Effects of Direct Antiviral Agents on Hepatitis C Virus Arthropathy

Study Overview
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Brief Summary
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The prevalence of HCV infection in Egypt is 14.7%. HCV is both a hepatotropic and a lymphotropic virus, it may exert a chronic stimulus on the immune system with both T and B lymphocyte alterations. In addition to cryoglobulinaemic vasculitis, HCV may trigger different immune-mediated extrahepatic disorders. A variable combination of HCV with other unknown enviromental and/or hostgenetic cofactors may lead to different clinical phenotypes that characterise HCV syndrome. Patients who have HCV -related arthropathy are accounted for by 2 clinical subsits: Rheumatoid-like arthritis and Cryoglobulin-related arthritis. Patients with mild arthritis, conservative manegement using analgesics with anti- inflammatory activity is recommended. In patients who have contraindications to their use, short term low dose prednisone is an option. In HCV infection with concomitant RA, ACR guidelines published in 2008 provided recommendations pertaining to these of DMARDs that are based on the severity of liver disease using the child- pugh- turcotte classification. For patients with severe cryoglobulinaemia such as severe debilitating disease or systemic in improvement, a combination of immunosuppressive and antiviral therapy is preferred. It has been found that antiviral therapy with interferon immunosuppressive and antiviral therapy is preferred. It has been found that antiviral therapy with interferon improves the musculoskeletal manifestations in HCV arthropathy. The DIrect antiviral agents seems very promising in treatment of HCV arthropathy. As HCV genotype 4 is the most common genotype in Egypt, the effective optional antiviral agents are sofosbuvir, daclatasvir, ledipasvir, paritaprevir, velpatasvir, ombitasvir and simeprevir.

Official Title
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Effects of Direct Antiviral Agents on Hepatitis C Virus Arthropathy

Conditions
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Hepatitis C

Intervention / Treatment
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* Drug: Antiviral agents


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Antiviral patients with arthropathy concomitant HCV (proved by PCR testing). Exclusion Criteria: patients with child-pugh B and child-pugh C decompensated cirrhosis. patients more that 60 years. patients with chronic infection e.g.(pulmonary T.B). patients with organ failure e.g.( heart failure, respiratory failure). patients with CKD with GFR lead that 60 ml/ ministry/1.73m2. patients on immunosuppressive agents. patients with HBV- coinfection.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Hepatitis C patients<br>Antiviral agents (sofosbuvir,daclatasvir,ribavirin) will be given to hepatitis C patients with arthropathy. | Drug: Antiviral agents<br>* combination therapy consists of Sofosbuvir,daclatasvir and ribavirin<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| rate of Improvement of manifestations of arthropathy | Improvement of manifestations of arthropathy in hepatitis C patients after treatment by assessment through pain scale | 3_6 months |