title: Characterization and differentiation of autoimmune versus viral liver involvement in patients with Sjögren's syndrome.
abstract: OBJECTIVE
  To analyze the prevalence and clinical significance of liver involvement in patients with Sjögren's syndrome (SS), focusing on the characterization and differentiation of autoimmune versus chronic viral liver disease.
  
  
  METHODS
  We investigated liver involvement (clinical signs, analytical data, chronic viral infections, and autoantibodies) in 475 consecutive patients with SS. All patients fulfilled 4 or more of the 1993 European Community Study Group criteria for SS.
  
  
  RESULTS
  Liver involvement was detected in 129 (27%) patients. After ruling out chronic illnesses or use of hepatotoxic drugs, the main etiologies were chronic viral liver disease in 64 (13%) cases [chronic hepatitis C virus (HCV) infection in 63 and HBV infection in one] and autoimmune liver diseases in 24 (5%; primary biliary cirrhosis in 16 patients and type-1 autoimmune hepatitis in 8). The analytical liver profile was not useful in differentiating between viral and autoimmune liver disease. In contrast, patients with SS and autoimmune liver disease presented higher mean values of erythrocyte sedimentation rate (p = 0.044), circulating gammaglobulins (p = 0.007), and a higher prevalence of antinuclear antibodies (p < 0.001), antimitochondrial antibodies (p < 0.001), anti-smooth muscle antibodies (p = 0.026), anti-Ro/SSA (p < 0.001), and anti-La/SSB (p = 0.01), while patients with chronic viral liver disease had a higher frequency of cryoglobulinemia (p < 0.001) and hypocomplementemia (p < 0.001).
  
  
  CONCLUSIONS
  Chronic viral liver disease (associated overwhelmingly with HCV) was the main cause of liver involvement in our patients with SS, with a prevalence of 13%, nearly 3-fold greater than that observed for autoimmune liver involvement. The immunological pattern played a key role in the differentiation of viral (predominance of cryoglobulins and low complement levels) and autoimmune (higher frequency of autoantibodies) liver involvement.
authors.affiliation: Department of Autoimmune Diseases and Hepatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, School of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ramos-Casals
authors.forename: Jose-María
authors.initials: JM
authors.lastname: Sánchez-Tapias
authors.forename: Albert
authors.initials: A
authors.lastname: Parés
authors.forename: Xavier
authors.initials: X
authors.lastname: Forns
authors.forename: Pilar
authors.initials: P
authors.lastname: Brito-Zerón
authors.forename: Norma
authors.initials: N
authors.lastname: Nardi
authors.forename: Pilar
authors.initials: P
authors.lastname: Vazquez
authors.forename: Desirée
authors.initials: D
authors.lastname: Vélez
authors.forename: Isabel
authors.initials: I
authors.lastname: Arias
authors.forename: Albert
authors.initials: A
authors.lastname: Bové
authors.forename: Joan
authors.initials: J
authors.lastname: Plaza
authors.forename: Juan
authors.initials: J
authors.lastname: Rodés
authors.forename: Josep
authors.initials: J
authors.lastname: Font
mesh_terms: D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012859:Sjogren's Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013030:Spain / Q000453:epidemiology
chemical_list: D001323:Autoantibodies