ORIGINAL ARTICLE
Chronic viral hepatitis as the cause of arthritis

The aim of the study was to assess rheumatic symptoms and their correlations with transaminases activity in patients with chronic viral hepatitis. 80 patients with chronic hepatitis (30 female and 50 male of mean age 43.5 years) hospitalized in two clinics of Military Institute of Medicine in Warsaw (Department of Internal Diseases and Rheumatology and Department of Infectious Diseases and Alergology) during 1998-2003 years were included in the study. 16 patients were infected with hepatitis virus B, 60 with virus C, 4 patients suffered from both, hepatitis B and C. Rheumatic symptoms were evaluated on the basis of questionnaire and physical examination. Laboratory tests included: blood morphology, ESR, serum activity of transaminases, concentration of CRP, bilirubin and proteins. If needed, X-rays of the hands and feet and sacro-iliac joints were performed.
The existence of at least one rheumatic symptom was noticed by 57 (71%) patients, the frequency was similar in infected with HBV and HCV. 51% of patients claimed extraarticular symptoms, 38% complained of muscle pain, 48% developed arthralgia and 28% – arthritis. Most frequently (22%), mainly in infected with HBV, three rheumatic symptoms were present at the same time. In 31% of patients, muscle-skeletal disease was diagnosed during the course of hepatitis.
Abnormalities in physical examination were found in 35 (44%) cases. 19 patients revealed arthritis, the joints of hand and wrist were most frequently involved (14 cases), 7 patients manifested skin rash and 17 suffered from sicca syndrome. There was no correlation between liver enzymes activity and presentation of rheumatic symptoms.
The authors concluded that rheumatic symptoms are common in patients with chronic viral hepatitis. Therefore the patients with rheumatic symptoms should be routinely screened for the presence of viral hepatitis.