The British Journal of Rheumatology, Vol 36, 981-985, Copyright © 1997 by British Society for Rheumatology
J Rivera, A de Diego, M Trinchet and A Garcia Monforte
The objective was to determine whether there might be an association
between hepatitis C virus (HCV) chronic infection and fibromyalgia (FM). We
determined the prevalence of HCV infection in 112 FM patients, in
comparison with matched rheumatoid arthritis (RA) patients from the
out-patient clinic of a teaching tertiary care general hospital.
Furthermore, we looked for evidence of FM in 58 patients diagnosed with
chronic hepatitis due to HCV, compared with matched surgery clinic
patients, HCV antibodies were determined by enzyme-linked immunosorbent
assay (ELISA) and recombinant immunoblot assay (RIBA). Serum RNA of HCV
(HCV-RNA) was determined by polymerase chain reaction. In the group of FM
patients, HCV antibodies were found by ELISA in 17 (15.2%) patients and in
six (5.3%) of the RA controls (P < 0.05). RIBA was positive in 16 and
indeterminate in one of the FM patients. Serum HCV-RNA was found in 13 of
these FM patients. In eight (47%) FM patients, alanine aminotransferase
(ALT) was normal, although HCV-RNA was detected in four (50%) of them. In
the group of patients with chronic hepatitis due to HCV, all patients had
HCV antibodies and the presence of HCV-RNA in serum. Within these patients,
31 (53%) had diffuse musculoskeletal pain, while six (10%) fulfilled FM
diagnostic criteria. In the control group, 13/58 (22%) had diffuse
musculoskeletal pain (P < 0.001), whereas only one female patient (1.7%)
fulfilled FM criteria (P < 0.05). Serum ALT was 51.7 +/- 38.4 in FM
patients, whereas it was 122 +/- 76.3 in patients with HCV chronic
hepatitis but without FM (P < 0.001). There were no statistical
differences in autoimmune markers between patients with and without FM.
These data suggest that there exists an association between FM and active
HCV infection in some of our patients. FM is not associated with liver
damage or autoimmune markers in these patients. HCV infection should be
considered in FM patients even though ALT elevations were absent.
ORIGINAL PAPERS
Fibromyalgia-associated hepatitis C virus infection
Rheumatology Unit, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
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