The clinical roles of rheumatoid factor in the treatment of chronic hepatitis C infection

Objective: The hepatitis C virus infection is associated with arthritis. However, the clinical roles of the rheumatoid factor in patients who received anti-viral treatment are not as clear. Methods: To identify the association between the rheumatoid factor and the treatment response in hepatitis C virus infected patients, we enrolled patients who received anti-viral treatment with peg-interferon plus weight-based ribavirin according to response guided therapy. Patients who had a mix type hepatitis C infection, any autoimmune diseases, hepatitis B co-infection or intolerance to the side effects of therapy were excluded. Patients were divided into a rheumatoid factor (RF) positive (>20 IU/ml) group and a rheumatoid negative group. The patient’s characteristics, treatment response, dynamic changing of the rheumatoid factor and factors influenced the sustained virus response (SVR) of therapy, which were analyzed. Results: A total of 271 patients completed the anti-viral treatment and analysis. The positive rate of the rheumatoid factor is 47.23% (128/271). In the RF positive group, the SVR rate was 82.8%, 71.0%, 96.6% for overall, genotype 1 infected, and non-genotype 1 infected patients, respectively. In the RF negative group, the SVR rate was 77.6%, 66.7%, 91.9% for overall, genotype 1 infected, and non-genotype 1 infected patients, respectively. There is a trend toward a higher SVR rate in RF positive patients, but no statistical difference was noted. In RF positive patients who achieved SVR, the RF values reduced significantly (56.4±78.0 vs. 39.4±39.6, P<0.001) after treatment but not in the non-SVR group (43.8±25.9 vs. 31.7±13.5, P=0.074). In the RF negative group, 37.8% and 34.4% of the patients’ RF became positive after treatment in the SVR group and in the non-SVR group. A lower virus load (<800,000 copies/ml), non-genotype 1 infection, alanine aminotransferase (ALT) rapid normalization, rapid viral response (RVR) and complete early viral response (cEVR) are significant predictive factors associated with SVR. The present or dynamic change of the rheumatoid factor cannot predict the effect of the treatment response. Conclusions: The rheumatoid factor was positive in 47% of the chronic hepatitis C virus infected patients. In the RF positive group, the treatment response was better but not statistically significant. After treatment, the RF value was significantly reduced in cured patients.