Does hepatitis C infection affect how rheumatoid arthritis is treated?

This study examined the disease characteristics and treatment of patients with rheumatoid arthritis plus hepatitis C infection.

Both rheumatoid arthritis and hepatitis C infection are relatively common diseases. It has been estimated that 0.02% of Americans are living with both of these diseases (40000 people). Having both conditions may affect how patients are treated medically.

Drugs normally used to treat rheumatoid arthritis can reduce the body’s normal immune response. Although this helps decrease the symptoms of rheumatoid arthritis, it may increase the risk of reactivating the hepatitis C virus. This can increase the patients’ risk of developing liver damage. As a result of this, it has been suggested that rheumatoid arthritis activity and severity might be worse in patients who suffer from both diseases. However, there is limited data comparing patients with both disease to patients with rheumatoid arthritis only.

Patients with both diseases were identified from the Veterans Affairs Rheumatoid Arthritis (VARA) registry. Veterans with rheumatoid arthritis but no hepatitis C were included for comparison. Medication use for all patients was determined from pharmacy records.

Overall 1706 patients with rheumatoid arthritis were included in the study. 5.1% of those patients also had hepatitis C infection.

Patients with both diseases reported higher pain, more tender joints, and poorer overall health. Assessment of the number of swollen joints or level of joint function did not reveal any difference between the two groups of patients.

There were significant differences in the type of drugs prescribed to patients with and without hepatitis C. The odds of patients who had hepatitis C receiving methotrexate (Rheumatrex, Trexall) was 73% less likely than for patients without hepatitis C. However, the odds of patients with hepatitis C receiving prednisone (Deltasone) was 41% more likely than patients without hepatitis C. The odds of receiving TNF blocking drugs (e.g. infliximab (Remicade)) was also higher (51%) for patients with hepatitis C than for patients without hepatitis C.

Rheumatoid arthritis patients who have hepatitis C are more likely to experience more pain, more tender joints, and report poorer overall health. They were less likely to receive methotrexate and more likely to receive prednisone and biologic medication.