Beneficial effect of phlebotomy on hepatitis C virus-associated musculoskeletal manifestations.

Chronic hepatitis C virus (HCV) infection may lead to many extrahepatic manifestations which pose a serious therapeutic challenge. Recently, increasing evidence suggesting an association between iron overload and chronic HCV infection has emerged. However, the effect of iron reduction therapy on extrahepatic manifestations of HCV infection is unknown. We describe two patients with chronic HCV infection and severe rheumatic manifestations, namely: myalgia and seronegative nonerosive symmetrical polyarthritis. Interestingly, the response to anti-inflammatory and second line drugs was poor but unexpectedly recurrent phlebotomies was followed by marked improvement of the symptoms. This observation suggests that iron overload may have some role in the pathophysiology of HCV associated rheumatic complications. Further studies are needed to confirm our observation and to clarify the underlying mechanism.