Rheumatologic Manifestations of Viral Hepatitis B and C

The clinical course of viral hepatitis can get complicated by a myriad of rheumatic symptoms which can alter the management strategies and have a profound potential to impair the quality of life of the patient. Rheumatic complications are often seen with hepatitis B (HBV) and hepatitis C (HCV) virus infections. The mechanism of these rheumatic complications seems to be immune mediated. Chronic HBV infection is linked to several extrahepatic syndromes like polyarteritis nodosa, serum sickness like syndrome, essential mixed cryoglobulinemia and varied arthritic manifestations. The clinical picture in HBV can range from mild arthralgias to severe systemic vasculitis with renal involvement which can seriously jeopardize the life of the patient. Prompt recognition and therapy with antivirals and immunosuppressive medication have led to a remarkable improvement in the prognosis of HBV associated PAN. HCV infection has an unusual propensity to trigger autoimmune disorders, especially with cutaneous manifestations. Mixed cryoglobulinemia syndrome (MCs) constitutes the prototype of HCV-associated autoimmune-lymphoproliferative disorders and is characterized by palpable purpura, arthralgias and fatigue. Widespread vasculitis and B-cell Non hodgkins lymphoma (NHL) may complicate a minority of cases and they constitute the most dreaded spectrum of the disease which carries a dismal prognosis. The management of these vasculitic complications is further complicated as interferon therapy used as an antiviral agent could potentially worsen this autoimmune process. The availability of directly acting antiviral agents (DAAs) now seems to increase the therapeutic armamentarium against HCV although further studies are needed to confirm their benefit in patients of HCV with rheumatologic complications.