Extrahepatic Manifestations of Hepatitis C - Part 1

This is part 1 in our series about Extrahepatic Manifestations of hepatitis C. Read more in part 2.

Patients with hepatitis C virus often have what is called extrahepatic manifestations of the virus. Extrahepatic means occurring or originating outside of the liver. It is difficult to know if a particular medical issue is due to having hepatitis C, or if it is a separate problem unrelated to having the virus. Therefore the prevalence of these manifestations has been quoted from as little as forty percent of patients to as high as seventy-five percent of the patient population. It is important for medical providers to understand that their patients may be exhibiting manifestations of hepatitis C so that they can be identified and tested for hepatitis C if their status is unknown, and be treated for the virus and the illnesses that come along with the virus.

Patients suffering with extrahepatitic manifestations may present with joint pain (arthralgia), numbness and tingling, muscle pain (myalgia), itching (puritis), dry mouth and eyes (sicca), skin eruptions, kidney disease, thyroid disease, insulin resistance or type II diabetes, and cryoglobulinemia. Physicians should be mindful of the connection that these symptoms may have to hepatitis C virus and test their patients if no other reason can be found.

This article will focus on cryoglobulinemia, or cryo, for short. Cryoglobulinemia actually means cold antibody in the blood. It is one of the most frequent disorders that occurs in hepatitis C patients. There are actually three types of mixed cryoglobulinemia with type II occurring most frequently in patients who harbor the hepatitis C virus. Cryo can be very mild or quite severe. It happens when abnormal proteins form in the blood. The proteins clump together when the blood is chilled and dissolve when the blood is warmed. The proteins may be deposited in the small and medium sized blood vessels of the patient causing blockages. The most common symptoms of cryo are joint pain and rashy or blotchy skin. Besides the skin and joints, it can affect the nerves and kidneys. Some patients complain of peripheral neuropathy, which causes tingling and burning. Others may have Reynaud’s Syndrome, which cause the hands and or feet to turn red, white and blue in cold weather. Skin ulcers, and non-hodgkins lymphoma are also considered extra manifestations of the virus. The most common manifestations of cryoglobulinemia caused by hepatitis C are:

Mixed cryoglobulinemia vasculitis (4 to 40%)

Fatigue, arthralgia, myalgia (35 to 54%)

Renal disease (27 to 30%)

Palpable purpura (18 to 33%)

Neuropathy (11 to 30%)

Sicca syndrome (10 to 25%)

There is a simple blood test to diagnose cryoglobulinemia and treatment often consists of curing hepatitis C virus, which is the underlying problem. Occasionally, medications to suppress the immune system may be needed. The most common drugs are called Disease Modifying Anti-Rheumatic Drugs (DRMDs).