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Tsagkaris C, Papadakos SP, Moysidis DV, Papazoglou AS, Koutsogianni A, Papadakis M. Hepatomusculoskeletal disorders: Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease. World J Gastrointest Pathophysiol 2022; 13:124-127. [PMID: 36161230 PMCID: PMC9350596 DOI: 10.4291/wjgp.v13.i4.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/07/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Chronic liver disease can affect many body systems including the musculoskeletal system. The pathogenetic crosstalk between the liver and organs such as the brain and the kidneys has already been described with compound terms merging the organs affected by the pathology, such as the hepatorenal syndrome. Nevertheless, the musculoskeletal manifestations of chronic liver disease have not been coined with such a term to date. Because of this shortage, documenting the musculoskeletal implications of chronic liver disease in both research and clinical practice is challenging. To fill this gap, the authors propose the term hepatomusculoskeletal disorders, a compound term of Greek origin that encompasses all the body structures involved in the aforementioned pathologic crosstalk.
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Affiliation(s)
- Christos Tsagkaris
- Public Health and Policy Working Group, Stg European Student Think Tank, Amsterdam, Netherlands
| | - Stavros P Papadakos
- Laiko General Hospital of Athens, National and Kapodistrian University of Athens, Athens 18233, Greece
| | - Dimitrios V Moysidis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | | | - Alexandra Koutsogianni
- Laiko General Hospital of Athens, National and Kapodistrian University of Athens, Athens 18233, Greece
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, University of Witten-Herdecke, Wuppertal 42283, Germany
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A Review on Extrahepatic Manifestations of Chronic Hepatitis C Virus Infection and the Impact of Direct-Acting Antiviral Therapy. Viruses 2021; 13:v13112249. [PMID: 34835054 PMCID: PMC8619859 DOI: 10.3390/v13112249] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 02/06/2023] Open
Abstract
Extrahepatic manifestations are a feature of chronic hepatitis C virus (HCV) infection. In the course of chronic HCV infection, about 70% of patients have one or more extrahepatic manifestations. The latter are often the first and only clinical sign of infection. Experimental and clinical data support a causal association for many extrahepatic manifestations and HCV infection, which include mixed cryoglobulinemia, non-Hodgkin lymphomas (NHL), cardiovascular disease, insulin resistance, type 2 diabetes, neurological and psychiatric disease and other rheumatic diseases. All these extrahepatic conditions influence the morbidity, quality of life and mortality of HCV-infected patients. Currently, interferon-free therapeutic regimens with direct-acting antiviral agents (DAA) offer the possibility of treatment to almost the entire infected population, irrespective of stage of cirrhosis and associated serious comorbidities, always maintaining a high efficacy and tolerability. Several studies have shown a close association between HCV clearance by DAAs and an improvement or reduction in the risk of extrahepatic manifestations. Patients with HCV after a sustained virologic response (SVR) by DAA treatment have a lower risk than non-responders of developing cryoglobulinemic vasculitis and B-cell non-Hodgkin’s lymphomas. Furthermore, the SVR by DAA also reduces the risk of acute coronary syndrome, cardiovascular disease, insulin resistance and type 2 diabetes, and it improves atherosclerosis. HCV clearance by DAA also improves the quality of life and survival of patients with chronic HCV infection with associated extrahepatic diseases. Thus, DAAs should be initiated as early as possible in HCV patients with extrahepatic manifestations.
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Priora M, Borrelli R, Parisi S, Ditto MC, Realmuto C, Laganà A, Centanaro Di Vittorio C, Degiovanni R, Peroni CL, Fusaro E. Autoantibodies and Rheumatologic Manifestations in Hepatitis C Virus Infection. BIOLOGY 2021; 10:1071. [PMID: 34827064 PMCID: PMC8614641 DOI: 10.3390/biology10111071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
HCV is a virus that can cause chronic infection which can result in a systemic disease that may include many rheumatologic manifestations such as arthritis, myalgia, sicca syndrome, cryoglobulinemia vasculitis as well as other non-rheumatological disorders (renal failure, onco-haematological malignancies). In this population, the high frequency of rheumatoid factor (45-70%), antinuclear (10-40%) and anticardiolipin (15-20%) antibodies is a B-cell mediated finding sustained by the infection. However, the possibility that a primitive rheumatic pathology may coexist with the HCV infection is not to be excluded thus complicating a differential diagnosis between primitive and HCV-related disorders.
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Affiliation(s)
- Marta Priora
- Department of General and Specialistic Medicine, Rheumatology Clinic, Hospital of Mondovì, 12084 Cuneo, Italy
| | - Richard Borrelli
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Simone Parisi
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Maria Chiara Ditto
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Cristina Realmuto
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Angela Laganà
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Chiara Centanaro Di Vittorio
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Rosanna Degiovanni
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Clara Lisa Peroni
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Enrico Fusaro
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
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Abstract
Viral hepatitis can cause a wide spectrum of clinical presentations from a benign form with minimal or no symptoms to acute liver failure or death. Hepatitis D coinfection and superinfection have distinct clinical courses, with the latter more likely leading to chronic infection. Management of chronic hepatitis D virus is individualized because of the paucity of treatment options and significant side effect profile of currently available treatments. Sporadic cases of hepatitis E caused by contaminated meats are becoming increasingly prevalent in immunocompromised hosts. Human herpesviruses are an important cause of disease also in immunocompromised individuals.
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