الفهرس 
Hepatitis C virus infectionOnly 14 pages are availabe for public view
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Abstract
Hepatitis C is a disease with a significant global impact. It causes chronic liver disease in 70–80% of patients and leads to severe complications such as cirrhosis and liver cancer after many years. HCV infection is usually asymptomatic. It is often detected incidentally either through a routine evaluation of liver tests or at the time of blood donor testing.Although asymptomatic joint involvement and arthralgias are frequent in patients with hepatitis C virus chronic infection, a true arthritis affects only up to 4% of the subjects. HCVrA is usually distinguished in two clinical subsets: a more frequent symmetrical polyarthritis, similar to rheumatoid arthritis but much less serious, and an intermittent mono-oligoarthritis that involves medium and large sized joints, mainly the ankle. This latter subset is strictly related to the presence of HCV-induced mixed cryoglobulinemia and its cutaneous manifestations, in particular purpura. According to recent reports, anti-CCP antibodies are considered very useful in differentiating the symmetrical polyarthritis subset from rheumatoid arthritis.The treatment of HCVrA is still largely empirical because few studies have analyzed this topic. However, COXIBs, NSAIDs, low doses of corticosteroids, hydroxychloroquine. The comorbidity may be treated with the standard therapeutic strategies for RA in particular for methotrexate and leflunomide. However, they may be employed after carefully evaluating and monitoring liver involvement.On the basis of recent studies, the administration of cyclosporine also seems to be sufficiently safe. The scarcely aggressive nature of HCVrA does not favour the use of anti-TNF agents. The use of biologics (rituximab) may be considered in more severe cases. Specific anti-viral therapy (interferon-α + ribavirin) must be accurately evaluated because interferon-α can induce the development or the worsening of the original rheumatic complaints.MCs represents the prototype of virus-related autoimmune-lymphoproliferative diseases. MCs can be treated at different levels by means of etiological treatment with antivirals (peg-interferon-alpha plus ribavirin) aimed at HCV eradication and/or pathogenetic/symptomatic treatments directed to both immune-system alterations and the vasculitic process (rituximab, cyclophosphamide, steroids or plasmapheresis).In clinical practice, the therapeutic strategy should be modulated according to severity/activity of the MCs and possibly tailored to each individual patient’s conditions. Cryoglobulinemic skin ulcers may represent a therapeutic challenge, which should be managed by means of both local and systemic treatments.Primary Sjögren’s syndrome is rarely associated with HCV infection, while sicca syndrome and myalgia are frequently detectable in hepatitis C patients, with or without cryoglobulinemic vasculitis. Other autoimmune rheumatic disorders (poly/dermatomyositis, polyarteritis nodosa, osteosclerosis and fibromyalgia) have been reported as potentially associated with HCV infection in patient populations from different countries, suggesting the role of genetic and/or environmental co-factors. The therapeutic approach to these disorders should be decided according to each individual patient’s evaluation, including hepatic, virological, and immunological findings.