Synovial Biopsy Findings in Arthritis Associated with Hepatitis C Virus Infection

Synovial Biopsy Findings in Arthritis Associated with Hepatitis C Virus InfectionTo the Editor:The worldwide prevalence of arthritis presumed to be due to hepatitis C virus (HCV) infection has been reported between 2.4 million and 45.9 million people 1,2 .Histopathological changes in HCV-associated synovitis have not been examined.We have performed a histological and immunohistochemical analysis of synovial biopsies from the knee joints of 2 patients with HCV infection and arthritis.Laboratory values are summarized in Table 1.Patient 1 was a 56-yearold African American man with joint pain involving hands, wrists, elbows, shoulders, knees, and ankles of 4 months' duration.There was no history of sexually transmitted diseases or gastroenteritis in the preceding months.Physical examination revealed warmth, swelling, and tenderness over the elbows, wrists, metacarpals, proximal interphalangeal joints, knees, ankles, and metatarsal bones.A closed-needle synovial biopsy was performed on 1 knee joint.At 3 years' followup, the patient is maintained on low-dose prednisone and continues to have arthralgias but no overt joint swelling.Patient 2 was a 42-year-old white man with a painful right knee effusion of 1 month's duration.He denied prior trauma or illness, but reported sweats and chills.There was no recent history of sexually transmitted diseases and no gastroenteritis in the months prior.A closed-needle synovial biopsy was performed on the affected knee joint.Symptoms resolved after an intraarticular injection of triamcinolone hexacetonide and subsequent treatment with nonsteroidal antiinflammatory drugs.Two years later the arthritis has not recurred.Synovial tissue sections from both patients were stained with H&E or immunostained for CD15 (neutrophilic granulocytes), CD3, CD20, CD38, CD68, Ki-67, and von Willebrand factor (vWF) 3,4 .A previously validated synovitis score 5 was modified in that the score of each specimen represents the average of 5-10 microscopic fields (200× magnification).Results were compared to results from synovial membranes from osteoarthritis (OA; n = 26) and rheumatoid arthritis (RA; n = 28) 3,4,6,7 .Vascular density was also compared to normal synovium (n = 15; 7 and unpublished data).Expression differences were assessed with receiver-operating characteristic (ROC) curve analysis (SPSS 14.0 software).Focal lining hyperplasia occurred in both specimens (Figure 1), but * Two years before biopsy; ** 3 years after biopsy; † 1 year before biopsy; † † 2 years after biopsy.C3 and C4: complement components 3 and 4; CCP: cyclic citrullinated peptide; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; HBV: hepatitis B virus; HIV: human immunodeficiency virus; ND: not determined; RF: rheumatoid factor; SF:

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