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Extrahepatic
Manifestations in Patients with Chronic Hepatitis C
Chronic
hepatitis C virus infection often has autoimmune clinical
and analytic features. This review analyzes recent data on
the close association of chronic hepatitis C virus infection
with autoimmune and lymphoproliferative processes.
Recent Findings
Hepatitis
C virus infection has been associated with both organ-specific
(thyroiditis, diabetes) and systemic autoimmune diseases.
Experimental,
virologic, and clinical evidence has demonstrated a close
association between hepatitis C virus infection and Sjogren
syndrome, with hepatitis C virus-associated Sjogren syndrome
being indistinguishable in most cases from the primary form.
With
respect to rheumatoid arthritis, patients with hepatitis C virus-related polyarthritis and
positive rheumatoid factor may fulfill the classification
criteria for rheumatoid arthritis.
Hepatitis
C virus has also been associated with an atypical presentation
of antiphospholipid syndrome, as well as with the development
of sarcoidosis.
A
higher prevalence of hematologic processes in patients with
hepatitis C virus infection has recently been reported, including
cytopenias and lymphoproliferative disorders.
Recent
data are available on the use of new immunosuppressive and
biologic agents (mainly mycophenolate mofetil, anti-tumor
necrosis factor agents, and rituximab) in patients with hepatitis
C virus infection and autoimmune or lymphoproliferative manifestations.
Summary
There
is increasing evidence of a close association of hepatitis
C virus infection with autoimmune and hematologic processes.
The
sialotropism of hepatitis C virus may explain the close association
with Sjogren syndrome, and its lymphotropism links the virus
to cryoglobulinemia,
autoimmune cytopenias, and lymphoma.
The
substantial overlap between cryoglobulinemic features and
the classification criteria for some systemic autoimmune diseases
(systemic lupus
erythematosus, rheumatoid arthritis,
and polyarteritis nodosa) make the differentiation between
mimicking and coexistence difficult.
Department of Autoimmune
Diseases, Institut d'Investigacions Biomediques August Pi
i Sunyer, School of Medicine, University of Barcelona, Hospital
Clinic, Barcelona, Spain.
06/20/05
Reference
M
Ramos-Casals and J Font. Extrahepatic manifestations in patients
with chronic hepatitis C virus infection. Current Opinions on Rheumatology
17(4): 447-455. July 2005.
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