Hello Mr. Bolin,
I am afraid my answer is somewhat inconclusive, but reflects the
uncertainty that exists among researchers. But there is definitely a
lot of interest in a possible connection between Hepatitis C and
rheumatological disease in general, including rheumatoid arthritis. I
can report to you several relevant studies and commentaries.
1. My first referral is to an article that seems to be an overview of
what is known about such a possible connection, written by a physician
at the Soroka Medical Center in Israel. This article appeared in 2000
in the journal Current Opinion in Rheumatology. The author states,
quite unambiguously, the following: ? Rheumatologic complications of
hepatitis C virus (HCV) infection are common and include mixed
cryoglobulinemia, vasculitis, sicca symptoms, myalgia, arthritis, and
fibromyalgia.?
The article also says ?HCV-infected subjects express a high
prevalence of a variety of autoantibodies, usually in low titers.?
(This seems significant to me, because it would suggest?but certainly
does not prove?that hepatitis C infection makes one more susceptible
to automimmune diseases such as rheumatoid arthritis.)
However, the article also says that ?the clinical significance of most
of these autoantibodies is not clear. The prevalence and titer of
these autoantibodies are unaffected by interferon-alpha therapy.
Several studies have attempted to assess whether HCV infection may be
involved in the etiopathogenesis of rheumatic and autoimmune diseases.
The results of most of these studies do not support the idea that HCV
infection may play a pathogenic role in the development of systemic
lupus erythematosus, antiphospholipid syndrome, or leukocytoclastic
vasculitis. Experience treating patients with HCV-associated arthritis
is limited and treatment remains controversial. No major therapeutic
trials in HCV-associated arthritis were reported in the past 2 years.?
This last statement seems to suggest that although HCV and
rheumatological diseases are often seen together in the same patient,
that HCV causes them is not proven. (By the way, has your problem been
diagnosed at rheumatoid arthritis?)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10910182&dopt=Abstract
2. My second referral for you is to an epidemiological (disease
patterns in the popualtion) study that attempted to discern a
connection in health/disease statistics among the general US
population of people 60 year-old and up. Using data from the National
Health and Nutrition Survey III, the researchers looked at 4,769 such
persons. Of this group, 197 had met the criteria for diagnosis of
rheumatoid arthritis (RA). 63 had tested positive for the presence of
antibodies to HCV (meaning they had been exposed to the Hep-C virus,
but had not necessarily been infected with it.) Only two individuals
had both HCV antibodies and RA. And only one had both tested positive
to the definitive diagnostic test for HCV (the RNA test) AND had RA.
The conclusion of this statistical study was: ?These results argue
against a potential role for HCV in the etiology of RA in the US
population aged 60 years and over.?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12610800&dopt=Abstract
3. The third referral summarizes pretty startling and conclusive
findings that patients with HCV AND Cryoylobulinemia, (a definition of
this rare condition can be found at:
http://dynamics.org/~altenber/cryo/ ) have almost a 50/50 chance of
developing ?rheumatological symptoms.?
http://www.hepcassoc.org/news/article26.html
I am hoping that amid this information will be ammunition for you to
select, to use in your communication with the VA.
I wish you success, and better health.
Scribe_ga |
Request for Answer Clarification by
labolin_welton-ga
on
14 Apr 2004 20:28 PDT
As far as being dignosed with rhumatoid arthritis, my private
rhumatologist confirmed that I do have it and it showed up in my blood
test. But the VA doctors some how have a different oppinion and seem
to think it is more in the line of osteoarthritis, even though
rhumatoid arthritis still showed up in my blood test. I tend to think
that the VA doctors don't realy know what they are talking about. The
hepatitis-C clinic at the VA hospital was described to my congressman
as "state of the Art". I find this hard to believe since it is run by
two physician's assistants - no MD's at all.
|
Clarification of Answer by
scribe-ga
on
15 Apr 2004 03:40 PDT
Mr. Bolin,
To my understanding, whether you have rheumatoid arthritis OR
osteoarthritis is quite important. This is so because there may be a
connection between HCV and RHEUMATOID arthritis ONLY. You say you have
received conflicting medical opinion as to which type your arthritis
is.
I have learned that rheumatoid arthritis can be difficult to diagnose
in its early stages. There does exist a diagnostic blood test for
something called Rheumatoid Factor, but patients in the early stages
of RA may not test positive for this factor.
http://www.paralumun.com/arthritisdiagnosis.htm
Indeed, some people who have RA (about 20 percent) will NEVER test
positive for this factor. See "Rheumatoid Factor" on this page:
http://www.muhealth.org/~vocrehab/Arthritis/lab-tests.htm
You say that your private rheumatologist has confirmed you have the
rheumatoid type. Did he base this diagnosis on a blood test? You
mentioned in your original question that "you have large nodes" on
your knuckles. Was it these, (which are typical of rheumatoid
arthritis) that led your rheumatologist to his diagnosis? Did the VA
do a blood test which did not show the presence Rheumatoid Factor? For
information on nodules and RA, see this page:
http://health.allrefer.com/health/rheumatoid-arthritis-info.html
As for how good the clinic is at the VA, I can neither say nor
determine. However, I would say that in my personal experience
Physician Assistants can be extremely well informed and able. But
could you perhaps request a consultation with a rheumatologist at
another VA hospital?
All the best,
scribe_ga
|
Request for Answer Clarification by
labolin_welton-ga
on
19 Apr 2004 09:34 PDT
Hi Again: My private rhunatologist based his findings because my RA
factor was high when they did blood work. I originaly visited this
doctor because first I had a trigger finger in my thumb which sort of
freaked me out because my thumb would not move at all. Then about a
month latter both my hands refused to work for me. This realy scared
me because I could not even use my hands to get some toilet paper.
Both these problems were fixed with injections of cortizone. I can no
longer see this doctor because he is not a member of my insurance
plan. So now my pain management doctor has taken over the job of
injecting my hands with cortizone. Apparently, it is the only thing
that allows my hands to function. I don't know if I have mentioned it
to you or not, but I suffer from chronic pain. Because of this, I have
an implanted morphine pump that delivers morphine directly into my
"pain controle central" (AKA lower spinal area) via a line that goes
from my pump to my spine. To put it in a nut shell, my entire body is
a mess. I did win a case with the VA that I was told would never
happen. This is in reguards to the way I contacted my hepatitis-C
while in the navy. Back in the 1970's they used to line up the entire
platoon and proceed to give us injections (right & left arm) using one
of those air injection guns. If a person would flinch just a little,
it would cause the injection sight to bleed. One would think that they
would at least wipe the blood off the gun prior to using it on the
next person, but that would be to EZ. They would just keep using the
same gun on the next guy and so on. Also I had several operations
while I was in the navy. After the surgery, if you would ask for a
shot for pain. They would use a great big chrome syringe that left a
nice hole in your rear end. If you think they would change the needles
on the syringe, you are wrong. In fact, if the hospital corpsman
didn't like you he would dull the point of the needle so when you got
your shot, it would hurt like hell. Then you would have to put your
finger over the injction sight, otherwise the medication would leak
right back out. In addition, when they were nice enough to sterilize
the needles they would do it by using steem heat. It was not until
latter did the find out that heat did not kill the hepatitis virous.
Such a joy it was when you had surgery in a naval hospital. Nothing
like having a semi-private thirty man room. Sorry to lay my complaints
on you, but it just pisses me off to think they would treat a veteran
like that. The military would still be using those air injection guns
if it were not for the manufacture to stop making those guns out of
fear that it could/would transmitt blood born diseases. BTW- those
large nodes on my knuckles are still there. If you were to touch them,
look out because they hurt like hell. Thank you for your help that you
have been providing me. It's hard to type using one hand since thise
arthritis in my hands is very painfull. Hope you have a nice day. I
have an appointment with my pulmanary doctor because of my severe
sleep apnea. I wish like heck I never had that operation that was
supposed to cure that problem because that too was painfull.
|
Request for Answer Clarification by
labolin_welton-ga
on
19 Apr 2004 09:36 PDT
Hi Again: My private rhunatologist based his findings because my RA
factor was high when they did blood work. I originaly visited this
doctor because first I had a trigger finger in my thumb which sort of
freaked me out because my thumb would not move at all. Then about a
month latter both my hands refused to work for me. This realy scared
me because I could not even use my hands to get some toilet paper.
Both these problems were fixed with injections of cortizone. I can no
longer see this doctor because he is not a member of my insurance
plan. So now my pain management doctor has taken over the job of
injecting my hands with cortizone. Apparently, it is the only thing
that allows my hands to function. I don't know if I have mentioned it
to you or not, but I suffer from chronic pain. Because of this, I have
an implanted morphine pump that delivers morphine directly into my
"pain controle central" (AKA lower spinal area) via a line that goes
from my pump to my spine. To put it in a nut shell, my entire body is
a mess. I did win a case with the VA that I was told would never
happen. This is in reguards to the way I contacted my hepatitis-C
while in the navy. Back in the 1970's they used to line up the entire
platoon and proceed to give us injections (right & left arm) using one
of those air injection guns. If a person would flinch just a little,
it would cause the injection sight to bleed. One would think that they
would at least wipe the blood off the gun prior to using it on the
next person, but that would be to EZ. They would just keep using the
same gun on the next guy and so on. Also I had several operations
while I was in the navy. After the surgery, if you would ask for a
shot for pain. They would use a great big chrome syringe that left a
nice hole in your rear end. If you think they would change the needles
on the syringe, you are wrong. In fact, if the hospital corpsman
didn't like you he would dull the point of the needle so when you got
your shot, it would hurt like hell. Then you would have to put your
finger over the injction sight, otherwise the medication would leak
right back out. In addition, when they were nice enough to sterilize
the needles they would do it by using steem heat. It was not until
latter did the find out that heat did not kill the hepatitis virous.
Such a joy it was when you had surgery in a naval hospital. Nothing
like having a semi-private thirty man room. Sorry to lay my complaints
on you, but it just pisses me off to think they would treat a veteran
like that. The military would still be using those air injection guns
if it were not for the manufacture to stop making those guns out of
fear that it could/would transmitt blood born diseases. BTW- those
large nodes on my knuckles are still there. If you were to touch them,
look out because they hurt like hell. Thank you for your help that you
have been providing me. It's hard to type using one hand since thise
arthritis in my hands is very painfull. Hope you have a nice day. I
have an appointment with my pulmanary doctor because of my severe
sleep apnea. I wish like heck I never had that operation that was
supposed to cure that problem because that too was painfull. If you
can, please give your self another five dollor tip for helping me out.
|
Clarification of Answer by
scribe-ga
on
19 Apr 2004 11:24 PDT
Mr. Bolin,
Thanks very much for the tip.
I am very sorry to hear that you are afflicted with multiple health
problems. Your account of how the Navy gave shots back in the 70s is
pretty hair-raising. But I am sure they have cleaned up their act
since then, because of AIDS.
One question. Why must you prove to the VA that there is a connection
between your HCV and arthritis? The VA will treat any ailments you
have, no matter when, how or where acquired, won't they? And another
question: Aren't the cortisone shots you are receiving for pain a
common treatment for rheumatoid arthritis?
In any event, I hope your health improves in the near future, with all
the help the VA can--and should--give you.
All the best.
scribe_ga
|
Request for Answer Clarification by
labolin_welton-ga
on
20 Apr 2004 16:09 PDT
Dear scribe-ga: First of all, I wouldn't let the veterans
administration treat me if they were the last doctors on earth. I
don't know where they get their doctors, but you would think they
would at least teach them how to speak English correctly. As far as
what the differance is, you seem to forget the most important thing,
COMPENSATION for my injuries. I went by my old Rhumatologist today to
obtain my medical records for more ammo. I stand corrected concerning
my RH factor, which was just slightly elevated. But what my doctor did
write for me will do major damage in their refusal to pay. In the
letter he staited "To Whome It May Concern: Mr. Lee Bolin was followed
in our office from May 22, 1998 to September 16, 1999 for
polyarthritis that was felt most likely related to his Hepatitis-C.
Many viruses, including Hepatitis-C virus, can cause arthritis
conditions. When he was followed in our office, this was felt to be
the most likly cause of his difficulty". I believe this letter will
hit the nail directly on the head. The only thing that I have to have
him change is for him to say instead of "Most likely related to his
Hepatitis-C" to "Most likely than not, related to his Hepstitis-C".
Just those little words mean a big deal when it comes the the VA.
Did I tell you that recently there was a gentelman in the VA hospital
that had cancer in one of his lungs? Well, they waited for over six
months to preform the operation. By that time it was to late. The
cancer had already spread to his liver. The only option they gave him
was chemo therapy. How sad!
Thank You Again,
Lee Bolin
|
Clarification of Answer by
scribe-ga
on
21 Apr 2004 03:35 PDT
Hello Mr. Bolin,
I hope this letter to the VA from your rheumatologist does the job for
you. Good luck!
scribe_ga
|
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