HCV-ASSOCIATED CRYOGLOBULINEMIC VASCULITIS


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Abstract

Aim. To analyze clinical and laboratory features of cryoglobulinemic vasculitis (CGEV) associated with HCV infection. Material and methods. We examined 61 patients with clinical manifestation of CGEV in 2006-2011. CGEV was associated with autoimmune diseases in 31 patients (51 %), with HCV infection in 21 patients (34,4 %), essential (idiopathic) cryoglobulinemia in 8 patients (13 %) and lymphoproliferative diseases in 1 patient (1,6 %). 21 patients with HCV-associated CGEV were studied for main clinical and laboratory manifestations of the disease. Kidney and liver involvement was confirmed morphologically and immunomorphologically. Electroneurophysiological investigation evaluated peripheral nervous system involvement. Biopsy of parotid, lacrimal glands, peripheral lymph nodes, splenectomy and bone marrow trephine biopsy with morphological study and immunohistochemistry were used to identify type of lymphoma. Characteristics of monoclonal secretion were assessed with high-resolution electrophoresis in agarose gel with subsequent immunofixation of sera and concentrated urine. Results. Liver involvement was detected in 66 % of patients with HCV-associated CGEV., 34% patients were chronic HCV carriers with persistently normal liver function tests. Common rheumatologic manifestations of HCV-associated CGEV were skin lesions (90%), arthralgia (85%), frequent peripheral nervous system involvement (52%) and glomerulonephritis (38%). Prevalent immunological markers of CGEV associated with HCV were mixed monoclonal cryoglobulinemia with rheumatoid factor activity (62%), rare polyclonal (34%) and olygoclonal (4%) cryoglobulinemia, low levels of С4 compliment fraction (80%). Patients with mixed monoclonal cryoglobulinemia often developed clinical manifestations of Sjögren s syndrome (23 %) and malignant lymphoproliferative diseases (14 %). CGEV is a prognostically adverse sign in HCV infected patients and caused death of 14% patients even in a short period of follow-up (1-2 years).

About the authors

V I Vasiliev

Research Institute of Rheumatology of RAMS

д-р мед. наук, проф., вед. науч. сотр. лаб. интенсивных методов лечения ревматических болезней НИИР РАМН

S G Palshina

Research Institute of Rheumatology of RAMS

Email: vitalana@mail.ru
аспирант НИИ РАМН

O A Logvinenko

Research Institute of Rheumatology of RAMS

Email: oksanalogv@yandex.ru
канд. мед. наук, ст. науч. сотр. лаб. интенсивных методов лечения ревматических болезней НИИ РАМН

T N Safonova

Research Institute of Ophthalmology of RAMS

канд. мед. наук, вед. науч. сотр НИИ глазных болезней

E B Rodionova

Research Institute of Rheumatology of RAMS

канд. мед. наук, ст. науч. сотр НИИ РАМН

E J Varlamova

Hematological Research Center of RAMS

канд. мед. наук, зав. лаб. гуморального иммунитета

T P Nekrasova

I.M. Sechenov First Medical University

канд. мед. наук, доц. патологической анатомии

S G Radenska-Lopovok

Research Institute of Rheumatology of RAMS

д-р мед. наук, проф., зав. лаб. патоморфологии НИИР РАМН

N A Probatova

N.N. Blokhin Russian Cancer Research Center of RAMS

д-р мед. наук, проф., вед. науч. сотр. лаб. патоморфологии опухолей человека

E N Alexandrova

Research Institute of Rheumatology of RAMS

Email: irramn@rambler.ru
д-р мед. наук, рук. лаб. иммунологии и молекулярной биологии ревматических заболеваний НИИР РАМН

E L Nasonov

Research Institute of Rheumatology of RAMS

Email: sokrat@irramn.ru
д-р мед. наук, проф., акад. РАМН, дир. НИИ ревматологии РАМН

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