Autonomic neuropathy in mixed cryoglobulinemia

Area of Science:

• Neurology
• Hepatology
• Immunology

Background:

• Hepatitis C Virus-related mixed cryoglobulinemia (HCV-MC) is a systemic vasculitis.
• Peripheral neuropathy (PN) is a common complication, but autonomic neuropathy (AN) is less understood.
• The interplay between PN and AN in HCV-MC requires further investigation.

Purpose of the Study:

• To assess the prevalence and characteristics of autonomic neuropathy (AN) in patients with HCV-related mixed cryoglobulinemia (HCV-MC).
• To investigate the relationship between AN and peripheral neuropathy (PN) in this patient cohort.
• To evaluate the impact of standard treatments on AN and PN.

Main Methods:

• Retrospective, cross-sectional study of 30 HCV-MC patients.
• Clinical, neurological, and electrodiagnostic examinations, including cardiovascular tests and sympathetic skin response (SSR).
• Sural nerve biopsy in 10 patients with PN; treatment analysis included steroids and recombinant interferon-alpha2b (RIfn-alpha2b).

Main Results:

• Peripheral neuropathy (PN) observed in 90% of patients; autonomic neuropathy (AN) in 13.3%, all with co-existing PN.
• Sympathetic skin response (SSR) was the most frequently altered autonomic test.
• Nerve biopsy showed axonal degeneration, more pronounced in patients with AN; RIfn-alpha2b addition to steroids did not significantly improve PN or AN.

Conclusions:

• Autonomic neuropathy (AN) can occur in HCV-MC patients even without overt dysautonomic symptoms.
• SSR is a valuable test for identifying AN in HCV-MC, alongside other autonomic function tests.
• Combined steroid and RIfn-alpha2b therapy did not demonstrate significant benefits for PN or AN in this study.