|
1
|
Codes-Méndez H, Jeria S, Park HS, Moya P, Magallares-López B, Moltó E, Álvaro Y, Mariscal A, Moga E, Tandaipan JL, Díaz-Torne C, Laiz A, Sainz L, Castellví I, Corominas H. Clinical and Serological Profiles in Cryoglobulinemia: Analysis of Isotypes and Etiologies. J Clin Med 2024; 13:6069. [PMID: 39458019 PMCID: PMC11508573 DOI: 10.3390/jcm13206069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 10/02/2024] [Accepted: 10/09/2024] [Indexed: 10/28/2024] Open
Abstract
Objectives: Cryoglobulinemia (CG) is marked by abnormal immunoglobulins (Ig) in serum, precipitating at temperatures below 37 °C. Current classification categorizes CG into three subtypes (types I, II, and III) based on Ig clonality. The features distinguishing patients with CG based on their etiology remain unidentified. Aiming to characterize clinical and serological profiles of CG individuals, we conducted an observational analysis of a large cohort of patients and compared their characteristics based on underlying causes: hepatovirus (HV) infections, rheumatic diseases (RD), hematological disorders, and unidentified etiology (essential CG). Methods: We analyzed 252 cryoglobulin-positive serum samples from 182 patients and classified these into the four etiological groups. A separate sub-analysis was carried out for 10 patients meeting criteria for multiple diseases. We collected demographic, clinical, and laboratory data: CG characterization, complement (C3 and C4) levels, antinuclear antibodies (ANA), and rheumatoid factor (RF). Kruskal-Wallis and Wilcoxon-Mann-Whitney U-tests were used for comparisons. Results: Most patients (93.3%) had mixed cryoglobulinemia (types II + III), with 6.7% having type I. HV infection, predominantly hepatitis C, was the main (52.9%) associated condition within the cohort, followed by rheumatic (27.3%) and hematological (9.8%) disorders. In our cohort, ANA were frequent (45.3%) and often associated with RF positivity (43.6%) and decreased complement levels (C3: 42.4%, C4: 32.5%). Essential CG and CG associated with RD had a higher prevalence of cutaneous manifestations (p < 0.01) and renal involvement (p = 0.017). Hematological disorder-related CG showed higher cryoglobulin and RF concentrations (p < 0.01), despite milder symptoms. Conclusions: Our study underscores a mixed prevalence of CG across disease subgroups, with hepatitis-C virus as the primary factor, followed by rheumatic and hematological disorders. Four clinical and serological profiles of CG were identified based on their etiologies.
Collapse
Affiliation(s)
- Helena Codes-Méndez
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
| | - Sicylle Jeria
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
| | - Hye-Sang Park
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Multi-Organ Damage and Rheumatology Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Medicine Faculty, Universitat Autònoma de Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain
| | - Patricia Moya
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Multi-Organ Damage and Rheumatology Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Medicine Faculty, Universitat Autònoma de Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain
| | - Berta Magallares-López
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Multi-Organ Damage and Rheumatology Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Medicine Faculty, Universitat Autònoma de Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain
| | - Elisabeth Moltó
- Immunology Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (E.M.); (Y.Á.); (A.M.); (E.M.)
| | - Yolanda Álvaro
- Immunology Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (E.M.); (Y.Á.); (A.M.); (E.M.)
| | - Anais Mariscal
- Immunology Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (E.M.); (Y.Á.); (A.M.); (E.M.)
| | - Esther Moga
- Immunology Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (E.M.); (Y.Á.); (A.M.); (E.M.)
| | - Jose Luis Tandaipan
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Multi-Organ Damage and Rheumatology Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Medicine Faculty, Universitat Autònoma de Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain
| | - César Díaz-Torne
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Multi-Organ Damage and Rheumatology Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Medicine Faculty, Universitat Autònoma de Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain
| | - Ana Laiz
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Multi-Organ Damage and Rheumatology Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Medicine Faculty, Universitat Autònoma de Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain
| | - Luis Sainz
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Multi-Organ Damage and Rheumatology Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Medicine Faculty, Universitat Autònoma de Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain
| | - Ivan Castellví
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Multi-Organ Damage and Rheumatology Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Medicine Faculty, Universitat Autònoma de Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain
| | - Hector Corominas
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (H.C.-M.); (S.J.); (H.-S.P.); (P.M.); (B.M.-L.); (J.L.T.); (C.D.-T.); (A.L.); (L.S.); (I.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Multi-Organ Damage and Rheumatology Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Medicine Faculty, Universitat Autònoma de Barcelona (UAB), 08193 Cerdanyola del Vallès, Spain
| |
Collapse
|
|
3
|
Ferri C, Cacoub P, Mazzaro C, Roccatello D, Scaini P, Sebastiani M, Tavoni A, Zignego AL, De Vita S. Treatment with rituximab in patients with mixed cryoglobulinemia syndrome: results of multicenter cohort study and review of the literature. Autoimmun Rev 2011; 11:48-55. [PMID: 21821153 DOI: 10.1016/j.autrev.2011.07.005] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 07/19/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Mixed cryoglobulinemia syndrome (MCs) is a systemic vasculitis characterized by multiple organ involvement due to the vascular deposition of immune-complexes, mainly the cryoglobulins. B-lymphocyte expansion represents the underlying pathological alteration frequently triggered by hepatitis C virus (HCV) infection. The treatment of MCs syndrome is generally based on antiviral drugs and/or immunosuppressors, among which rituximab, an anti-CD20 monoclonal antibody, has been usefully employed for both cutaneous and visceral MCs organ involvement. This multicenter study retrospectively evaluated the effects of rituximab in a large series of patients with active MCs. The observed results were compared to those emerging from the updated review of the literature on this topic. METHODS The study included 87 patients (male/female 19/68, mean age 62.3±11.4SD years, mean disease duration 9±6.2SD years, HCV infection in 92% of cases) with active cryoglobulinemic vasculitis evaluated before rituximab monotherapy and after 6-month follow-up by means of main clinico-serological parameters. A PubMed search up to May 31, 2011, was done to find published clinical studies, including case reports of MCs treated with rituximab. RESULTS A significant clinical improvement was observed in a relevant percentage of cases, regardless the presence/absence of associated HCV infection; namely, complete/partial remission of pre-treatment active manifestations was observed in 74% of skin purpuric lesions, up to 87% of non-healing vasculitic leg ulcers, and 44% of the peripheral neuropathy, mainly paresthesias (patient's visual analogical scale from 62±25 to 37±27; p≤.0001). Moreover, cryoglobulinemic nephropathy, observed in 38 patients, significantly improved in 95% of cases (serum creatinine from 1.8±1.1SD to 1.4±0.8SD mg/dl, p≤.0001; 24-hour proteinuria from 2.2±2.1SD to 0.9±1.7SD g/24h, p≤.0001), with complete remission in the 50%. Among 6 patients with complicating non-Hodgkin's B-cell lymphoma a complete or partial remission was observed in 5/6. A complete remission of abdominal vasculitis was also observed in one patient. These beneficial effects were mirrored by the improvement of cryoglobulinemic serological hallmarks, namely cryocrit and low complement C4, in half cases. The safety of rituximab was confirmed by the small number of side effects recorded during the 6-month follow-up. On the whole, the results of the present study are in keeping with those reported in 39 papers present in world literature, including a total of 279 MCs patients. CONCLUSIONS Rituximab may be regarded as useful and safe pathogenetic treatment of cryoglobulinemic vasculitis. The actual role of this drug should be definitely confirmed by randomized controlled trials, as well as its position in the therapeutical strategy, mainly with respect to antiviral treatment in HCV-associated MCs.
Collapse
Affiliation(s)
- C Ferri
- Rheumatology Unit, Department of Internal Medicine, University of Modena e Reggio Emilia, Medical School, Via del Pozzo 71, Modena, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|