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Extrahepatic manifestations of chronic hepatitis C infection and the interrelationship between primary Sjogren's syndrome and hepatitis C in Swedish patients

Verbaan, Hans LU ; Carlson, Joyce LU ; Eriksson, Sten LU ; Larsson, A; Liedholm, R; Manthorpe, Rolf LU ; Tabery, Helena LU ; Widell, Anders LU and Lindgren, Stefan LU (1999) In Journal of Internal Medicine 245(2). p.127-132
Abstract
OBJECTIVE: To analyse the frequency of some extrahepatic manifestations of chronic hepatitis C virus (HCV) infection in northern European patients, including a postulated association between HCV and primary Sjogren's syndrome (SS). DESIGN: Cohort study. SETTING: Department of Medicine, Malmo University Hospital, Sweden. PATIENTS: Twenty-one patients with HCV infection and 53 with primary SS (according to the Copenhagen criteria). MAIN OUTCOME MEASURES: Cryoglobulins were analysed in all patients, while patients with primary SS were investigated with regard to markers of HCV infection, and HCV patients with objective tests of SS (Schirmer-1 test, break-up time, van Bijsterveld score, sialometry, labial salivary gland biopsy) and antibodies... (More)
OBJECTIVE: To analyse the frequency of some extrahepatic manifestations of chronic hepatitis C virus (HCV) infection in northern European patients, including a postulated association between HCV and primary Sjogren's syndrome (SS). DESIGN: Cohort study. SETTING: Department of Medicine, Malmo University Hospital, Sweden. PATIENTS: Twenty-one patients with HCV infection and 53 with primary SS (according to the Copenhagen criteria). MAIN OUTCOME MEASURES: Cryoglobulins were analysed in all patients, while patients with primary SS were investigated with regard to markers of HCV infection, and HCV patients with objective tests of SS (Schirmer-1 test, break-up time, van Bijsterveld score, sialometry, labial salivary gland biopsy) and antibodies against nuclear antigens, smooth muscle (SMA) and mitochondria (AMA). HCV antigens in small salivary glands from lower lip biopsies were detected by immunohistochemical analysis. RESULTS: Only one of the SS patients had detectable cryoprecipitates, while another was HCV-positive. None of the 21 HCV patients had cryoprecipitates. A total of 14/21 (67%) patients with HCV infection had at least one abnormal objective test suggestive of xerostomia or keratoconjunctivitis sicca, while eight (38%) had objective evidence of both eye and salivary gland involvement. HCV antigens were not detected in affected glands. Only two patients had clinical symptoms of SS, and two fulfilled the Copenhagen criteria for SS. None of the HCV-positive patients had detectable antibodies against SS-A, SS-B, RNP, Jo-1, PCNA or Scl-70, and the frequency of ANA/SMA/AMA was low. CONCLUSIONS: While involvement of salivary and lacrimal glands was common in Swedish patients with HCV infection, cryoglobulinaemia was not observed. The pathogenetic mechanism responsible for glandular inflammation appears to be different from that in primary SS. HCV infection does not seem to be an aetiological factor for primary SS in this population. These observations suggest that viral, genetic or possibly environmental factors may be responsible for the reported high frequencies of systemic complications associated with chronic hepatitis C infection in southern Europe. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
chronic hepatitis C infection, cryoprecipitates, HCV, keratoconjunctivitis sicca, primary Sjögren's syndrome, xerostomia
in
Journal of Internal Medicine
volume
245
issue
2
pages
127 - 132
publisher
Wiley-Blackwell Publishing Ltd
external identifiers
  • pmid:10081515
  • scopus:0033026118
ISSN
1365-2796
DOI
10.1046/j.1365-2796.1999.00414.x
language
English
LU publication?
yes
id
4a222998-0693-4f5e-b8b3-5b5b768a5235 (old id 1114248)
date added to LUP
2008-07-03 15:41:38
date last changed
2017-02-12 04:13:57
@article{4a222998-0693-4f5e-b8b3-5b5b768a5235,
  abstract     = {OBJECTIVE: To analyse the frequency of some extrahepatic manifestations of chronic hepatitis C virus (HCV) infection in northern European patients, including a postulated association between HCV and primary Sjogren's syndrome (SS). DESIGN: Cohort study. SETTING: Department of Medicine, Malmo University Hospital, Sweden. PATIENTS: Twenty-one patients with HCV infection and 53 with primary SS (according to the Copenhagen criteria). MAIN OUTCOME MEASURES: Cryoglobulins were analysed in all patients, while patients with primary SS were investigated with regard to markers of HCV infection, and HCV patients with objective tests of SS (Schirmer-1 test, break-up time, van Bijsterveld score, sialometry, labial salivary gland biopsy) and antibodies against nuclear antigens, smooth muscle (SMA) and mitochondria (AMA). HCV antigens in small salivary glands from lower lip biopsies were detected by immunohistochemical analysis. RESULTS: Only one of the SS patients had detectable cryoprecipitates, while another was HCV-positive. None of the 21 HCV patients had cryoprecipitates. A total of 14/21 (67%) patients with HCV infection had at least one abnormal objective test suggestive of xerostomia or keratoconjunctivitis sicca, while eight (38%) had objective evidence of both eye and salivary gland involvement. HCV antigens were not detected in affected glands. Only two patients had clinical symptoms of SS, and two fulfilled the Copenhagen criteria for SS. None of the HCV-positive patients had detectable antibodies against SS-A, SS-B, RNP, Jo-1, PCNA or Scl-70, and the frequency of ANA/SMA/AMA was low. CONCLUSIONS: While involvement of salivary and lacrimal glands was common in Swedish patients with HCV infection, cryoglobulinaemia was not observed. The pathogenetic mechanism responsible for glandular inflammation appears to be different from that in primary SS. HCV infection does not seem to be an aetiological factor for primary SS in this population. These observations suggest that viral, genetic or possibly environmental factors may be responsible for the reported high frequencies of systemic complications associated with chronic hepatitis C infection in southern Europe.},
  author       = {Verbaan, Hans and Carlson, Joyce and Eriksson, Sten and Larsson, A and Liedholm, R and Manthorpe, Rolf and Tabery, Helena and Widell, Anders and Lindgren, Stefan},
  issn         = {1365-2796},
  keyword      = {chronic hepatitis C infection,cryoprecipitates,HCV,keratoconjunctivitis sicca,primary Sjögren's syndrome,xerostomia},
  language     = {eng},
  number       = {2},
  pages        = {127--132},
  publisher    = {Wiley-Blackwell Publishing Ltd},
  series       = {Journal of Internal Medicine},
  title        = {Extrahepatic manifestations of chronic hepatitis C infection and the interrelationship between primary Sjogren's syndrome and hepatitis C in Swedish patients},
  url          = {http://dx.doi.org/10.1046/j.1365-2796.1999.00414.x},
  volume       = {245},
  year         = {1999},
}