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For a list and short descriptions of HCV Extrahepatic Manifestations visit our new glossary.
The hepatitis C virus mainly affects the liver, but there are many other conditions that are associated with hepatitis C. Extrahepatic manifestation means diseases or conditions that affect organs other than the liver. Extrahepatic manifestations of hepatitis C can be found in the skin, eyes, joints, immune system, nervous system and kidneys. Some of these conditions – cryoglobulinemia, for example – are somewhat more common and well-documented, while others are infrequent or their association with hepatitis C has not yet been proven.
A large study by the MULTIVIRC group reported that 74% of patients with hepatitis C had at least one extrahepatic (outside the liver) manifestation. The most common conditions included essential mixed cryoglobulinemia (40%), arthralgia or joint pain (23%), paresthesia (burning or pricking sensations) (17%), myalgia (muscle pain) (15%), pruritus (itching) (15%), and sicca syndrome (dry eyes/mouth) (11%). This factsheet will discuss one of the most common conditions associated with hepatitis C called essential mixed cryoglobulinemia(EMC).
Vasculitis refers to a group of conditions that are characterized by inflammation of the walls of blood vessels; these include the veins, arteries and capillaries. Essential mixed cryoglobulinemia is a blood disorder that is caused by abnormal proteins in the blood called cryoglobulins that precipitate or clump together when blood is chilled and then dissolve when re-warmed.
It is estimated that about 4 to 10 million people in the United States and 3-6% of the world population have fibromyalgia (fibro or FM for short), and, while a direct link between fibromyalgia and hepatitis C hasn’t been established, there are more people living with hepatitis C who are also living with fibromyalgia than in the general population. Hepatitis C and fibromyalgia also share many symptoms such as fatigue, depression, cognitive issues and muscle/joint pain.
The most common type of glomerulonephritis (kidney disease) found in people with hepatitis C is membranoproliferative glomerulonephritis (MPGN). Other less common forms of kidney disease include noncryoglobulinemic MPGN, membranous glomerulonephritis, MPGN type III, and mesangial proliferative glomerulonephritis. This fact sheet article will concentrate on MPGN.
Lichen planus is a fairly common skin disorder that lasts for months to years. Lichen planus affects about 1 to 2% of the U.S. population and usually affects people between the ages of 30 and 70 years old and is slightly more prevalent in women than in men. The exact cause of lichen planus is unknown, but it seems to be triggered by stress, genetics, allergic reactions to medicines, and by viral infections such as hepatitis C. The onset may be gradual or quick. There have been studies that have found a prevalence of HCV in people with lichen planus from 3.5% to 60%. For this reason, it has been recommended that people with lichen planus (especially with elevated liver enzymes) should be tested for HCV.
Non-Hodgkin’s lymphoma (NHL) is a form of cancer that starts in the lymphatic system. The lymphatic system is a network of lymph vessels that carry a clear fluid called lymph, made up of a type of white blood cells that fight infection. The lymphatic system is a circulatory system that collects white blood cells which are taken from veins, circulated throughout the body, and returned to the bloodstream.
Neuropathy is a medical term for any disease of the nerves. There are four major forms of neuropathy – polyneuropathy, autonomic neuropathy, mononeuropathy and the most common form, peripheral polyneuropathy – more commonly called peripheral neuropathy (PN). Peripheral neuropathy damages the nerves in the legs and arms. Usually the first area that PN affects is the feet and legs before the hands and arms. This fact sheet will discuss the HCV-related form of peripheral neuropathy including the cause, symptoms, and treatments.
Porphyrins are complex molecules in the body that combine with iron to produce heme, which is responsible for giving blood its red color. They combine with globin to form hemoglobin. Porphyria is the name of a group of diseases caused by an excess of porphyrins in the blood. Porphyria Cutanea Tarda (PCT) is one of the most common types of porphyria, triggered by a deficiency of an enzyme called uroporphyrinogen decarboxylase (UROD).
Pruritus is one of the most common symptoms reported by people with hepatitis C (20%), but is more commonly found in people with advanced liver disease and cirrhosis. Pruritus is itching that may be localized to a specific part of the body such as hands and feet, but it can also be a generalized itching all over the body. Some people even report that it feels like their internal organs itch. Pruritus can be related to high bilirubin levels, autoimmune disease or dry skin, and can be a side effect of treatment.
In someone with hepatitis C, Raynaud’s phenomenon is generally caused by HCV-related cryoglobulinemia. The prevalence of Raynaud’s phenomenon in the hepatitis C population is unknown, but it is believed to be an uncommon condition. In people with HCV-related cryoglobulinemia, however, one study found that 30% of people also had Raynaud’s phenomenon.
Sjögren’s (Show grins) syndrome is an autoimmune disorder that has not been directly linked to hepatitis C, but is seen more often in people with hepatitis C than in the general population. The exact cause of Sjögren’s is unknown, but heredity, viral infections and, possibly, hormones may be contributing factors. There also seems to be a link between Sjögren’s and rheumatic disorders such as rheumatoid arthritis. Sjögren’s can affect many parts of the body, but most often affects the tear and saliva glands.
Systemic lupus erythematosus (SLE) is a disease that can cause inflammation and damage to various parts of the body. Lupus can affect any area of the body, but it most often affects the joints, skin, kidneys, heart, lungs, blood, or brain. Lupus is an autoimmune disease – this is when a person’s immune system produces antibodies against normal cells and organs. It is estimated that about 1.5 million Americans have been diagnosed with lupus and there are about 16,000 Americans who develop lupus each year.
Vitiligo is a specific type of dermatological condition characterized by loss of pigment of the skin that can affect almost any part of the body, including premature graying of hair. The exact cause of vitiligo is unknown but it is believed to be an autoimmune disease that can be caused by genetic and/or environmental factors. The relationship between HCV and vitiligo is controversial.
Waldenstrom macroglobulinemia (WM) is a chronic low-grade type of cancer of the lymph cells. The prevalence of WM in the hepatitis C population is unknown, but it has been found to be higher than in the general population. But WM is considered a rare or uncommon condition in people with hepatitis C.