AfricanJournal ofRheumatology Systemic

G.O.Oyoo, F.Adelowo. "AfricanJournal ofRheumatology Systemic.". In: ISSN. Vol. 1.; 2013:.


Background: Hepatitis C Virus (HCV)
infection is a worldwide burden whose
seroprevalence is higher in developing countries with Cameroon being the
third most aff ected country in Africa.
HCV both a hepatotropic and lympho-
tropic infection is responsible for a great
number of hepatic and extra hepatic
disorders some of which are rheumatic
in nature. These rheumatologic mani-
festations though extensively studied
in western countries; there is little or no
data in sub-Saharan Africa.
Objective: The study was conducted
with the aim to describe the musculo-
skeletal manifestations associated to
HCV infection in a hospital setting in
Design: A cross-sectional study.
Setting: Three hospitals in Cameroon:
the Douala General Hospital, a tertiary
referral hospital with a capacity of 320
beds in Douala, the largest city and
economic capital of Cameroon; the
University Teaching Hospital of the
Faculty of Medicine and Biomedical
Sciences of the university of Yaoundé
1, a 240 beds hospital in Yaoundé the
political capital of Cameroon and the
“Centre Médical de la Cathédrale”,
a private acceptable standard
Gastroenterology clinic also found in
Patients and methods: From February
to June 2009, we did a multicentric
cross-sectional study of patients from
the Gastroenterology, Rheumatology
and Internal medicine outpatient clinics
of three hospitals in Cameroon. Patients
with HIV or HBV infection and those on
antiviral treatment were excluded.
Results: Among 148 patients with HCV
infection identifi ed during the study
period, only 62 fulfi lled eligibility, 15
(24.2%) of whom had musculoskeletal
manifestations related to HCV, the
commonest of which were myalgia
9/62 (14.5%) , arthritis 6/62 (9.7%), bone
pain 6.4% (4/62), sicca syndrome 3/62
(4.8%), and Raynaud’s phenomenon
6/62 (9.7%). Among patients with
rheumatologic manifestations, 9/15
(60%), had rheumatologic symptoms at
HCV diagnosis and in 6/15 (40%). HCV
infection was discovered during routine
medical check-up. Musculoskeletal
manifestations were neither associat ed
with the genotype (p=0.17) nor with the
viral load (p>0.98).
Conclusion: Arthralgia is the most
common presenting feature of the
symptomatic disease. Musculoskeletal
manifestations may be confused with symptoms of common tropical infections, leading to delayed diagnosis
and treatment of HCV infection.
Key words: Hepatitis C Virus, Arthralgia,
Extra hepatic manifestations; Africa
Hepatitis C Virus (HCV) infection
which occurs worldwide has a higher
seroprevalence in Africa, estimated
at 5.3% compared to about 1.03%
in Europe1,2. Cameroon, the third
most affected country in Africa, has a
seroprevalence which varies from as low
as 0.6% to 4.8% in Pygmy groups and
blood donors, to as high as 13% in hospital
based studies4,5. Hepatitis C virus (HCV)
which is a single-stranded, spherical RNA enveloped fl avivirus, measuring 38 to 50
nm in diameter has multiple genotypes
and quasispecies classifi ed in six major
clades. This genetic diversity confers to
this virus a difference in pathogenicity,
disease severity, and response to treatment
with interferon3. Though considered a
hepatotropic virus, HCV’s lymphotropic
nature is responsible for a great number of
extra hepatic immune system disorders1.
About 40 to 70% of affected patients will
develop an extra hepatic manifestation
that can have a rheumatic nature

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