Do You Think It's Related?
Doctors are discovering
what many hepatitis patients have known all along: Not all
symptoms of hepatitis C come from your liver.
"I’ve had pain in my legs, arms, hands and
just about everywhere. ... I was diagnosed two months ago with
fibromyalgia and myofascial pain syndrome. …My liver enzymes
are normal. ... Do you think all these problems could be
caused by the hepatitis? Does that mean that it is mimicking
fibromyalgia or has it caused it to occur? Is it possible to
have all these symptoms and yet have fairly normal liver
the past six years, similar questions have been posed to me by
hepatitis C patients thousands of times. Too often, their
doctors tell them their symptoms and other medical conditions
are not related to hepatitis C, which causes frustration and
confusion for patients. The fact that so many patients report
similar symptoms and that a multitude of research has shown a
remarkable number of Hepatitis C Virus patients with other conditions, makes
it clear that there is more to the relation between these
conditions than just coincidence.
her book Hepatitis C - A Personal Guide To Good Health,
Beth Ann Petro Roybal writes, “Certain symptoms, such as
itchy skin and jaundice, are directly caused by liver damage
brought on by Hepatitis C Virus. ... Symptoms such as chronic fatigue may
not be caused by liver damage per se, but may be a result of
Hepatitis C Virus’s assault on the immune system. ... Some people with
hepatitis C also develop other conditions as a result of their
damaged immune system. Some of these conditions include mixed
cryoglobulinemia, rheumatoid arthritis, lichen planus and
glomerulonephritis (kidney disease).”
Dolan, citing several studies in his book The Hepatitis C
Handbook, backs up this claim. Dolan points to a study by
Christian Stassburg and Michael Manns in Viral Hepatitis
Review that noted: “Chronic hepatitis C infection has
been found to be associated with an array of autoimmune
disease including … autoimmune thyroid disease, autoimmune
hepatitis, porphyria cutanea tarda, Sjögren’s syndrome,
etc. This means that immune stimulants such as interferon may
cause more problems in patients with autoimmune symptoms.”
the many studies and papers associating autoimmune diseases in
patients with Hepatitis C Virus, why has it been so difficult to be
diagnosed and treated for such illnesses? Dolan writes,
“Patients will find that they are experiencing symptoms that
specialists would not normally expect given a particular set
of liver function test results. ... Patients who present
without clear signs of liver disease and with low or
undetectable virus can experience (diagnostic and treatment)
problems; doctors may often be unwilling to accept that such
patients are experiencing debilitating symptoms.”
hepatitis C’s reputation of being only a liver disease,
these overlapping autoimmune conditions may complicate the
potential treatments of Hepatitis C Virus, Strassburg and Manns noted, and
cause confusion for the patient as well as their doctor.
lymphatic system — a major component of our overall immune
system — is key in
aiding our bodies to fight off viruses and infections.
of the circulatory system consisting of a complex network of
vessels, tissues and organs, the lymphatic system helps defend
the body against infection by supplying disease-fighting cells
— called lymphocytes. The lymphatic system also helps
maintain fluid balance in the body by collecting excess fluid
and particulate matter from tissues and depositing them in the
bloodstream. So how does the lymphatic system get itself
involved with a virus that affects the liver?
points to several studies that indicate Hepatitis C Virus lives and
replicates within the lymphatic system as well as the liver
causing immune system malfunction. Dolan details how the virus
is able to mutate and avoid the immune system’s attack.
Additionally, he describes how the virus can trick the immune
system into attacking the body’s own tissues. This
understanding of Hepatitis C Virus as a systemic disease — a disease that
affects several bodily systems at once — may explain why
some people with high viral loads have little damage or
inflammation in the liver, yet they experience severe symptoms
very similar to the flu.
people with chronic Hepatitis C Virus experience a range of symptoms usually
classified as autoimmune,” Dolan states. “This occurrence
may owe at least as much to the presence of Hepatitis C Virus in the
lymphatic system as to the liver.” Due to the
autoimmune-related nature of these conditions, they may not be
seen in other forms of hepatitis, which makes it difficult for
liver specialists to recognize them let alone relate them to
recently, hepatitis C has been perceived by the medical
community to be a localized infection of the liver.
Researchers have found that hepatitis C is not just a liver
disease but a disease that affects many bodily systems at
once, causing the immune system to malfunction and lose the
ability to differentiate between Hepatitis C Virus particles and human
overlapping nature of hepatitis C as a liver and immune system
disease, notes Dr. Parveen Kumar and Dr. Michael Clark,
editors of Clinical Medicine, can lead to an
autoimmune disease. “An autoimmune disease occurs when the
immune system fails to recognize the body’s own tissues as
self and mounts an attack on them. Illnesses are divided into
those that affect just one organ (organ-specific) and those
that affect many systems (systemic).”
Diagnosis and Treatment Challenge
the last five or six months, I’ve woken up every morning
with extreme pain in my back. I think it’s in the kidney
area, just below my ribs. I also have chronic joint pain,
constant fatigue; I have had blood tests and a biopsy but
nothing has ever been explained ...”
Hepatitis C Virus Patient
Hepatitis C Virus patients describe how their lives have become a vicious
cycle as they try to get recognition and treatment for their
various symptoms and conditions that are not specific to liver
disease. Their autoimmune-related symptoms are difficult to
diagnose as often their lab tests are below diagnostic levels
or they do not fully develop all of the clinical diagnostic
symptoms linked to a particular disease.
Ben Cecil, a hepatologist experienced with Hepatitis C Virus patients who
present with overlapping autoimmune diseases confirms the
findings: “I have several patients with cryoglobulinemia and
one with renal failure and malignant hypertension. Many of my
patients have pains in their muscles and joints which are
probably related to Hepatitis C Virus.”
said he recognizes the potential contradictions of lab results
and symptoms, and comments that the low titers of antinuclear
antibody and other autoimmune disease markers are nonspecific.
He suggests that your doctor should consult with a
rheumatologist if there is suspicion of overlapping disease
processes. He also suggests potential autoimmune tests such as
the rheumatoid factor for rheumatoid arthritis, cryoglobulins
for cryoglobulinemia as well as the erythrocyte sedimentation
rate for evidence of general inflammation. Depending on your
symptoms and your doctor’s advice, additional tests to
detect kidney disease, thyroid dysfunction and diabetes may
also be required.
Charge of Your Care
For the past two years, I have been in pain, almost
flu like in nature, achy bones, etc. This past spring the pain
became very intense, and I developed swollen feet and ankles
on both legs. Blood tests show no sign of autoimmune disease,
and my liver counts were fine. The liver doctor has written me
off saying my symptoms have no connection to the hep C. I am
becoming very frustrated!
Hepatitis C Virus Patient
stories like these coming to me nearly every day, it is clear
that diagnostic medicine, which considers hepatitis C to be
only a liver disease and relies wholly on laboratory measures,
is failing to help hepatitis C patients who suffer from Hepatitis C Virus-related,
autoimmune disorders. It is important to keep in mind that
intuition and interpretation on the part of the physician is
of utmost importance, and the possible existence of autoimmune
diseases should not be ruled out simply because the early lab
reports are negative for diagnostic markers.
American Liver Foundation has stated, “First, we need to
intensify efforts to educate primary care physicians and
patients. Physicians must be armed with state-of-the-art
information about diagnostic testing and optimal care.
Physicians and patients must be empowered to make informed
decisions about treatment.”
and patients may benefit from standard evaluation guidelines
which list tests for related conditions and how to interpret
them, since as mentioned, many of these conditions do not
always fit the known diagnostic criteria. Such an approach
could provide the doctor with an opportunity to design a
carefully planned treatment protocol that could then help to
protect the patient from having the underlying conditions
you feel you are suffering from possible Hepatitis C Virus-related
autoimmune diseases, the best thing you can do is to find a
doctor who is aware of the connections with Hepatitis C Virus, one who is
willing to listen to you, and provide you with appropriate
treatment and symptomatic relief. If you find yourself being
dismissed, look for another doctor and keep looking until you
find the one right for you.
Co-Ailments with Hepatitis C
are some common conditions linked to hepatitis C according to The
Hepatitis C Handbook, Hepatitis C - A Personal Guide to Good
Health and www.askemilyss.com:
Arthritis is an inflammatory condition that affects
joints causing pain, inflammation, breakdown, and eventual
loss of the cartilage of the joints.
Syndrome is characterized by progressive destruction
of the exocrine glands (sweat glands, lachrymal glands,
salivary glands, tear glands). Symptoms include dry eyes,
dry mouth, persistent cough (dry airways), and lack of
phenomenon causes poor blood flow to the hands and feet
leading to sudden feelings of coldness in these
extremities and causing them to turn red. Poor blood flow
to parts of the brain might also be linked to depression
and ‘brain fog’. Symptoms include paling of the skin
followed by bluish skin, then redness, as well as,
numbness, tingling, burning, and often pain. Typically
caused by exposure to cold.
is a condition where the blood gels when exposed to cool
temperatures. Symptoms can be triggered to exposure to
cool temperatures and include intolerance to cold weather,
muscle and joint aches, fever upon exposure, and skin
rashes. Many symptoms of cryoglobulinemia dissipate when
the patient becomes warm again. One of the most common
autoimmune diseases reported among Hepatitis C Virus patients.
features intense inflammation of the blood vessels with
red painful rashes along the veins. Associated with, or is
an aspect of, many autoimmune conditions including
rheumatoid arthritis, lupus, and systemic sclerosis.
Abnormalities are common but, due to similar symptoms of
Hepatitis C Virus itself, it can be difficult to diagnose.
Hyperthyroidism (overactive) can cause insomnia, weight
loss, palpitations, warm and moist skin or ankle swelling.
Hypothyroidism (under active) can result in cold
intolerance, sparse and dry hair, scaly skin, and physical
and mental sluggishness.
II Diabetes is a condition where enough insulin is
produced but the body does not respond to the action of
the insulin. Symptoms include fatigue, headaches,
sweating, and weight loss or weight gain.
is an immune-mediated (autoimmune) kidney disease where
immune complexes are deposited in the glomeruli, the parts
of the kidney responsible for filtering the blood.
Symptoms are uncomfortable and debilitating, including
edema (swelling and fluid retention) and a loss of blood
protein via the urine, known as proteinuria (urine tests
reveal the presence of albumin).
Planus is a skin disease that appears as flat,
purplish pimples or patches with fine, gray lines on the
surface. Common sites are wrists, forearms, ankles,
abdomen, lower back, and in the mouth. On mucous
membranes, the lesions appear gray and lacy. Nails may
have ridges running lengthwise.