Rheumatologic symptoms in patients with mixed cryoglobulinemia

Abstract

Chronic hepatitis C virus (HCV) infection is frequent worldwide and causes hepatic damage as well as a wide spectrum of extrahepatic manifestations. This capacity of the infection to determine several extrahepatic comorbidities was demonstrated early after discovery of the infectious agent and appears to be related to its ability to infect immune cells, namely B cells. This can lead to their abnormal activation and end in an autoimmune or lymphoproliferative disease. The strict link between HCV and mixed cryoglobulinemia (MC) is well known. In addition, it is clear that many symptoms of rheumatologic interest can be present in the setting of chronic HCV infection, such as arthralgias and fatigue. In some cases, as in sicca syndrome, MC manifests as a true infectious-related autoimmune disease. Here we review the main rheumatic symptoms that can occur during MC (HCV chronic infection) and discuss the principles underlying their clinical management.