RESEARCH - Autoimmune versus viral liver involvement in patients with Sjogren's syndrome

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J Rheumatol. 2006 Aug;33(8):1593-9.

Characterization and differentiation of autoimmune versus viral liver

involvement in patients with Sjogren's syndrome.

Ramos-Casals M, -Tapias JM, Pares A, Forns X, Brito-Zeron P, Nardi N,

Vazquez P, Velez D, Arias I, Bove A, Plaza J, Rodes J, Font J.

Department of Autoimmune Diseases and Hepatology, Hospital Clinic, Institut

d'Investigacions Biomediques August Pi i Sunyer, IDIBAPS, School of

Medicine, University of Barcelona, Barcelona, Spain.

OBJECTIVE: To analyze the prevalence and clinical significance of liver

involvement in patients with Sjogren's syndrome (SS), focusing on the

characterization and differentiation of autoimmune versus chronic viral

liver disease. METHODS: We investigated liver involvement (clinical signs,

analytical data, chronic viral infections, and autoantibodies) in 475

consecutive patients with SS. All patients fulfilled 4 or more of the 1993

European Community Study Group criteria for SS. RESULTS: Liver involvement

was detected in 129 (27%) patients. After ruling out chronic illnesses or

use of hepatotoxic drugs, the main etiologies were chronic viral liver

disease in 64 (13%) cases [chronic hepatitis C virus (HCV) infection in 63

and HBV infection in one] and autoimmune liver diseases in 24 (5%; primary

biliary cirrhosis in 16 patients and type-1 autoimmune hepatitis in 8). The

analytical liver profile was not useful in differentiating between viral and

autoimmune liver disease. In contrast, patients with SS and autoimmune liver

disease presented higher mean values of erythrocyte sedimentation rate (p =

0.044), circulating gammaglobulins (p = 0.007), and a higher prevalence of

antinuclear antibodies (p < 0.001), antimitochondrial antibodies (p <

0.001), anti-smooth muscle antibodies (p = 0.026), anti-Ro/SSA (p < 0.001),

and anti-La/SSB (p = 0.01), while patients with chronic viral liver disease

had a higher frequency of cryoglobulinemia (p < 0.001) and

hypocomplementemia (p < 0.001).

CONCLUSION: Chronic viral liver disease (associated overwhelmingly with HCV)

was the main cause of liver involvement in our patients with SS, with a

prevalence of 13%, nearly 3-fold greater than that observed for autoimmune

liver involvement. The immunological pattern played a key role in the

differentiation of viral (predominance of cryoglobulins and low complement

levels) and autoimmune (higher frequency of autoantibodies) liver

involvement.

PMID: 16881116

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6881116

Not an MD