To the Editor:
Primary biliary cirrhosis (PBC) is a chronic cholestatic autoimmune liver disease of unknown etiology, associated with the presence of antimitochondrial antibodies in 95% of patients1–6. Prevalence of this condition is estimated at between 20 and 240 cases per million population, the most frequent symptoms being fatigue, jaundice, and pruritis. Arthritis is reported in 4%–42% of patients with PBC in several series1–3. Some patients develop a symmetrical erosive small-joint arthritis, often in association with a positive rheumatoid factor (RF), that is indistinguishable from rheumatoid arthritis (RA). There is an increased incidence of RA, Sjögren’s syndrome, Raynaud’s phenomenon, and hypothyroidism in patients with PBC7. Up to 31% of patients, however, develop an asymmetric, nondeforming arthritis that seems unique to PBC7. However, there have been reports of PBC patients developing a deforming and/or erosive arthritis3,4, …
Address correspondence to Dr. Smith; E-mail: malcolm.smith{at}health.sa.gov.au