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Approximately 130 million people worldwide are infected with hepatitis C virus (HCV). Although HCV primarily damages the liver, infection also causes multiple extrahepatic manifestations, including elicitation of autoimmune reaction, deposition of immune complexes and/or lymphoproliferation. Some patients develop arthritis, and many patients with HCV-related polyarthritis also meet the American College of Rheumatology criteria for rheumatoid arthritis (RA). Consequently, clinicians have noted an association between rheumatic diseases and chronic HCV infection. It has been difficult, however, to document this association in research studies.
In a recently published study in PLoSOne, investigators Fu-Hsiung Su, MBBS, PhD, and colleagues describe their research to assess the risk of developing RA among patients with chronic HCV infection.1 The researchers studied patients in Taiwan, a country with a high prevalence of both HCV and hepatitis B virus (HBV) infections, as well as RA (52.4 per 100,000).
After adjusting for covariates, the team found that chronic infection with HCV was associated with the development of RA. The increased risk remained significant even after the investigators restricted their analysis to patients who were prescribed disease-modifying antirheumatic drugs. Men were more likely than women to have RA associated with chronic HCV infection.
Additionally, researchers found that patients with chronic HCV infection and HBV/HCV dual infection were more likely to have RA than patients with non-chronic HBV and HCV infections, although chronic HBV infection was not associated with a high risk of developing RA.
This latter finding stands in contrast to previous studies that suggested chronic HBV infection may trigger the development of autoimmune rheumatic diseases. The investigators did find, however, that chronic HBV infection with persistent or periodic impairment of liver function was associated with RA.