Does RA Factor mean anything for HCV+?

Hello Dr. D.,

I am a treatment naive GT1a, cirrhotic with stage 1 varicies, platelets holding around 90. My labs indicate good hepatic function for the most part. Most likely will begin treatment in the fall with Alinia added to the mix as I feel I can't wait for Telaprevir approval.

Extremely swollen ankles got me back to the doctor in 2006 after ignoring my health issues for almost 10 years. At that appointment the doc looked at them and said it has nothing to do with my liver. He didn't know why they were swollen.  I have recently visited a new hepatologist in preparation to treat and the teaching fellow that did my exam noted my swollen ankles/feet and did a "hmmmmm, these are very swollen." Unfortunately it didn't get discussed when the Big Doc came in to talk about a plan. We forgot!

I did get my labs back and noticed that new guy (wonderful doctor!) ran a cryo test and RA factor. The cryo came back "Trace" and the RA Factor was 59. I have read here that this is common result for people with this virus but really don't understand what it means if anything.

Could I actually have RA? Do I care? Or do heppers just have the weird test result? If RA, maybe it would explain this intermittent TREMENDOUS swelling of ankles (also suffer from very painful shoulders and knees) and possibly solve the numb fingers mystery as well? Neither hepatologist mentioned this when looking at these puffer fish I call feet. Or is this just life with HCV and there is nothing to be done but treat?

On that note, I think I understand that the cryo is cured by treating, will the RA factor change anything?

Last question, to deal with these problems, I have taken ibuprofen over the years, but they tell me now, no nsaids or aspirin. Tylenol doesn't help much. If I keep the advil to a minimum is it OK?

Thank you for your time and the info.

Foo Fighter

[Douglas Dieterich, MD]

Most everything you describe is easily attributable to the HCV. You do need some water pills for the swollen ankles and you do need treatment as well. I cant comment on the NSAIDS because I am presuming your platelets are low and they dont want you to bleed which is reasonable. If you need something for pain ask them about tylenol with codeine or oxycodone. Sounds like you are in good hands. Good luck! DTD