Musculoskeletal manifestations and factors elevating hepatic enzyme in patients with hepatitis B and C viral infection

Bae, Sung Kwon; Song, Jung Soo; Park, Won

Abstract

BACKGROUND: To investigate the musculoskeletal manifestations and factors aggravating hepatic enzyme in patients with hepatitis B (HBV) and C (HCV) viral infection.
METHODS
Eighty seven patients with HBV (72 patients) and HCV (15 patients) infection complaining of musculoskeletal symptoms were investigated retrospectively.
RESULTS
Extrahepatic manifestations of patients with hepatitis viral infection were arthralgia/ arthritis (77%/72%), dermatologic manifestations(16%), neurologic manifestations (11%), and constitutional symptoms (6%). The kinds and the incidence of extrahepatic symptoms were not different between two viral infections. The rheumatologic diagnosis of patients with hepatitis viral infection were RA (41%), fibromyalgia (13%), Sj gren's syndrome (7%), SLE (5%), sacroiliitis (5%), Behcet's disease (5%), carpal tunnel syndrome (3%), and unclassified arthritis (32%). The diagnosis were not different between the two groups. There was no association of the hepatitis viral infection with any specific rheumatic disease. The patterns of arthritis were polyarthritic (79%), oligoarthritic (16%), and monoarthritic (5%) and the involvement sites were peripheral (89%), root (38%), and axial(29%). The involvement of root joint in patients with HBV (41%) infection was more frequent than HCV (22%) infection (p<0.05). The involvement of axial and peripheral joint was not different between the two groups. The prevalence of rheumatoid factor and anti-nuclear antibody were 48% and 21% in patients with hepatitis viral infection respectively. Patients taking steroid, hydroxychloroquine, bucillamine, or combined disease modifying antirheumatic drugs (DMARDs) tended to have aggravated hepatic enzyme level (p<0.05).
CONCLUSION
The patients with hepatitis viral infection showed various musculoskeletal manifestations without relation to any specific rheumatic disease. The patients with HBV infection had more involvement in root joint than HCV infection. The steroid, hydroxychloroquine, bucillamine, or combined DMARDs were related to aggravated hepatic enzyme.