Anti-Cyclic Citrullinated Peptide Frequency in Egyptian Patients with Chronic Hepatitis C Virus Infection with and without Articular Manifestation

Background. The presence of extra hepatic manifestations is a relatively common feature in patients with chronic hepatitis C. Besides the role in the etiology of liver diseases, this virus is known to produce autoimmune phenomena. Among them, rheumatic diseases. Aim of the work. Our aim in the present study was to investigate the presence of anti-CCP antibodies in Egyptian patients with chronic hepatitis C virus infection, with and without articular manifestation. Patients and Methods. Blood samples were obtained from 86 patients with HCV from the Rheumatology, Internaland Tropical Medicine outpatient clinicsof Elzhraa, Elhussen and Bab Elshaaria University hospitals Alazhar University Cairo Egypt. A history was taken from all patients, and a clinical examination was performed, including a musculoskeletal examination, abdominal ultrasonography, and laboratory investigations in the form of routine laboratory tests (CBC, ESR, LFT, RFT, viral marker, and tests for RF and anti-CCP antibodies). Results The studied group included 86 patients classifiedinto three groups:, Group I (HCV and RA) included 29 (33.7%) patients 15 females and 14 males, with the mean age of 44.6 ± 8.79 years. The disease duration among this group was less than one year in 12 patients and more than one year in 17 patients Group II (HCV with articular manifestation) included 31 (36 %) patients 12 females and 19 males, with the mean age of 42.5 ± 8.07years, The disease duration among this group was less than one year in 11 patients and more than one year in 20 patients. Group II (HCV without articular manifestation) included 26 (30.2%) patients 8 females and 18 males, with the mean age of 45.0 ± 9.10years, The disease duration among this group was less than one year in 20 patients and more than one year in 6 patients. Regarding to clinical exam 22(75.9%) and 10 (32.3%) of our patients in group I & II respectively presented with morning stiffness while no patients experienced morning stiffness in group III (p 0.001). 23 (79.3%) and 5 (16.1%) experienced symmetric arthritis in group I & II respectively while one patients (2.7%) experienced symmetric arthritis in group III (p< 0.001). Regarding to the X ray finding 19 (65.5%) and 8 (25.8%) patients in group I & II respectively showed erosions on X ray finding while no patients with erosions were found in group III (p<0.001). The mean ESR 1 hour were 40.55 ± 12.6 mm/h, 13.90 ± 3.5 mm/h and 13.19 ± 5.6 mm/h in group I,II, and III respectively. There was a statistically significant increases in the level of ESR 1 hour in group I compared to group ΙI and ΙII. Regarding to the rheumatoid factor (RF) level the mean level were 32.2±19.6 U/L, 28.9±16.7 U/L and 26.1±15.5 U/L in group I, II and III respectively with no statistical significant differences between the groups (p< 0.4). The mean level of anti-CCP antibodies was significant higher (55.8±6.3 U/mL) in group I, compared to (21.28±3.4 U/mL) in group II and (15.5±2.7 U/mL) in group IIIp (0.001). Conclusions The distinction between HCV associated arthropathy and rheumatoid arthritis has great relevance for clinicians. Our results showed that antiCCP antibodies were a significant marker for diagnosis of HCV associated with RA and rarely present in HCV infected patients with rheumatoid like manifestations and were a reliable serological marker to discriminate between patients with HCV associated rheumatological manifestations and patients with rheumatoid arthritis. [M.Elnadry, M. Abdel-Rashed, M.A. Abdel-Monem, S.El-Eter and W. Fathy. Anti-Cyclic Citrullinated Peptide Frequency in Egyptian Patients with Chronic Hepatitis C Virus Infection with and without Articular Manifestation. J Am Sci2013;9(11):268-273]. (ISSN: 1545-1003). http://www.jofamericanscience. org. 35