Association between rheumatoid arthritis and primary biliary cirrhosis.
Primary biliary cirrhosis (PBC) is an autoimmune disease, characterized by chronic biliary duct destruction, which mainly affects women aged between 35 and 45 years. Prolonged liver inflammation can cause scarring, leading to cirrhosis. The most common first clinical manifestations are pruritus, asthenia or jaundice, but most patients remain asymptomatic. PBC can be associated by itself with arthralgia, but polyarthritis and synovitis are exceptional. PBC is often associated with other non-hepatic autoimmune diseases, especially primary Sjogren's syndrome, which may favour articular involvement. PBC and rheumatoid arthritis (RA) have been suggested to coexist in 1.8 to 5.6% of patients with PBC, but data supporting this association are scarce. We report two cases of such an association. Both of these patients presented severe erosive RA. We discuss the therapeutic management of these patients, taking into account hepatic involvement and drug toxicity.
Caramella
Caroline
C
Service de Rhumatologie A, Université René Descartes, Faculté de Médecine, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, 75014 Paris, France.
Avouac
Jérome
J
Sogni
Philippe
P
Puéchal
Xavier
X
Kahan
André
A
Allanore
Yannick
Y
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects; D008105:Liver Cirrhosis, Biliary / Q000150:complications* / Q000276:immunology; D008111:Liver Function Tests; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged
D018501:Antirheumatic Agents; D008727:Methotrexate