Immune disorders and rheumatologic manifestations of viral hepatitis

Abstract

Infection with hepatotropic viruses is not limited to the liver and can lead to the development of various immunological disorders (the formation of cryoglobulins, rheumatoid factor, antinuclear antibodies, autoantibodies specific for autoimmune hepatitis and primary biliary cholangitis, and others), which can manifest as glomerulonephritis, arthritis, uveitis, vasculitis (cryoglobulinemic vasculitis, polyarteritis nodosa, Henoch-Schonlein purpura, isolated cutaneous necrotizing vasculitis), and other rheumatologic disorders, and be a trigger for the subsequent development of autoimmune hepatitis and primary biliary cholangitis. A further study of the association between autoimmune liver diseases and hepatotropic virus infection would be useful to assess the results of treatment of these associated diseases with antiviral drugs. The relationship of these immune disorders and their manifestations with hepatotropic viruses is best studied for chronic hepatitis B and C. Only isolated cases of these associations are described for hepatitis A. These links are least studied, and are often controversial for hepatitis E, possibly due to their relatively rare diagnoses. Patients with uveitis, glomerulonephritis, arthritis, vasculitis, autoimmune liver diseases should be tested for biomarkers of viral hepatitis, and if present, these patients should be treated with antiviral drugs.

Virusassoziierte Arthritiden

“…25 % und Anti-CCP-Antikörper bei etwa 5 % der Patienten vor. Bei fast 50 % dieser Patienten ist eine Komplementverminderung nachweisbar [ 21 ].…”

“…Die Arthritis bildet sich in der Regel spontan oder nach Behandlung mit NSAR innerhalb von 3–7 Tagen komplett zurück [ 21 ]. Rezidive oder eine chronische (Poly-)Arthritis entwickeln sich nicht [ 20 ].…”

Vasculitis: From Target Molecules to Novel Therapeutic Approaches

“…The etiopathogenesis of PAN is strongly linked to viral hepatitis infection, particularly hepatitis B virus, which comprised over one-third of 348 PAN cases in the largest case series to date [9,10]. About 35% of polyarteritis nodosa (PAN) cases are associated with hepatitis B [11]. The incidence of hepatitis B virus-related PAN has declined substantially over the last four decades after improvements in immunization, transfusion practice, and hepatitis B virus therapy.…”

Autoantibodies and Rheumatologic Manifestations in Hepatitis C Virus Infection

“…Extra-hepatic manifestations of HCV infection are clinically present in forty to seventy percent of the patients [14][15][16][17], while rheumatologic manifestations have an incidence of 38% [18][19][20][21][22][23] (Table 1). These are mostly mediated by immunological mechanisms, rather than being related to the infection of extra-hepatic tissues [24].…”

“…Extra-hepatic manifestations of HCV infection are clinically present in forty to seventy percent of the patients [ 14 , 15 , 16 , 17 ], while rheumatologic manifestations have an incidence of 38% [ 18 , 19 , 20 , 21 , 22 , 23 ] ( Table 1 ).…”