Cryoglobulinemic vasculitis

Current Opinion in Rheumatology

Volumn 18, Issue 1, 2006, Pages 54-63

  Ferri, Clodoveo ^a,b   Mascia, Maria Teresa ^a  

^a UNIVERSITY OF MODENA AND REGGIO EMILIA   (Italy)

^b UNIVERSITY OF MODENA AND REGGIO EMILIA   (Italy)

Author keywords

Cryoglobulinemic vasculitis; Hepatitis C virus; Lymphoma; Mixed cryoglobulinemia; Sj gren's syndrome

Indexed keywords

ANTIVIRUS AGENT; AUTOANTIBODY; B LYMPHOCYTE RECEPTOR; CD81 ANTIGEN; CRYOGLOBULIN; CYCLOPHOSPHAMIDE; CYCLOSPORIN A; GLYCOPROTEIN E2; HYDROXYCHLOROQUINE; INHIBITOR OF APOPTOSIS PROTEIN; PROTEIN BCL 2; RITUXIMAB; STEROID; TUMOR NECROSIS FACTOR ALPHA INHIBITOR;

ANTIGEN ANTIBODY COMPLEX; AUTOIMMUNE DISEASE; AUTOIMMUNE HEPATITIS; B CELL LYMPHOMA; B LYMPHOCYTE; CELL SURVIVAL; CRYOGLOBULINEMIC VASCULITIS; DIAGNOSTIC PROCEDURE; DISEASE ASSOCIATION; DISEASE SEVERITY; ENVIRONMENTAL FACTOR; GENE ACTIVATION; GENE REARRANGEMENT; GEOGRAPHIC DISTRIBUTION; HEPATITIS C; HOST; HUMAN; IMMUNE COMPLEX DISEASE; IMMUNOSTIMULATION; LYMPHOPROLIFERATIVE DISEASE; PALLIATIVE THERAPY; PATHOGENESIS; PLASMAPHERESIS; PRIORITY JOURNAL; PROGNOSIS; PROTEIN PROTEIN INTERACTION; PROTO ONCOGENE; REVIEW; SJOEGREN SYNDROME; STEROID THERAPY; SURVIVAL; SYMPTOMATOLOGY; SYSTEMIC VASCULITIS; TREATMENT INDICATION; CRYOGLOBULINEMIA; HEPATITIS C VIRUS; IMMUNOLOGY; VASCULITIS; VIROLOGY;

CRYOGLOBULINEMIA; HEPACIVIRUS; HEPATITIS C; HUMANS; VASCULITIS;

EID: 33645031646     PISSN: 10408711     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (100)

1. Meltzer M, Franklin EC, Elias K, et al. Cryoglobulinemia: a clinical and laboratory study. II: Cryoglobulins with rheumatoid factor activity. Am J Med 1966; 40:837-856.
2. Brouet JC, Clouvel JP, Danon F, et al. Biologic and clinical significance of cryoglobulins. Am J Med 1974; 57:775-788.
3. Gorevic PD, Kassab HJ, Levo Y, et al. Mixed cryoglobulinemia: clinical aspects and long-term follow-up of 40 patients. Am J Med 1980; 69:287-308.
4. Gorevic PD, Frangione B. Mixed cryoglobulinemia cross-reactive idiotypes: implication for relationship of MC to rheumatic and lymphoproliferative diseases. Semin Hematol 1991; 28:79-94.
5. Ferri C, Zignego AL, Pileri SA. Cryoglobulins. J Clin Pathol 2002; 55:4-13.
6. Ferri C, Pileri S, Zignego AL. Hepatitis C virus, B-cell disorders, and non-Hodgkin's lymphoma. In: Goedert JJ, editor. Infectious causes of cancer: targets for intervention. National Cancer Institute (NIH). Totowa, NJ: The Humana Press Inc.; 2000. p. 349.
7. Dammacco F, Sansonno D, Piccoli C, et al. The cryoglobulins: an overview. Eur J Clin Invest 2001; 31:628-638.
8. Bombardieri S, Ferri C, Migliorini P, et al. Cryoglobulins and immune complexes in essential mixed cryoglobulinemia. La Ricerca Clin Lab 1986; 16:281-288.
9. Abel G, Zhang QX, Agnello V. Hepatitis C virus infection in type II mixed cryoglobulinemia. Arthritis Rheum 1993; 36:1341-1349.
10. Monti G, Galli M, Invernizzi F, et al. Cryoglobulinaemias: a multi-centre study of the early clinical and laboratory manifestations of primary and secondary disease. QJM 1995; 88:115-126.
11. Ferri C, Sebastiani M, Giuggioli D, et al. Mixed cryoglobulinemia: demographic, clinical, and serologic features and survival in 231 patients. Semin Arthritis Rheum 2004; 33:355-374. The first follow-up study on a large Italian series of cryoglobulinemic vasculitis, reporting the 10th year survival, the main prognostic clinical features, and therapeutical aspects. In addition, the proposal of preliminary classification criteria and more recent etiopathogenetic studies are discussed.
12. Bombardieri S, Ferri C, Di Munno O, Pasero G. Liver involvement in essential mixed cryoglobulinemia. La Ricerca Clin Lab 1979; 9:361-368.
13. Levo Y, Gorevic PD, Kassab HJ, et al. Association between hepatitis B virus and essential mixed cryoglobulinemia. N Engl J Med 1977; 296:1501-1504.
14. Choo GL, Kuo G, Weiner AJ, et al. Isolation of a cDNA clone derived from a blood-borne non-A non-B viral hepatitis genome. Science 1989; 244:359-361.
15. Ferri C, La Civita L, Longombardo G, et al. Hepatitis C virus and mixed cryoglobulinemia. Eur J Clin Invest 1993; 23:399-405.
16. Ferri C, Zignego AL. Relation between infection and autoimmunity in mixed cryoglobulinemia. Curr Opin Rheumatol 2000; 12:53-60.
17. Ferri C, Monti M, La Civita L, et al. Infection of peripheral blood mononuclear cells by hepatitis C virus in mixed cryoglobulinemia. Blood 1993; 82:3701-3704.
18. Ramos-Casals M, Font J. Extrahepatic manifestations in patients with chronic hepatitis C virus infection. Curr Opin Rheumatol 2005; 17:447-455. This review mainly focuses on the frequent overlapping between extrahepatic HCV-related disorders and some well defined systemic autoimmune autoimmune diseases.
19. Agnello V, De Rosa FG. Extrahepatic disease manifestations of HCV infection: some current issues. J Hepatol 2004; 40:341-352. A wide and updated review of the complex field of extrahepatic disorders associated with HCV infection.
20. Nissen MJ, Fontanges E, Allam Y, et al. Rheumatological manifestations of hepatitis C: incidence in a rheumatology and non-rheumatology setting and the effect of methotrexate and interferon. Rheumatology (Oxford) 2005; 44:1016-1020. The study analyzes the clinical and serological features of 21 HCV-positive patients followed in a rheumatology department compared with 41 patients from an HCV support association.
21. Lunel F, Musset L, Cacoub P, et al. Cryoglobulinemia in chronic liver diseases: role of hepatitis C virus and liver damage. Gastroenterology 1994; 106:1291-1300.
22. Pawlotsky J, Mustapha B, Andre C, et al. Immunological disorders in C virus chronic active hepatitis: a prospective case-control study. Hepatology 1994; 19:841-848.
23. Kayali Z, Buckwold VE, Zimmermann B, Schmidt WN. Hepatitis C, cryoglobulinemia, and cirrhosis: a meta-analysis. Hepatology 2002; 36:978-985.
24. Lenzi M, Johnson PJ, McFarlane IG, et al. Antibodies to hepatitis C virus in autoimmune liver disease: evidence for geographical heterogeneity. Lancet 1991; 338ii:277-280.
25. Weiner SM, Berg T, Berthold H, et al. A clinical and virological study of hepatitis C virus-related cryoglobulinemia in Germany. Hepatology 1998; 29:375-384.
26. Au WY, Kwok JS, Chu KM, Ma ES. Life-threatening cryoglobulinemia in HCV-negative Southern Chinese and a novel association with structural aortic abnormalities. Ann Hematol 2005; 84:95-98. The study reports the low rate of mixed cryoglobulinemia and of its association with HCV infection in a large southern Chinese general population.
27. Lenzi M, Frisoni M, Mantovani V, et al. Haplotype HLA-B8-DR3 confers susceptibility to hepatitis C virus-related mixed cryoglobulinemia. Blood 1998; 91:2062-2066.
28. Ossi E, Bordin MC, Businaro MA, et al. HLA expression in type II mixed cryoglobulinemia and chronic hepatitis C virus. Clin Exp Rheumatol 1995; 13:91-93.
29. Zignego AL, Ferri C, Giannini C, et al. Hepatitis C virus genotype analysis in patients with type II mixed cryoglobulinemia. Ann Intern Med 1996; 124:31-34.
30. Zehender G, De Maddalena C, Bernini F, et al. Compartmentalization of hepatitis C virus quasispecies in blood mononuclear cells of patients with mixed cryoglobulinemic syndrome. Virology 2005; 79:9145-9156. An interesting pathogenetic hypothesis based on the reduced HCV quasispecies heterogeneity in cryoglobulinemic vasculitis, possibly due to HCV genotype 1.
31. Vassilopoulos D, Younossi ZM, Hadziyannis E, et al. Study of host and virological factors of patients with chronic HCV infection and associated laboratory or clinical autoimmune manifestations. Clin Exp Rheumatol 2003; 21 (Suppl 32):S101-S111.
32. Ivanovski M, Silvestri F, Pozzato G, et al. Somatic hypermutation, clonal diversity, and preferential expression of the VH 51p1/VL kv325 immunoglobulin gene combination in hepatitis C virus-associated immunocytomas. Blood 1998; 91:2433-2442.
33. Kaplanski G, Maisonobe T, Marin V, et al. Vascular cell adhesion molecule-1 (VCAM-1) plays a central role in the pathogenesis of severe forms of vasculitis due to hepatitis C-associated mixed cryoglobulinemia. J Hepatol 2005; 42:334-340. The study underlines the pathogenetic and therapeutic relevance of high serum levels of vascular cell adhesion molecule-1 in patients with HCV-positive cryoglobulinemic vasculitis compared with HCV-infected patients without cryoglobulinemic syndrome.
34. Fabris M, De Marchi G, Sacco S, De Vita S. Fibronectin gene polymorphisms influence type ii mixed cryoglobulinemia clinical manifestations [abstract]. Ann Rheum Dis 2005; 64 (Suppl iii):263.
35. Park KJ, Choi SH, Choi DH, et al. Hepatitis C virus NS5A protein modulates c-Jun N-terminal kinase through interaction with TNF receptor-associated factor 2. J Biol Chem 2003; 278:30711-30718.
36. Hosui A, Ohkawa K, Ishida H, et al. Hepatitis C virus core protein differently regulates the JAK-STAT signaling pathway under interleukin-6 and interferon-gamma stimuli. J Biol Chem 2003; 278:28562-28571.
37. Zignego AL, Ferri C, Giannelli F, et al. Prevalence of BCL-2 rearrangement in hepatitis C virus-related mixed cryoglobulinemia with or without complicating B-cell lymphoma. Ann Intern Med 2002; 137:571-580.
38. Pileri P, Uematsu Y, Campagnoli S, et al. Binding of hepatitis C virus to CD81. Science 1998; 282:938-941.
39. Machida K, Cheng KT, Sung VM, et al. Hepatitis C virus induces a mutator phenotype: enhanced mutations of immunoglobulin and protooncogenes. Proc Natl Acad Sci U S A 2004; 23:4262-4267. This is an excellent molecular laboratory study supporting the oncogenetic potential of HCV infection with regards to both liver carcinoma and B-cell lymphomas. These findings are particularly relevant in the field of RNA-virus related oncogenesis.
40. Antonelli A, Ferri C, Fallahi P, et al. Thyroid involvement in patients with overt HCV-related mixed cryoglobulinaemia. QJM 2004; 97:499-506. This study confirms the suggested role of HCV in thyroid dysfunction and cancer in patients with cryoglobulinemic vasculitis.
41. Ferri C, Fallahi P, Ghinoi A, et al. Thyroid involvement in HCV-related cryoglobulinemic vasculitis. Ann Rheum Dis 2005; 64 (Suppl III):272.
42. Fujino Y, Tamakoshi A, Hoshiyama Y, et al. Prospective study of transfusion history and thyroid cancer incidence among females in Japan. Int J Cancer 2004; 20:722-725. This study supports the possible role of HCV in thyroid cancer on the basis of epidemiological observations.
43. Duberg AS, Nordstrom M, Torner A, et al. Non-Hodgkin's lymphoma and other nonhepatic malignancies in Swedish patients with hepatitis C virus infection. Hepatology 2005; 41:652-659.
44. Rieu V, Cohen P, Andre MH, et al. Characteristics and outcome of 49 patients with symptomatic cryoglobulinaemia. Rheumatology (Oxford) 2002; 41:290-300.
45. Lamprecht P, Gause A, Gross WL. Cryoglobulinemic vasculitis. Arthritis Rheum 1999; 42:2507-2516.
46. Hermida Lazcano I, Mendez LS, Santos JS. Mixed cryoglobulinemia with renal failure, cutaneous vasculitis and peritonitis due to Brucella melitensis. J Infect 2005; 10 June [Epub ahead of print].
47. Tagle M, Barriga JA, Gutierrez S, et al. Relapsing viral hepatitis type A complicated with renal failure. Rev Gastroenterol Peru 2004; 24:92-96.
48. Castillo JR, Kirchner E, Farver C, Calabrese LH. Cryoglobulinemic vasculitis and lymphocytic interstitial pneumonitis in a person with HIV infection. AIDS Read 2005; 15:252-255.
49. Granel B, Serratrice J, Morange PE, et al. Cryoglobulinemia vasculitis following intravesical instillations of bacillus Calmette-Guerin. Clin Exp Rheumatol 2004; 22:481-482.
50. Trejo O, Ramos-Casals M, Garcia-Carrasco M, et al. Cryoglobulinemia: study of etiologic factors and clinical and immunologic features in 443 patients from a single center. Medicine (Baltimore) 2001; 80:252-262.
51. Casato M, Lilli D, Donato G. Occult hepatitis C virus infection in type II mixed cryoglobulinaemia. J Viral Hepat 2003; 10:455-459.
52. Castillo I, Pardo M, Bartolomé J, et al. Occult hepatitis C virus infection in patients in whom the etiology of persistently abnormal results of liver function tests is unknown. J Infect Dis 2004; 189:7-14. An important study focusing on the subset of patients with suspected HCV-related diseases but without HCV serological markers. In these patients virological evaluation of liver biopsy can be decisive for the correct diagnosis.
53. Carreno V, Castillo I, Bartolomé J, et al. Comparison of hepatitis C virusRNA detection in plasma, whole blood and peripheral blood mononuclear cells of patients with occult hepatitis C virus infection. J Clin Virol 2004; 31:312-313. This study reinforces the relevance of occult HCV infection and the major role of liver biopsy to detect viral infection compared with peripheral lymphocyte analysis.
54. Fadda P, La Civita P, Zignego AL, Ferri C. Hepatitis C virus infection and arthritis: a clinico-serological investigation of arthritis in patients with or without cryoglobulinemic syndrome. Reumatismo 2002; 54:316-323.
55. Wener MH, Hutchinson K, Morishima C, Gretch DR. Absence of antibodies to cyclic citrullinated peptide in sera of patients with hepatitis C virus infection and cryoglobulinemia. Arthritis-Rheum 2004; 50:2305-2308. This interesting study suggests the usefulness of anti-CCP determination for a correct diagnosis of rheumatoid arthritis in HCV-positive patients with and without rheumatic disorders, including mixed cryoglobulinemia.
56. Seo JH, Ryan HF, Claussen GC, et al. Sensory neuropathy in vasculitis: a clinical, pathologic, and electrophysiologic study. Neurology 2004; 63:874-878.
57. Casato M, Saadoun D, Marchetti A, et al. Central nervous system involvement in hepatitis C virus cryoglobulinemia vasculitis: a multicenter case-control study using magnetic resonance imaging and neuropsychological tests. J Rheumatol 2005; 32:484-488. This excellent study demonstrated the high rate of impaired cognitive function and inflammatory central nervous system involvement in a large series of mixed cryoglobulinemia patients.
58. Morgello S. The nervous system and hepatitis C virus. Semin Liver Dis 2005; 25:118-121.
59. Uchiyama Tanaka Y, Mori Y, Kishimoto N, et al. Membranous glomerulonephritis associated with hepatitis C virus infection: case report and literature review. Clin Nephrol 2004; 61:144-150. The authors report an interesting observation of renal viral inclusions in cryoglobulinemic glomerulonephritis, along with a good review of the literature.
60. Antonelli A, Ferri C, Fallahi P, et al. Type 2 diabetes in hepatitis C-related mixed cryoglobulinaemia patients. Rheumatology (Oxford) 2004; 43:238-240. The high risk of developing type 2 diabetes is demonstrated in a large series of cryoglobulinemic patients.
61. Ferri C, Bertozzi MA, Zignego AL. Erectile dysfunction and HCV infection. JAMA 2002; 14:698-699.
62. Monteverde A, Rivano MT, Allegra GC, et al. Essential mixed cryoglobulinemia, type II: a manifestation of low malignant lymphoma? Clinical-morphological study of 12 cases with special reference to immunohistochemical findings in liver frozen sections. Acta Haematol 1988; 79: 20-25.
63. Monti G, Pioltelli P, Saccardo F, et al. Incidence and characteristics of non-Hodgkin lymphomas in a multicenter case file of patients with hepatitis C virus-related symptomatic mixed cryoglobulinemias. Arch Intern Med 2005; 165:101-105. This multicenter study demonstrated the increased incidence and the clinico-pathological features of B-cell lymphomas complicating HCV-related cryoglobulinemic vasculitis. The relative risk of developing non-Hodgkin's lymphoma is about 35 times higher compared with the general population.
64. Saadoun D, Suarez F, Lefrere F, et al. Splenic lymphoma with villous lymphocytes, associated with type II cryoglobulinemia and HCV infection: a new entity? Blood 2005; 105:74-76. This excellent study further supports the previous description of a frequent association between splenic lymphoma with villous lymphocytes, cryoglobulinemic vasculitis, and HCV infection.
65. Ferri C, Longombardo G, La Civita L, et al. Hepatitis C virus as common cause of mixed cryoglobulinemia and chronic liver disease. J Intern Med 1994; 236:31-36.
66. Lamprecht P, Gutzeit O, Csernok E, et al. Prevalence of ANCA in mixed cryoglobulinemia and chronic hepatitis C virus infection. Clin Exp Rheumatol 2003; 21 (6 Suppl 32):S89-S94.
67. Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjogren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 2002; 61:554-558.
68. Ramos-Casals M, Garca-Carrasco M, Cervera R, et al. Hepatitis c virus infection mimicking primary Sjogren's syndrome: a clinical and immunologic description of 35 cases. Medicine (Baltimore) 2001; 80:1-8.
69. Ioannidis JPA. Vassiliou VA, Moutsopoulos HM. Long term risk of mortality and lymphoproliferative disease and predictive classification of primary Sjögren's syndrome. Arth Rheum 2002; 46:741-747.
70. Vasil'ev VI, Probatova NA, Varlamova Elu, et al. Prognostic implications of mixed monoclonal cryoglobulinemia in Sjogren's disease. Ter Arkh 2004; 76:61-68. This is an interesting follow-up study reporting the worse prognosis of Sjogren's disease associated with mixed cryoglobulinemia. The authors did not correlate this important finding with the possible HCV exposure.
71. Pillemer SR, Smith J, Fox P, Bowman SJ. Outcome measures for Sjogren's syndrome, april 10-11, 2003. Bethesda, Maryland, USA. J Rheumatol 2004; 31:143-149.
72. Ramos-Casals M, Brito-Zeron P, Yague J, et al. Hypocomplementaemia as an immunological marker of morbidity and mortality in patients with primary Sjogren's syndrome. Rheumatology (Oxford) 2005; 44:89-94.
73. Ramos-Casals M, De Vita S, Tzioufas A. Hepatitis C virus, Sjogren's syndrome and B-cell lymphoma: linking infection, autoimmunity and cancer. Autoimmun Rev 2005; 4:8-15.
74. Ramos-Casals M, Loustaud-Ratti V, De Vita S, et al. Sjogren syndrome associated with hepatitis C virus: a multicenter analysis of 137 cases. Medicine 2005; 84:81-89. The authors suggest the term of 'Sjogren's syndrome secondary to HCV' for a specific patient subset characterized by HCV infection and sicca syndrome. A careful analysis of this subset shows a peculiar combination of low rate of ENA autoantibodies, mixed cryoglobulinemia, hypocomplementemia, and frequent vasculitic manifestations.
75. Perlemuter G, Cacoub P, Sbai A, et al. Hepatitis C virus infection in systemic lupus erythematosus: a case-control study. J Rheumatol 2003; 30:1473-1478.
76. Buskila D. Hepatitis C-associated arthritis. Curr Opin Rheumatol 2000; 12:295-299.
77. Invernizzi F, Galli M, Serino G, et al. Secondary and essential cryoglobulinemias: frequency, nosological classification, and long-term follow-up. Acta Haematol 1983; 70:73-82.
78. Sene D, Ghillani-Dalbin P, Thibault V, et al. Long term course of mixed cryoglobulinemia in patients infected with hepatitis C virus. Rheumatology 2004; 31:2199-2206.
79. Ferri C, Giuggioli D, Cazzato M, et al. HCV-related cryoglobulinemic vasculitis: an update on its etiopathogenesis and therapeutic strategies. Clin Exp Rheumatol 2003; 21 (Suppl 32):S78-S84.
80. Mazzaro C, Franzin F, Tulissi P, et al. Regression of monoclonal B-cell expansion in patients affected by mixed cryoglobulinemia responsive to α-interferon therapy. Cancer 1996; 77:2604-2613.
81. Giannelli F, Moscarella S, Giannini C, et al. Effect of antiviral treatment in patients with chronic HCV infection and t[14;18) translocation. Blood 2003; 102:1196-1201.
82. Alric L, Plaisier E, Thebault S, et al. Influence of antiviral therapy in hepatitis C virus-associated cryoglobulinemic MPGN. Am J Kidney Dis 2004; 43:617-623. The authors describe the therapeutic usefulness of antiviral treatment in a large series of cryoglobulinemic glomerulonephritis patients.
83. Cacoub P, Saadoun D, Limal N, et al. PEGylated Interferon Alfa-2b and ribavirin treatment in patients with hepatitis C virus-related systemic vasculitis. Arthritis Rheum 2005; 52:911-915. The study confirms the efficacy of antiviral treatment in nine patients with HCV-associated cryoglobulinemic vasculitis.
84. Mazzaro C, Zorat F, Caizzi M, et al. Treatment with peg-interferon alfa-2b and ribavirin of hepatitis C virus-associated mixed cryoglobulinemia: a pilot study. J Hepatol 2005; 42:632-638. This interesting study analyzes the safety and usefulness of peg-interferon α-2b and ribavirin in 18 mixed cryoglobulinemia patients. The observed results suggest that the antiviral treatment in mixed cryoglobulinemia seems to be less effective than in patients with HCV-positive chronic hepatitis without cryoglobulinemia.
85. Ammendola A, Sampaolo S, Ambrosone L, et al. Peripheral neuropathy in hepatitis-related mixed cryoglobulinemia: electrophysiologic follow-up study. Muscle Nerve 2005; 31:382-385.
86. Niewold TB, Swedler WI. Systemic lupus erythematosus arising during interferon-alpha therapy for cryoglobulinemic vasculitis associated with hepatitis C. Clin Rheumatol 2005; 24:178-181.
87. Batisse D, Karmochkine M, Jacquot C, et al. Sustained exacerbation of cryoglobulinaemia-related vasculitis following treatment of hepatitis C with peginterferon alfa. Eur J Gastroenterol Hepatol 2004; 16:701-703.
88. Beuthien W, Mellinghoff HU, Kempis JV. Vasculitic complications of interferon-alpha treatment for chronic hepatitis C virus infection: case report and review of the literature. Clin Rheumatol 2005; 30 June [Epub ahead of print].
89. Casato M, Lagana B, Pucillo LP, Quinti I. Interferon for hepatitis C virus-negative type II mixed cryoglobulinemia. N Engl J Med 1998; 338:1386-1387.
90. Bhopale GM, Nanda RK. Emerging drugs for chronic hepatitis C. Hepatol Res 2005; 12 July [Epub ahead of print].
91. Zaja F, De Vita S, Mazzaro C, et al. Efficacy and safety of rituximab in type II mixed cryoglobulinemia. Blood 2003; 101:3827-3834.
92. Sansonno D, De Re V, Lauletta G, et al. Monoclonal antibody treatment of mixed cryoglobulinemia resistant to interferon alpha with an anti-CD20. Blood 2003; 101:3818-3826.
93. Roccatello D, Baldovino S, Rossi D, et al. Long-term effects of anti-CD20 monoclonal antibody treatment of cryoglobulinaemic glomerulonephritis. Nephrol Dial Transplant 2004; 19:3054-3061. This interesting study reports the efficacy and safety of rituximab in a series of six HCV-related cryoglobulinemic glomerulonephritis patients. The authors observed an improvement in both systemic manifestations and renal function without significant variations of viral load.
94. Migliaresi S, Ambrosone L, Colutta E, et al. Rituximab in HCV-related mixed cryoglobulinemia: report of 4 cases [abstract]. Ann Rheum Dis 2005; 64 (Suppl III):539.
95. Lamprecht P, Lerin-Lozano C, Merz H, et al. Rituximab induces remission in refractory HCV associate cryoglobulinaemic vasculitis. Ann Rheum Dis 2003; 62:1230-1233.
96. Levine JW, Gota C, Fessler BJ, et al. Persistent cryoglobulinemic vasculitis following successful treatment of hepatitis C virus. J Rheumatol 2005; 32:1164-1167. This study describes the absence of clinical improvement in four cryglobulinemic patients despite the HCV eradication with antiviral therapy.
97. Cem Ar M, Soysal T, Hatemi G, et al. Successful management of cryoglobulinemia-induced leukocytoclastic vasculitis with thalidomide in a patient with multiple myeloma. Ann Hematol 2005; 84:609-613.
98. Koukoulaki M, Abeygunasekara SC, Smith KG, Jayne DR. Remission of refractory hepatitis C-negative cryoglobulinaemic vasculitis after rituximab and infliximab. Nephrol Dial Transplant 2005; 20:213-216.
99. Chandesris MO, Gayet S, Schleinitz N, et al. Infliximab in the treatment of refractory vasculitis secondary to hepatitis C-associated mixed cryoglobulinaemia. Rheumatology (Oxford) 2004; 43:532-533.
100. Calabrese LH, Zein N, Vassilopoulos D. Safety of antitumour necrosis factor (anti-TNF) therapy in patients with chronic viral infections: hepatitis C, hepatitis B, and HIV infection. Ann Rheum Dis 2004; 63 (Suppl 2):18-24.