RT Journal Article
SR Electronic
T1 Systemic Vasculitis in Patients with Hepatitis C Virus Infection with and without Detectable Mixed Cryoglobulinemia
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 104
OP 110
DO 10.3899/jrheum.100191
VO 38
IS 1
A1 BENJAMIN TERRIER
A1 DAMIEN SÈNE
A1 AGNÈS DECHARTRES
A1 DAVID SAADOUN
A1 NICOLAS ORTONNE
A1 PHILIPPE ROUVIER
A1 LUCILE MUSSET
A1 MATTHIEU RESCHE RIGON
A1 THIERRY MAISONOBE
A1 PATRICE CACOUB
YR 2011
UL http://www.jrheum.org/content/38/1/104.abstract
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.