HCV-Related Rheumatic Manifestations and Therapeutic Strategies.
A number of hepatic and extra-hepatic autoimmune disorders may complicate a percentage of patients with hepatitis C virus (HCV) infection that is both hepatotropic and lymphotropic agent; the resulting clinical phenotypes can be grouped into the so-called HCV syndrome. This latter includes various rheumatic disorders that are frequently characterized by clinical or serological overlap; thus, a correct patients' classification is necessary prior to decide the therapy. The management of these conditions is particularly difficult, given the coexistence of viral infection and immunological alterations. In this scenario, cryoglobulinemic vasculitis represents the prototype of HCV-related rheumatic disorders that can be treated at different levels by means of etiological (antivirals) and/or pathogenetic and/or symptomatic treatments (rituximab, cyclophosphamide, steroids, plasmapheresis, etc). In clinical practice, the therapeutic strategy should take into account the specific symptoms combination and the severity/activity of the disease, according to each patient's conditions. This review focuses on the clinico-diagnostic assessments and therapeutical approaches of some rheumatic disorders complicating HCV infection, mainly arthritis, sicca syndrome, and osteosclerosis; while, cryoglobulinemic vasculitis is comprehensively examined in another article of the present issue.
Rheumatology Unit, University of Modena and Reggio Emilia, Medical School, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy.
Marco
M
Sebastiani
Rheumatology Unit, University of Modena and Reggio Emilia, Medical School, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy.
Dilia
D
Giuggioli
Rheumatology Unit, University of Modena and Reggio Emilia, Medical School, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy.
Michele
M
Colaci
Department of Internal Medicine, School of Medicine, University of Pisa, Pisa, Italy.
Poupak
P
Fallahi
Center for Systemic Manifestations of Hepatitis Viruses (MASVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Laura
L
Gragnani
Department of Internal Medicine, School of Medicine, University of Pisa, Pisa, Italy.
Alessandro
A
Antonelli
Center for Systemic Manifestations of Hepatitis Viruses (MASVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Anna Linda
AL
Zignego
Rheumatology Unit, Department of Internal Medicine, University of Modena and Reggio E., Policlinico di Modena, Via del Pozzo, 71, 41100 Modena, Italy.
Clodoveo
C
Ferri
D018501:Antirheumatic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003449:Cryoglobulinemia / Q000150:complications / Q000628:therapy* / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000628:therapy*; D006801:Humans; D010956:Plasmapheresis; D012216:Rheumatic Diseases / Q000628:therapy*; D056653:Rheumatoid Vasculitis / Q000628:therapy / Q000821:virology; D012859:Sjogren's Syndrome / Q000628:therapy / Q000821:virology
D018501:Antirheumatic Agents; D000998:Antiviral Agents
HCV; Hepatitis C virus; Sjögren's syndrome; antiviral; arthritis; lymphoma; mixed cryoglobulinemia; ostesclerosis; rituximab; vasculitis