Background Hepatitis C is a disease with significant global impact.Extrahepatic manifestations (EHM) are frequently noted in HCV patients (pts). Cryoglobulinemia can be detected in 25 to 30% of the pts & is one of the most common disorders associated with HCV with a wide spectrum from mild purpura to life-threatening vasculitis.The most effective treatment (Rx) of symptomatic HCV MC is eradication of HCV infection.
Objectives To study the impact of interferon alpha (IFN-α) therapy on clinical and laboratory parameters in pts with HCV infection with & without cryoglobulin (CG)
Methods EHM & manifestations of CG as purpura, arthralgia, fatigue, renal,nor neurological complications were detected & registered during the first & follow-up visits. CBC, kidney functions, as well as the followings before & after IFN-α therapy: liver functions (PT/INR, AST, ALT, s. albumin, total proteins, s. bilirubin) ESR, RF, quantitative PCR for HCV, s. CG, C4.The study included 100 HCV pts treated with peg-IFN plus ribavirin for 12 weeks regardless HCV genotype. Pts with other possible cause of CG were excluded
Results Mean pts age:37.05±5.28 ys, mean disease duration 10.8±2.5 ys.The followings were observed: High prevalence of CG in chronic HCV pts (45% of patients). After Rx 13 CG +ve pts became -ve. (Complete responders (CR): HCV RNA became undetectable at the end of 12th week).Unlike the partial responders (PR), there was statistical significant difference in CG before and after Rx in CR (<0.001*), the median CG decreased from 99 to 52 pg/ml & the mean of C4 increased in CR (P<0.001*). There was statistical significant difference between RF & ESR before and after Rx in CR and PR P<0.001* & 0.020*. There was +ve correlation between CG level & duration of infection, ALT, viral load and RF and a -ve one between CG & albumin levels, total proteins and C4. <0.001. Symptoms of mixed cryglobulinemia were present in both CG +ve and -ve pts except PN & nephropathy which occurred only in CG+ve pts (table). There was statistical significant difference between purpura, fatigue, arthralgia, arthritis and myalgia with RF (P<0.05), & none between PN & nephropathy and RF (P>0.05). IFN plus ribavirin were very effective in decreasing the viral load, improving liver functions, decreasing CG, RF, ESR & increasing C4 in CR more than PR. They were effective in the improvement of all CG symptoms except PN, nephropathy & fatigue.
Conclusions CG testing has been neglected in routine clinical laboratory by clinicians
Patients with manifestations suggestive of cryoglobulinemia should be tested for hepatitis C and conversely, signs and symptoms of this condition should be screened in patients with known HCV infection.
Ferri C, et al.: Current treatment of hepatitis C-associated rheumatic diseases. Arthritis Res Ther 2012; 14:215.
Disclosure of Interest None declared