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Rheumatic symptoms reported by women with hepatitis C. (Infected by Contaminated Blood Products).

NEW ORLEANS -- Numerous rheumatologic complaints are surfacing among a large cohort of women who were inadvertently infected with the hepatitis C virus through contaminated anti-D immunoglobulin.

The results of a survey of 100 of these women, infected in Ireland in 1977, are a window into the natural history of hepatitis C and reveal a surprising 91% rate of significant musculoskeletal problems, Dr. Suzanne Donnelly said at the annual meeting of the American College of Rheumatology.

Stiffness in more than two joints was reported by 80%, most commonly in the lumbar and cervical spine, shoulders, and hands. Intermittent swelling of the large and small joints was reported by 43% and 39%, respectively.

Also, 49% complained of shoulder pain and 50% of lumbar pain, said Dr. Donnelly of the Medical Research Council Immunohistochemistry Unit, Oxford (England).

"Sicca symptoms were common, with 71% complaining of dry mouth and 54% of gritty eyes," she said in a poster session.

A total of 79% had Raynaud's disease features, 9% had Sjogren's syndrome, and 2% had undifferentiated connective tissue disease, she said. Yet just 3% had rheumatoid factor--positive inflammatory arthritis.

"Although inflammatory arthritis was rare, we have uncovered a high prevalence of mild but treatable conditions in a group of women who are suffering from an illness that would have been preventable had proper screening of our blood products been undertaken," Dr. Donnelly said.

Some 850 pregnant women who were given anti-D immunoglobulin to prevent Rh-factor incompatibility were infected because the blood product originated from a donor with jaundice. During the time of exposure, there were six reports of unexplained jaundice in the pregnant women.

More than half of the infected women continue to have laboratory evidence of hepatitis C virus (HCV) infection, and at least one has died of liver disease.

HCV was not identified until 1989, and the connection between hepatitis and the anti-D immunoglobulin was not made until 1994. Since that time more than 63,000 people have been screened for the disease as part of a national anti-D recipient/HCV program.

A report by a tribunal established to investigate the contamination criticized the Republic of Ireland's Blood Transfusion Service Board, and the board subsequently apologized and admitted liability (Dublin: Government Stationery Office, 1997).

"A total of 219 million pounds has been paid out by the state in compensation, and our blood transfusion board has been totally reorganized to ensure that a tragedy of this magnitude never recurs," Dr. Donnelly said.

Rheumatic symptoms associated with HCV may represent essential mixed cryoglobulinemia (J. Med. Virol. 66[2]:200-03, 2002). In this syndrome, cryoglobulins composed of HCV immune complexes, immunoglobulins, rheumatoid factor, and complement are deposited in tissues.
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Author:Walsh, Nancy
Publication:Internal Medicine News
Date:Jan 1, 2003
Previous Article:Hepatitis B mortality up fourfold since 1979. (Significant Rise in use of Hospital Services).
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