The Pathogenesis of Arthritis Associated with Viral Hepatitis

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Abstract
Eighteen patients with acute viral hepatitis had initial symptoms of arthralgia, arthritis or urticaria. Total serum hemolytic complement (CH50) and C4 tended to be severely depressed in the nine patients studied in the acute phase of their joint symptoms. The C3 levels were moderately depressed, and the C1q levels were widely variable. C1 inhibitor and C9 serum concentrations were normal. Patients with viral hepatitis in convalescence or remission from arthritis, or without a history of these symptoms, had a normal or elevated serum CH50 and C3 level, a widely variable C1q level and low normal C4 levels. Low serum levels of complement in viral hepatitis were associated with high titers of hepatitis-associated antigen. Five patients with acute nonviral hepatitis had normal or elevated serum complement levels. The correlation of joint and skin symptoms with hepatitis-associated antigen and depressed levels of complement activity in the acute state suggests that this serum-sickness-like syndrome may be caused by circulating immune complexes.