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Birmingham vasculitis activity score, disease extent index and complement factor C3c reflect disease activity best in
P Lamprecht1, F Moosig, A Gause
1Poliklinik für Rheumatologie, Universitätsklinikum Lübeck, Medizinische Universität zu Lübeck, Germany. bibliobb@aol.com
Insights
Hepatitis C virus (HCV)-associated cryoglobulinemic vasculitis (CV) patients achieved remission with cyclophosphamide or interferon-alpha 2b. Birmingham Vasculitis Activity Score (BVAS), Disease Extent Index (DEI), and C3c levels effectively monitored treatment response.
Area of Science:
- Rheumatology
- Hepatology
- Immunology
Background:
- Hepatitis C virus (HCV) infection is a common cause of cryoglobulinemic vasculitis (CV).
- Monitoring disease activity and treatment response in HCV-associated CV is crucial for patient management.
Purpose of the Study:
- To evaluate clinical and serological parameters for monitoring HCV-associated CV.
- To compare the efficacy of cyclophosphamide and interferon-alpha 2b in treating HCV-associated CV.
Main Methods:
- 15 patients with HCV-associated CV were treated with either cyclophosphamide (7 patients) or interferon-alpha 2b (8 patients).
- Clinical measures (Birmingham Vasculitis Activity Score [BVAS], Disease Extent Index [DEI]) and serological/immunological parameters were assessed at diagnosis and during therapy.
Main Results:
- Both treatment groups showed complete or partial response.
- BVAS, C3c, cryoglobulinemia, and rheumatoid factor significantly decreased in both groups (p < 0.05).
- DEI significantly decreased with cyclophosphamide (p < 0.05) and trended with interferon-alpha 2b (p = 0.06). BVAS and DEI correlated positively, and both negatively correlated with C3c levels.
Conclusions:
- Cyclophosphamide and interferon-alpha 2b are effective treatments for HCV-associated CV, inducing remission.
- BVAS, DEI, and C3c are valuable for follow-up, with C3c providing additional information beyond ESR and CRP.
Objective:
Clinical measures of vasculitis activity (Birmingham vasculitis activity score = BVAS) and disease extent (Disease Extent Index = DEI), serological and immunological parameters were evaluated for the monitoring of hepatitis C virus (HCV)-associated cryoglobulinemic vasculitis (CV), treated with either cyclophosphamide or interferon-alpha 2b depending on disease severity.
Methods:
Serial serum samples of 15 patients with HCV-associated CV were analyzed, and BVAS, DEI, serological and immunological parameters were recorded at diagnosis and during therapy. Eight patients were treated with interferon-alpha 2b and 7 patients with cyclophosphamide.
Results:
A complete or partial response of the CV was seen in both treatment groups. BVAS, complement factor C3c, cryoglobulinemia, and rheumatoid factor significantly decreased in both treatment groups during 6 months (p < 0.05). DEI decrease was significant in the cyclophosphamide group (p < 0.05), and there was a trend in the interferon-alpha 2b group (p = 0.06). BVAS and DEI were significantly positively correlated, and both parameters were significantly negatively correlated with C3c levels in both treatment groups (interferon-alpha 2b/cyclophosphamide: r = -0.89, p = 0.001 versus r = -0.87, p < 0.001, respectively) whereas other parameters were not, e.g. ESR and CRP.
Conclusions:
Patients with different degrees of disease severity, treated with either cyclophosphamide or interferon-alpha 2b depending on their disease activity, achieved remission of their CV. BVAS, DEI and C3c were especially useful in the follow-up of HCV-associated CV. C3c correlated with BVAS and DEI during therapy and provided additional information about vasculitis activity that was not reflected by other serological or immunological parameters, e.g. ESR or CRP.