Evaluation of rheumatic disorders in patients with primary biliary cirrhosis

Twenty-six consecutive patients with primary biliary cirrhosis (PBC) were subjected to clinical, radiological and serological assessment for evidence of rheumatic disease. Seven patients had asymptomatic liver disease, while the rest had symptoms indicating varying stages of advanced disease. Of the 18 patients with arthropathy, in 13 there was considered to be an association between the arthropathy and PBC as no other underlying causes could be discovered. In about half of the patients the symptoms were episodic, while the others had chronic pain. Usually both large and small joints were affected bilaterally. The joint symptoms had an average duration of 5 years, and had started in all patients after the onset of the liver disease. All 7 patients with arthritis fulfilled the criteria of the American Rheumatism Association for rheumatoid arthritis (RA). Five patients were classified as definite or classical RA. Circulating immune complexes were present in 35% of all patients, but there was no correlation with the presence of arthropathy. Seven patients were HLA-B27 positive, of whom 4 had arthritis. The investigation demonstrates that rheumatic disorders are common in PBC patients, whether or not they are symptomatic, and sometimes joint symptoms may even dominate the clinical picture.