Costochondritis prior to and after SVR ...any similar stories?

I have finally figured out that much of my mid-back and rib pain over the years can be described as costochondritis.  It has been more painful at the junction of the ribs and the spine at mid-back location, but the pain also follows around the ribcage to the anterior chest wall.  It is aggravated by heavy lifting, stress, twisting motions, and overhead work.  

I have read many other similar descriptions of this syndrome by those with HCV, or those who have noticed the condition after long term interferon therapy.  I finally put the symptoms together, and did some google search on the subject.  Of course it also seems that autoimmune conditions, and fibromyalgia are heavily associated with costochondritis.  And these afflictions are also associated both with being HCV positive, and with Interferon therapy.

So, my questions for the medical community are these:  Does HCV cause this costochondritis, either directly (from viral attack), or indirectly, from immune system and antibody responses?
Why does this syndrome remain after tx and in my case, long after SVR?  Is there a direct connection between costochondritis and HCV?  And, finally, what can be done to alleviate it?

To our forum members, I would like to know how many have experienced this 'rib' or 'chest' pain that feels like chronic inflammation, rib wall spasm, mid-back pain, etc.  I am curious as to how many with HCV, either before or after tx, SVR or no SVR, have had, or still have bouts of similar pain.  

The research is very lacking on this subject.

I appreciate all replies!

DoubleDose

[DRAGON SLAYER]

LOCTERON: New Interferon: Once Every Two weeks
OctoPlus has entered into a partnership with Biolex, Inc., a protein therapeutics company, to develop a controlled release formulation of recombinant human alfa interferon. The product, named LocteronT, combines OctoPlus' proprietary biodegradable PolyActiveT drug delivery technology with Biolex' BLX-883, a recombinant alfa interferon produced in its proprietary LEX SystemT. LocteronT is designed to be more convenient for patients than the current pegylated alfa interferon products on the market as it is expected to be administered every two weeks. Alfa interferon is a protein used to treat infectious diseases, such as Hepatitis C and B, and certain cancers. World-wide sales for alfa interferon in 2004 exceeded USD 3 billion.

In preclinical studies, Biolex has shown that BLX-883 is comparable to commercially available alfa interferon and that it can be produced cost-effectively using Biolex' proprietary LEXT System in the company's cGMP manufacturing facilities. Biolex recently announced the filing of an Investigational New Drug Application (IND) with the U.S. Food and Drug Administration and the European equivalent, a Clinical Trial Application (CTA), for the initiation of clinical trials of BLX-883, an immediate release formulation of LocteronT.

OctoPlus has shown in preclinical studies that, when formulated with PolyActiveT, sustained alfa interferon levels in plasma can be achieved, for a period up to two weeks and longer, with a single injection. In contrast, all pegylated alfa interferon products currently on the market require weekly injections. OctoPlus has also demonstrated in these preclinical studies that alfa interferon, when formulated with PolyActiveT, is gradually released after injection, thus avoiding both high peak and low trough plasma levels. This key feature may result in an improved clinical profile for the drug candidate with possibly fewer side-effects.

http://www.octoplus.nl/default.asp?id=00075
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Locteron, New Interferon: Once Every Two weeks
"Biolex's Series B Brings In $36M For Product Pipeline, Production"

By Jennifer Boggs
Bioworld Today
Sept 1, 2005

In its largest financing to date, Biolex Therapeutics Inc. raised $36 million to advance its lead product candidates and also support ongoing collaborations involving its plant-based protein production technology.

The oversubscribed Series B round was led by Polaris Venture Partners, of Boston. Biolex, which has brought in about $70 million to date, conducted its last financing in August 2003, raising $24.4 million.

Proceeds will be used mainly to advance the company's internal pipeline, starting with its lead product, Locteron, a controlled-release formulation of alfa interferon designed to treat hepatitis C. Locteron is expected to begin Phase I studies next quarter.

The formulation aims at offering "benefits to patients with regards to compliance and dosing," said Jan Turek, president and CEO of Pittsboro, N.C.-based Biolex. "Locteron is given once every two weeks, as opposed to the once-a-week pegylated formulation, and has fewer side effects."

Biolex is developing Locteron with OctoPlus Technologies NV, of Leiden, the Netherlands, in an agreement that calls for OctoPlus to combine its PolyActive technology to Biolex's recombinant human alfa interferon.

Following Locteron is Biolex's direct-acting fibrinolytic agent, BLX-155, which Turek described as "a super-clot-buster," to treat peripheral arterial occlusive disease. That product is set to enter preclinical development by the end of the year and move into the clinic in 2006.

"I believe these funds will drive the growth and valuation of the company," Turek told BioWorld Today. "By 2007, we should have one drug entering Phase III, at least one drug entering Phase II, and, hopefully, a few of our partnered programs will be ready to go into Phase I trials."

Biolex has several ongoing collaborations involving its LEX system, a technology portfolio designed to simplify the production of hard-to-make complex proteins and monoclonal antibodies. The largest of those deals involves Malvern, Pa.-based Centocor Inc., a unit of Johnson & Johnson, which paid Biolex an undisclosed up-front fee and pledged three years of funding in exchange for 10 proteins advanced using the LEX system. Under the agreement signed in March, Biolex stands to receive milestone payments for each protein developed, as well as supply fees and royalties from any product sales. (See BioWorld Today, March 22, 2005.)

Biolex's other collaborators include Debiopharm SA, of Lausanne, Switzerland, and Medarex Inc., of Princeton, N.J.

The LEX system uses the natural characteristics of the tiny, aquatic plant Lemna - also known as duckweed - combined with genetic engineering to develop proteins that previously have proved to be too difficult or expensive to make, Turek said.

The LEX system offers three main advantages, he added. The first is speed.

"We can go from a gene to an [investigational new drug application] in 18 months, faster than any other transgenic system," Turek said.

The second advantage, Turek said, is rapid development by using a simple and cost-effective process that can return high expression levels. And lastly, he said, "we believe our approach will be regulatory friendly for GMP manufacturing."

Biolex has about 15,000 square feet of manufacturing capability in Pittsboro, which includes bioprocessing units and areas for recovery and purification work. Funds from the recent financing and other sources also will go toward expanding the facility for the large-scale manufacturing capacity needed for Phase III testing and commercial-scale production.

"In the last eight months we have doubled the number of employees to just over 90," Turek said, "as part of our desire to advance the manufacturing capability."

During the past year and a half, Biolex has focused on consolidating intellectual property relating to plant-based antibody production. In April 2004, it acquired San Diego-based Epicyte Pharmaceutical Inc. to gain control of property to manufacture antibodies in plants, and then brought in IP associated with plant-made pharmaceuticals through the purchase of Lyon, France-based LemnaGene SA in July of that year. (See BioWorld Today, May 6, 2004.)

Along with Polaris, investors in the Series B round included Intersouth Partners, of Durham, N.C.; Quaker BioVentures, of Philadelphia; Johnson & Johnson Development Corp., of New Brunswick, N.J.; Mitsui and Co. Venture Partners, of New York; and Kitty Hawk Capital, of Charlotte, N.C.

Terry McGuire, a managing general partner at Polaris, will join the company's board in conjunction with the financing.

[1fairygirl]

I found much documentation to support many of our thoughts about if brain fog is related to tx, hcv, or just old age.  I found an interesting article.  Here it is:

http://www.hcvadvocate.org/hcsp/articles/cognitive_impairment.html

They do show it's not just the tx or just in our minds....

Smiles, Sue

[layla]

Cuteus, very amazing memory! I am surprise. DD and I have had many some similar problems/experiences over tx time. I truly beleive it has to do with doing so much long term tx. I just got in from working/traveling and really need to sleep but I will check in and chat tomorrow.  DD, sorry you are having this pain, I know how uncomfortable it is. LL

[cuteus]

someone complained last year of a chest pain that turned out to be what you mentioned, was it Layla? grrr, I can't t remember! She said it was in the rib junction also, she was on tx at that time and did not sound as if she had it before. I wish the person would check in.  It is the only one that mentioned it until now. When you commented on your symptoms last time, I remember her post, but could not recall the condition's name.
I hope you find some effective relief.

[couldn't think of a nickname]

Have you been to a chiro. or trigger point (massage therapist)?
People with HCV often have muscle aches and pains which could be attributed to myofascial trigger points (which are muscle knots). Trigger points refer pain to other parts of the body, and set up satellite trigger points there as well. Since the virus is myotoxic in nature, it perpetuates the trigger points as they are a build-up of toxins in the muscles. I have them, and they can cause a wide variety of symptoms, including many that are attributed to HCV. They will keep coming back as long as perpetuating factors are present. I also think (my own hypothesis) that muscle aches/pains after treatment may be from that, and until those issues are worked out, they will remain. They can be worked out by a deep tissue massage followed by drinking plenty of water. The deep tissue massage breaks up the knots, and then the lymph system drains the toxins.
I would check and see if there could be a myofascial component to your issue. Note of caution though, not all doctors are that familiar with trigger points. Do an internet search, and you might be surprised.

[layla]

When I had CC there was no way anyone could touch either side rib area on me when it was at its worse. It was so tender. It lasted a long time after finishing tx. My doc recommended I do as little as possible including stopping execising, which I did and then it very slowly got better. It was very fustrating. It still kept flaring up as soon as I started doing any pysical  for a long time, over a year. This was very different than the muscle cramps I experinced on tx which was more crampy than inflamation (inflammation) and pain. I am now 14 months post tx and have just started running again and exercising regularly. I am very careful about anything near my ribs still from habit. It was very painful for me when I did have it. From my own experience I could see someone experiencing this for a long time. You did a lot of tx DD. For me it seem tx recovery is working oout to how ling I was on tx. I still have very little thinks like a sore spot on my eye. I got some riba rash on my eye and one spot still flares up now and again. It's very slight but it is still there. All in all I am still very glad I did tx and would still have chosen the path I did and extended tx. LL

[rearfang]

Doubledose,
I am on week 17 of 48. For roughly 10 years I have had intermittent stiffness/pain in my spine, where it feels as though it is "fused together".It is always about mid-spine. I find that I must twist and stretch to "crack" it, which sometimes works and sometimes does not. It is less pain than stiffness. It can disappear for weeks and then comes back for awhile. It does not seem to be affected by movement or lifting. At times it hurts when I take a deep breath. I have never really pursued it, because it is not that painful.
Lauren

[Califia]

I know you specifically said before and after tx, but I just wanted to add that I definitely developed costochondritis of the left rib cage DURING treatment.   It seems to have abated, but it does not surprise me in the least that random inflammation of the autoimmune sort would persist after treatment,  even "successful" treatment with an SVR outcome.   I do believe that infection with HCV, whether active or resolved, causes an immune system derangement that is forever with us, and interferon can also set us permanently on overdrive.  So the suggestion of "couldn't think"'s about doing serious myofascial or trigger point work is, I think, a very solid one.   And as for persisting autoimmune problems,  Traditional Chinese Medicine could prove really helpful--definitely has for me in the past.   (As soon as I've gathered a little more energy post-tx, I'll be commuting back to my OMD doc to get everything back on track.)   Don't be afraid of exploring alternative medicine at this point, as it's all we really have to address immune dysregulation.

[couldn't think of a nickname]

p.s. I am NOT a member of the medical community.

John

[nanniegea]

I know what you are talking about. I too suffer from back pains and stiffness,(upper mid line)   I have had it since before tx but noticed it has gotten worse since I started tx. I also have increasing joint pains. Sometimes when I exert myself too much I get so weak and nauseus that I have to go and lie down. And the minute my head hits the pillow I am out for at least two hours. On waking, I feel weak and sick which can last up to 24 hours. Nothing about this tx is easy and for those that have a relatively easy time of it can consider yourselves most fortunate. Best wishes to all and may you all reach svr.

[Moeymitt]

I have the RUQ pain also. Comes and goes and I have driven myself crazy trying to figure out what I am doing to bring it on, to much coffee, sleeping wrong, sitting wrong, work, etc.....I have had Hep c 30 years and why this comes on now I can't explain...so off to the medical field I go, they all said the same,(3 different doctors) not related to liver but to membrane around liver and when liver is ifl. as to getting larger it causes infl in the membrane which feels like rib and back pain.(Always on the right side) I also found a PT in CAlif (I live in WA state) who treats people with Hep C rib pain by doing trigger Point work for 350 an hour!!!  I did not pursue this but you can find an article in Hepatitis Magazine in June about him.   I also get regular massages and thats helps. I also talked with my doctor who said that just because I do tx does not mean the pain will go away, he has lots of patents  who have done tx and still have the pain.

[wkwithit]

I worked in Rheumatology so I know what helps.  Wet heat..take a wash closh and wet it, wring it out and heat in micro.....(please don't burn yourself)  and apply to area.  If you have a heating pad you can put that on top of the washcloth.....about 15-20 minutes several times a day.  

Silvia