Rheumatic manifestations of HCV infection

Hepatitis C virus (HCV) is the major cause of post transfusion viral hepatitis and affects > 180 million people world wide. Besides being hepatotropic, HCV is lymphotropic as well and predominantly affects the B cells leading to nonneoplastic clonal proliferation with potential to induce B-cell malignancies. Rheumatic manifestations are being increasingly recognized and appreciated as part of spectrum of chronic HCV infection. Mixed cryoglobulinemia (MC) is the most common and prototype disorder induced. Besides MC, sicca syndrome, HCV associated arthritis, systemic vasculitis, cytopenias, fatigue and fibromyalgia have been documented. Moreover, chronic HCV infection induces a number of autoantibodies and may mimic various autoimmune disorders. Recognition and distinction of these features may help in choosing correct therapeutic approach as immunosuppressive therapy may be detrimental in HCV infection. Antiviral regimen, ribavirin and interferon-α, remains the cornerstone for the treatment of MC, however other rheumatic manifestations may not respond similarly. There is a great need for better understanding of the pathophysiology of these manifestations.