Rheumatologic manifestations of hepatic diseases

Abstract

The course of hepatic diseases may be complicated by a multitude of rheumatologic manifestations, which can complicate the diagnostic approach and alter the natural history of primary liver disease, sometimes worsening prognosis due to associated multiple organ dysfunction. These manifestations can occur in association with a multitude of liver diseases, including viral hepatitis, autoimmune hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, hemochromatosis, or Wilson's disease. It is necessary not only for rheumatologists, but also for other clinicians, to be aware that these atypical manifestations may reflect an undiagnosed hepatic disease. On the other hand, it is crucial that, in a patient with known hepatic disease presenting with rheumatologic symptoms, an accurate distinction be made between the rheumatologic manifestations of hepatic disease and primary rheumatologic disease, since the treatment is often different. This review aims to summarize the current evidence regarding rheumatologic manifestations of hepatic diseases, how to distinguish them from primary rheumatologic disorders, and how to provide adequate management.

A Review on Extrahepatic Manifestations of Chronic Hepatitis C Virus Infection and the Impact of Direct-Acting Antiviral Therapy

“…Sjögren's syndrome (pSS), defined as presence of xerostomia, xerophthalmia, anti-SSA or anti-SSB antibodies and typical salivary gland histology is rare in patients with HCV infection [108].…”

Hepatomusculoskeletal disorders: Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease

“…In more detail, Hepatitis C is frequently associated with rheumatologic phenomena. Polyarthralgia either in the context of mixed cryoglobulinemia triad of purpura, fatigue and arthralgia or alone as hepatitis C virus (HCV)-induced arthritis is documented frequently[ 7 , 8 ]. Overt arthritis and fibromyalgia are less frequently diagnosed in parallel with HCV infection.…”

Autoantibodies and Rheumatologic Manifestations in Hepatitis C Virus Infection

“…In fact, B-cell non-Hodgkin lymphoma (NHL), diffuse large B-cell lymphoma and follicular lymphoma have been positively associated with a chronic HCV infection [ 33 ]. However, as observed by Couronne et al in 2018 [ 34 ], B-cell receptors (BCR) from HCV-associated lymphoma patients are not actually able to bind to HCV antigens; additionally, stereotyped BCR sequences that contribute to a highly biased range in HCV-associated B-NHL have been also detected in other HCV-negative B-cell malignancies such as MALT lymphoma, chronic lymphocytic leukaemia, non-malignant B cells with RF activity and non-malignant marginal zone splenic B cell therefore suggesting that HCV-associated lymphoma might originate from precursors with autoimmune properties rather than B cells specifically aimed at eliminating the virus; in this scenario, the chronic inflammatory states that the continuous stimulus given to B-lymphocytes would act as an enhancer, rather than a promoter [ 35 , 36 , 37 , 38 ].…”

“…As stated in the previous section, HCV is capable of inducing an aberrant activation of B-lymphocytes as well as their prolonged survival therefore increasing the production of antibodies. Before the DAAs age, HCV represented the cause of about 80% of cryoglobulinemia vasculitis; nowadays, such therapies have dramatically reduced the incidence of this clinical scenario [ 35 , 36 , 37 ]. Circulating cryoglobulins are present in the serum of 40–60% of patients with HCV [ 24 ]; its occurrence is frequently asymptomatic, and it is labelled as cryoglobulinemia.…”