الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hepatitis C virus (HCV) infection is a worldwide disease which considered a major cause of morbidity and mortality, especially in Egypt where the highest prevalence of HCV infection in the world. Musculoskeletal and rheumatologic extrahepatic manifestations are associated with both HCV infections and its management. Different researches was applied to assess the efficacy and safety of new direct-acting antiviral agents (DAAs) therapy on HCV-related extra-hepatic manifestations. The present study aimed to detect musculoskeletal manifestation in HCV patients receiving direct antivirals therapy. The study included200 Egyptian HCV patients complaining from musculoskeletal manifestation after receiving direct antiviral therapy (DAAs) All HCV patient had Complete history of HCV, line of management, duration ,response to therapy, full clinical, Rheumatological, laboratory and radiological examination. The current study revealed Two hundred HCV patients were diagnosed with PCR and treated with direct antiviral drugs (DAAs) therapy presented with musculoskeletal manifestation, 65% of them were female in their middle aged (35-55 years old), married, unemployed and non-smoker. Dual therapy protocol (Sofosbuvir/Daclatasvir) was more applied in studied HCV patients than triple therapy protocol (Sofosbuvir/Daclatasvir/Ribavirin). Most of studied HCV patients treated with DAAs therapy for 12 weeks duration and only 17% of them received treatment for 24 weeks duration. Almost all treated HCV by DAAs therapy had complete cure evident by PCR, with majority of them had no reported complication. Most of the studied HCV patients complained of bone pain 45%, knee pain 42%, back pain 25% and shoulder pain 14% while 38% of them complained of headache and fatigue. Most frequent involved joint was the knee 55% of studied HCV patients, while the least affected joint was the wrist 6% and the shoulder joint was 8% of them. 85% of them had progressive course. Most of studied HCV patients (55%) had osteopenia in more than one site and 55% of them had joint narrowing in more one site while knee joint narrowing was common in 38% of them .It is peculiar to our study to evaluate ophthalmic manifestation in studied HCV patients where the dryness in 33%, conjunctivitis in 20% of them. Fatigue was the most common complaint in 100% studied HCV patients treated with triple therapy protocol (Sofosbuvir/Daclatasvir plus ribavirin). Arthralgia in the wrist, knee and shoulder joints was presenting manifestation in majority 63% of studied HCV patients treated with dual therapy protocol (Sofosbuvir+ Daclatasvir).No significant difference in prevalence of arthralgia between studied HCV patients treated for 12weeks and 24 weeks duration. Joint swelling and limited joint mobility were more evident in studied patients treated with dual therapy protocol (Sofosbuvir/ Daclatasvir) than those treated with triple therapy protocol (Sofosbuvir/ Daclatasvir/Ribavirin). Sicca syndrome and dry eye was obvious in studied HCV patients treated with dual therapy protocol (Sofosbuvir /Daclatasvir) than those treated with triple therapy protocol Headache and fatigue were noticeable adverse events in studied HCV patients treated with DAAs therapy for 24 weeks duration than those treated for 12 weeks duration, unlike back pain which was common in studied patients treated for 12 weeks than those treated for 24 weeks duration. Joint tenderness was the common presentation in different age groups; (100%) in age group (35-55) years old, age group more than 55 years old and age group less than 35years old, while joint narrowing was more common finding in age group more than 55 years old and age group (35-55) years old. Osteopenia was common radiological finding in age group more than 55 years old, age group less than 35 years old and in age group 35-55 years old.