Hepatitis C Anti-Viral Drug-Induced Arthritis Save

Curative direct-acting antiviral therapy (DAAT) for hepatitis-C virus (HCV) infection has been revolutionary, but a novel report shows that nearly one quarter of DAAT treated patients developed new onset or significant worsening of MSK symptoms, despite being negative for hepatitis-C by PCR.

This study examined if DAAT(daclatasavir and sofosbuvir) treatment in HCV-patients had any MSK manifestations. All adult HCV-infected patients, who had completed DAAT leading to being PCR-negative were included in this study.

Chronic MSK symptoms were defined as any arthralgias lasting for > 6 weeks and not being related to trauma or occupational hazards. Worsening of MSK symptoms was defined as > 50% worsening of MSK symptoms compared to before commencing DAAT.

A total of 250 consecutive HCV-patients completing DAAT and being PCR-negative were evaluated.  The mean follow up after commencing DAAT was 6.5 months. Nearly one-quarter (27.6%) had chronic MSK symptoms prior to DAAT. Rheumatologic diagnoses included fibromyalgia (38), seronegative inflammatory arthritis (16) and rheumatoid arthritis (6). While 18 out of 69 (26%)  had stable MSK symptoms after DAAT, 74% had worsening of MSK symptoms after DAAT therapy.

Worsening of MSK symptoms incuded 43% (22/51) with inflammatory arthritis and the rest had chronic myofascial pains.  There were 11 cases of new onset of MSK symptoms post-DAAT, with half (53%) having inflammatory arthritis.

This is the first report of MSK complications arising from DAAT in HCV patients.