title: Mixed cryoglobulinaemia: a cross-road between autoimmune and lymphoproliferative disorders.
abstract: Mixed cryoglobulinaemia (MC) is a systemic vasculitis, secondary to the deposition in small and medium-sized blood vessels of circulating immune complexes, mainly the cryoglobulins, and complement. MC is characterised by a typical clinical triad (purpura, weakness, arthralgias) and by one or more organ involvement: chronic hepatitis, glomerulonephritis, peripheral neuropathy, skin ulcers and diffuse vasculitis. In a limited number of MC patients, a malignancy, that is B-cell non-Hodgkin's lymphoma or hepatocellular carcinoma, may also develop. Hepatitis C virus (HCV) infection has been found in the majority of patients with MC; the frequency of HCV markers (91%) was significantly higher than other rheumatic diseases (6.4%), namely systemic lupus, Sjögren's syndrome, rheumatoid arthritis and systemic sclerosis, or healthy controls (1.2%). The HCV infection of lymphoid tissues may represent the remote event leading to B-lymphocyte proliferation responsible for autoantibodies and immune-complex production. In a similar way, HCV infection may also be involved in the pathogenesis of other autoimmune (glomerulonephritis, thyroiditis, lung fibrosis, autoimmune hepatitis, porphyria cutanea tarda) and lymphoproliferative disorders (monoclonal gammopathies, B-cell lymphomas). MC shares numerous clinico-serological and pathological features with the above disorders. HCV seems to be their common etiological agent; however, a variable combination of unknown co-factors (infectious, genetic, environmental) should be determinant for the appearance of different clinical patterns.
authors.affiliation: Rheumatology Unit, Istituto Patologia Medica I, University of Pisa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Ferri
authors.forename: L
authors.initials: L
authors.lastname: La Civita
authors.forename: G
authors.initials: G
authors.lastname: Longombardo
authors.forename: A L
authors.initials: AL
authors.lastname: Zignego
authors.forename: G
authors.initials: G
authors.lastname: Pasero
mesh_terms: D001327:Autoimmune Diseases / Q000209:etiology*; D003449:Cryoglobulinemia / Q000209:etiology*; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000209:etiology*