Extra-hepatic disorders are those that have their origin or are found outside of the liver, but for people with hepatitis C can be triggered by the virus. Again having a chronic HCV infection does not mean all or any of these will develop but simply that it is a possibility for some people.
Dryness of mucous membrane lining the eyelids and outer eye surface caused by insufficient secretion of tears. (Keratoconjunctvitis sicca)
Dryness of the mouth and eyes and feeling of grittiness in the eyes. This is caused by the progressive destruction of sweat, saliva and tear glands. (A form of kerajunctivitis called Sjogrens syndrome)
Flat, itchy patches of skin, usually found on the wrists, shins, lower back, genitalia and sometimes the scalp. (Lichen planus).
Inflammation of the kidneys tiny blood vessels used for filtering waste. (Glomerulonephritis)
Sensitivity to light leading to blisters and ulcerations of the skin in areas usually exposed to sunlight such as the face, ears and backs of the hand. (Porphyria cutanea tarda).
Autoimmune thyroid dysfunction
The thyroid gland is the largest of the endocrine glands; which are glands that secrete hormones directly into the bloodstream. The main function of the thyroid gland is to increase the rate of the chemical reactions of most of the cells in the body particularly energy and protein reactions. There are two conditions associated with HCV infection where the immune system can either attack or stimulate thyroid tissue: Overeractive thyroid production (hyperthyroidism) can cause insomnia, weight loss, palpitations and ankle swelling and underactive thyroid production (hypothyroidism) which can cause physical and mental sluggishness. With hepatitis C, as in the general population, thyroid autoimmune dysfunction is more common amongst women. Treatment can also trigger thyroid malfunction and so during treatment your thyroid function is checked regularly. Everyone with hepatitis C should be having at least annual thyroid function blood tests.
Cryoglobulinemia
This is a disorder in which abnormal proteins may cause damage to the skin, nervous system and kidneys. Symptoms include mild fatigue, joint pains, or itching and increased sensitivity to temperature changes. Occasionally, people with cryoglobulinemia develop inflammation of the blood vessels (vasculitis) which can cause purple skin lesions (purpura) or numbness in the hands and feet or Raynauds phenomenon where the hands turn white, then blue, and then red from constriction and subsequent dilation of the blood vessels).
Non Hodgkins Lymphoma
There are two main types of lymphoma. Lymphoma is cancer of cells in the lymphatic system (which is part of the bodys immune and elimination system). One is called Hodgkins disease (named after Dr Hodgkin, who first described it). The other is called non-Hodgkins lymphoma (NHL) NHL is a group of around twenty types of cancers which affect the bodys lymphatic system. HCV frequently inhabits the lymphatic system in very low quantities.
As HCV was often seen as only infecting the liver, the connection between hepatitis C and NHL was not made and therefore lymphomas have been underreported.
The primary symptoms of Lymphatic diseases are:
- Painless swellings, usually in neck, armpits or groin
- Excessive sweating or fever
- Persistent itching all over the body
- Weight loss and loss of appetite.
Lymphoma is diagnosed by taking a biopsy of a cell sample from a suspect lymph node. It has been known for some time that people infected with HCV and long-term cryoglobulinemia are at greater risk from NHL. However, NHL is also now known to develop in people with HCV in the absence of cryoglobulinemia. The exact mechanism involved in HCV-associated lymphoma is still unknown.
Insulin Resistance and Diabetes
Insulin resistance is a condition in which there is too much insulin in the blood. This happens because the cells, which normally take up insulin to help them convert sugars from food into energy, block it instead. Ultimately your body cant absorb or process sugars properly. The exact mechanism of insulin resistance in relation to hepatitis C is unknown. It is likely that insulin resistance is an early abnormality that can go on to cause type 2 diabetes in people with hepatitis C. Some people have also developed diabetes as a result of treatment,
Gall Bladder Disease
Some people with hepatitis C have problems with their gall bladder. This takes the form of inflammation and pain with or without gallstones causing nausea and possibly vomiting and difficulty eating certain foods, especially fatty foods. It is not uncommon for people with hepatitis C to have their gall bladder removed as a result.
Arthritis
Several forms of arthritis have been linked to HCV infection but this is rare. The type most commonly associated with hepatitis C is rheumatoid arthritis (RA). Blood levels of people with HCV often show elevated levels of rheumatoid factor and it is thought that this may be a trigger to the development of rheumatoid arthritis. RA normally affects the synovial joints. These are joints with a space between them that is filled with a liquid called synovial fluid. Most joints in the body are of this type. RA causes membranes in these joints to overgrow causing inflammation of the linings of the joints. Symptoms include pain, swelling, redness and stiffness. As the condition progresses invading inflammatory proteins may damage surrounding cartilage, tendons and bone so affecting joint movement. It is generally thought that HCV related RA is an autoimmune disorder that results in antibodies starting to attack normal body tissue, but some doctors think it may be more closely related to liver damage and argue that the fact that the condition usually affects people who have progressed to cirrhosis supports this.
Treatment can be a problem in that some anti-inflammatory drugs used to treat autoimmune diseases can suppress the immune system and may lead to increased viral replication. Another concern is that many of the drugs used to treat RA are metabolised by the liver so that in people with liver damage toxins may build up in the liver. There is evidence that drug treatment which reduces the viral load can decrease arthritic symptoms.
Jaundice
Jaundice only affects a few patients during acute hepatitis and very few patients during chronic hepatitis C. However, jaundice is a common sign of decompensated cirrhosis The yellowing of the skin associated with jaundice comes from the pigment bilirubin, which gives bile its green/yellowish colour. It is formed during the breakdown of old blood cells. If the liver loses the ability to remove bile pigment it builds up in the blood and the skin. The whites of the eyes go yellow, the skin takes on a yellow hue, urine goes brown and stools can turn white.
