Institute in Egypt who underwent testing for erythrocytic sedimentation rate, C-reactive protein, rheumatoid factor, antinuclear antibody and anti-cyclic citrullinated peptide, as well as a plain X-ray, for hands and wrists.

Overall, 46.1% of patients (n=137) experienced hand abnormalities during the study. The most frequent hand manifestations observed among the cohort were arthralgia (28.6%), tenosynovitis in the flexor tendons of the hands (10.1%), Raynaud’s phenomenon (9.1%) and arthritis (5.1%). Rheumatoid factor was observed in 114 patients, cryoglobulins were found in 28, four patients had anti-cyclic citrullinated peptide, but were negative in HCV-related polyarthritis and cryoglobulinemia, and 19 had antinuclear antibody. Four percent of patients had abnormal X-rays due to hand erosions and narrow joint spaces. Hand erosions were found to be related to arthritis (P<.001), as well as arthralgia (P<.01). 

“The study emphasizes the important role of HCV in inducing rheumatic hand manifestations and autoantibodies in chronic HCV patients, but it is mostly non-deforming and non-significant,” the researchers concluded. “Therefore, surveillance for the occurrence of the rheumatic manifestations as well as testing for the autoantibodies with occasional multidisciplinary team approach to HCV patients for early diagnosis and treatment is needed.”

Disclosure: The researchers report no relevant financial disclosures.