Extrahepatic Conditions and Hepatitis C

There are many extrahepatic conditions associated with hepatitis C. Often, patients and family are not aware of related conditions. Many hepatitis C patients will experience extrahepatic manifestations (conditions outside of the liver).

Some conditions are more common, while some are less frequent. Autoimmune conditions can often appear with hepatitis C as well as other conditions relating to the heart, kidney’s, metabolic syndrome (like diabetes), and central nervous system disorders. Some conditions can be resolved after hepatitis C treatment with the elimination of the virus.

Extrahepatic conditions and hepatitis C: autoimmune disorders

• Thyroid conditions like hypothyroidism and hyperthyroidism are autoimmune disorders. Hypothyroidism (Hashimoto's thyroiditis is the most common thyroid disorder associated with hepatitis C.)
• Mixed cryoglobulinemia are abnormal proteins in the blood that clump together that cause blood to thicken in lower temperatures. This impairs blood circulation which can damage skin, joints, nerves and other organs, particularly the kidneys and liver. Mixed cryoglobulinemia can cause pain in the joints and muscles.
• Fibromyalgia is a disorder associated with musculoskeletal pain. Patients can also experience fatigue, sleep, memory and mood problems, and other associated disorders.
• Lupus is a chronic disease, causing inflammation in the connective tissues. There are several types of lupus, but systemic lupus erythematosus (SLE) is commonly associated with hepatitis C.
• Sjogren Syndrome is an autoimmune disorder that results in dry eyes and mouth. It is associated with other connective tissue disorders like rheumatoid arthritis, lupus, scleroderma, and polymyositis.
• Rheumatoid arthritis is a chronic inflammatory disorder affecting the lining of the joints. This causes pain and swelling in the joints. Rheumatoid arthritis can cause bone erosion and joint deformity. Rheumatoid arthritis is commonly seen in patients with hepatitis C who have cryoglobulinemia.
• Polyarteritis Nodosa (PAN) is a condition that causes swollen arteries that become inflamed and damaged. Polyarteritis Nodosa (PAN) is associated with problems with the immune system. Symptoms can include decreased appetite, sudden weight loss, abdominal pain, excessive fatigue, fever, muscle, and joint aches.
• Monoclonal gammopathy is a disorder where abnormal proteins known as monoclonal protein (M protein) is seen in the blood. Monoclonal gammopathy generally does not cause any problems but can sometimes progress over time to other disorders, causing blood cancer. Blood tests and monitoring is recommended.
• Immune Thrombocytopenic Purpura is a disorder that may lead to easy or excessive bleeding and bruising. The bleeding is caused by a low-platelets–cells that help blood clot.

Extrahepatic Conditions: non-autoimmune disorders

Other common comorbidities may include:

• Type 2 diabetes impacts the body's ability to metabolize sugar (glucose), which is a vital source of fuel for the body. With type 2 diabetes, the body does not regulate insulin (the hormone that regulated glucose) correctly, resulting in severe problems. Studies show patients with hepatitis C who have cirrhosis have a higher tendency to have type 2 diabetes.
• Glomerulonephritis (Nephritis and Nephrotic Syndrome) are diseases that injure the part of the kidneys that filter blood. If this condition continues, it can result in damage to the kidney’s which can result in kidney failure.
• B-cell NHL is where Non-Hodgkin Lymphoma (NHL) affects B-lymphocytes. Non-Hodgkin Lymphoma (NHL) is cancer that affects the white blood cells (lymphocytes), which are an important part of the immune system. One type of lymphocytes are B-cells, which make antibodies to fight infections.
• Hepatic encephalopathy (HE) which is a condition associated with patients with cirrhosis. HE can cause temporary brain function impairment due to the liver severe liver damage (cirrhosis) the liver cannot remove toxins from the blood which travel to the brain causing mental and physical impairment.
• Cardiovascular Disorders like stroke and heart disease
• Fatigueaffects the majority of people diagnosed with hep C.
• Depression