Effects of Direct Antiviral Agents on Hepatitis C Virus Arthropathy
Effects of Direct Antiviral Agents on Hepatitis C Virus Arthropathy
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.
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.