الفهرس 
Hepatitis COnly 14 pages are availabe for public view
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Abstract
This study was carried out on 60 Egyptian patients with chronic hepatitis C suffering clinically from of one or more of the HCV- related rheumatic manifestations and eligible for treatment with sofosbuvir (400 mg daily) plus daclatasvir (60 mg daily) as a direct-acting antivirals for 3 months.
In the present study, 21 patients met the criteria of Mixed cryoglobulinemia syndrome (MCS), 19 patients were complaining of Arthralgia, 17 patients were complaining of Fibromyalgia and 3 patients were complaining of Purpura without other criteria of MCS.
Regarding the clinical response to DAAs, the current study shows that viral eradication was associated with clinical improvement in most patients.
Complete clinical response was achieved in a significant number of patients with MCS, with significant reduction of the overall BVAS.v3 at SVR 12. Patients with fibromyalgia also show marked clinical improvement with significant reduction in symptom severity scale and widespread pain index at SVR 12.
Regarding patients with arthralgia in the current study, there was complete relief of pain in a significant number of patients with significant reduction in number of affected joints and VAS at SVR12
Regarding the immunologic response to DAAs, The results of the present study showed a great immunologic activation (high circulating cryoglobulins, RF, ANA, AntiCCP, lower C4 and C3) in patients with HCV related rheumatic manifestations at base line
Significant reduction but not complete normalization in auto-antibodies at short term follow up was observed, as immunologic response seems to be delayed, probably depending on the time required for reversion of the B-lymphocyte clonal expansion producing immunologic changes.