Navegando por Palavras-chave "Cryoglobulinaemia"

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    Prevalência De Crioglobulinemia E Vasculite Crioglobulinêmica Em Pacientes Portadores De Hepatite C Crônica Acompanhados Em Serviço De Referência
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Aguiar, Mariana Freitas De [UNIFESP]; Souza, Alexandre Wagner Silva De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    ABSTRACT Background. It has been estimated that between 130 and 170 million people are chronically infected by hepatitis C virus worldwide and up to two thirds of HCV-infected patients will experience extrahepatic manifestations, with cryoglobulinaemia being the most frequent. The cryoglobulinaemic vasculitis (CryoVas) is a systemic vasculitIs that mainly affects small-sized vessels and it is secondary to HCV infection in 80% of the cases. The expression of CrioVas varies from mild symptoms to more severe manifestations and constitutes a formal indication of antiviral therapy. Objective. To evaluate the prevalence of cryoglobulinaemia and CryoVas in HCV-infected patients followed at an outpatient clinic specialized in hepatitis treatment in São Paulo, Brazil, between 2016 and 2017. Methods. A cross-sectional study was conducted and included sixty-eight viremic HCV patients with age above 18 years, without HIV or hepatitis B coinfection. A thorough clinical and laboratorial evaluation was perfomed. Circulating cryoglobulins and rheumatoid factor were detected and serum levels of total hemolytic complement (CH100), hemolytic C2 (C2h), C3 and C4 were measured. Cryoglobulins were immunochemically characterised by immunoelectrophoresis. Fifty-four patients underwent liver biopsy. The classification criteria for cryoglobulinaemic vasculitis were applied. Results. The study's population comprised mainly middle-aged women with prolonged HCV infection (> 10 years) and advanced hepatic fibrosis was detected in 11.8% of the cases. Almost 60% of the patients had never been treated before, while 40% had received interferon-alfa based treatment, associated to ribavirin, with or without a first generation protease inhibitor, such as boceprevir or telaprevir. Cryoglobulins were detected in 33 patients (48.5%) with type III cryoglobulinemia being the most frequent type. CryoVas was present in 7 patients (10.3%) and the clinical manifestations were in order of frequency periferic neuropathy, palpable purpura, arthralgias and renal disease. Life-threatening manifestations were rare in our patients population. Low C2h, C4 and CH100 levels were a common finding in CrioVas group. There were no associations found between age, gender, HCV genotype or liver biopsy findings and the presence of cryoglobulinemia or CryoVas. Conclusions. Brazilian patients chronically infected by HCV have cryoglobulinaemia and CryoVas in a frequency as high as the rates described in specialized European centers. Clinically, there was a predominance of non life-threatening manifestations, specially peripheral neuropathy. Further studies, with a larger number of patients and with a longitudinal design would be helpful to better describe the outcomes of Brazilian patients with cryoglobulinaemia and CryoVas.