PT - JOURNAL ARTICLE AU - BENJAMIN TERRIER AU - DAMIEN SÈNE AU - AGNÈS DECHARTRES AU - DAVID SAADOUN AU - NICOLAS ORTONNE AU - PHILIPPE ROUVIER AU - LUCILE MUSSET AU - MATTHIEU RESCHE RIGON AU - THIERRY MAISONOBE AU - PATRICE CACOUB TI - Systemic Vasculitis in Patients with Hepatitis C Virus Infection with and without Detectable Mixed Cryoglobulinemia AID - 10.3899/jrheum.100191 DP - 2011 Jan 01 TA - The Journal of Rheumatology PG - 104--110 VI - 38 IP - 1 4099 - http://www.jrheum.org/content/38/1/104.short 4100 - http://www.jrheum.org/content/38/1/104.full SO - J Rheumatol2011 Jan 01; 38 AB - Objective. To describe hepatitis C virus (HCV)-related systemic vasculitis in patients without detectable mixed cryoglobulinemia (MC) and to compare them to typical cases of HCV-MC vasculitis. Methods. Twelve HCV RNA+ patients with histologically proven vasculitis in the absence of detectable MC (cases) were retrospectively compared with 48 HCV RNA+ patients with MC vasculitis (controls). Each case was matched with 4 controls for age and sex. Results. The main epidemiological and virologic features were similar between cases and controls. No clinical difference was found, except for lower rates of arthralgias (33% vs 71%; p = 0.02) and purpura (50% vs 83%; p = 0.03) in cases. Cases showed higher mean serum C3 (1.17 ± 0.21 vs 0.93 ± 0.23 g/l; p = 0.01) and median C4 levels (0.25 vs 0.04 g/l; p < 0.001), lower median serum IgM levels (0.6 vs 1.9 g/l; p < 0.001), and lower rates of rheumatoid factor positivity (8% vs 82%; p < 0.001) than controls. The main histologic features were similar between cases and controls. Immunofluorescence analysis of skin biopsy from 1 case revealed perivascular deposits of C3 and IgA. After treatment, overall clinical response of vasculitis (75% vs 83%) and sustained virological response (40% vs 64%; p = 0.3) were similar between cases and controls, except for higher complete clinical response (42% vs 73%; p = 0.05) in controls. Conclusion. HCV-related systemic vasculitis may occur in the absence of detectable MC. Our findings suggest that such vasculitis probably results from immune complex-mediated mechanisms, and that the therapeutic management of such vasculitis should be similar to that of HCV-MC vasculitis.