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Recent updates in the diagnosis and management of cryoglobulinemic vasculitis

Elena Treppo1, Luca Quartuccio1, Salvatore De Vita1

  • 1Rheumatology Unit, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy.

Expert Review of Clinical Immunology
|September 12, 2023
PubMed

Insights

Mixed cryoglobulinemic syndrome (MCS), a small vessel vasculitis, presents diverse clinical issues. Current treatments for cryoglobulinemic vasculitis (CV) include antivirals for HCV-related cases and B-cell therapies, with challenges in refractory disease.

Area of Science:

  • Rheumatology
  • Immunology
  • Vascular Medicine

Background:

  • Cryoglobulinemic vasculitis (CV), or mixed cryoglobulinemic syndrome (MCS), is a small vessel systemic vasculitis.
  • CV presents with diverse clinical manifestations, posing treatment challenges for clinicians.

Purpose of the Study:

  • To review the current diagnostic and management strategies for mixed cryoglobulinemia (MC).
  • To evaluate current treatment approaches for cryoglobulinemic vasculitis (CV).

Main Methods:

  • A comprehensive literature review was conducted.
  • The review focused on diagnosis, management, and treatment of MC.

Main Results:

  • Accurate clinical and serological evaluation is crucial for MC diagnosis, comorbidity identification, and complication monitoring.
  • Treatment is individualized, with direct antiviral agents (for HCV-related CV) and B-cell-targeted therapy being mainstays.
  • Hepatitis C virus (HCV)-related CV and autoimmune-associated CV are key areas of focus.

Conclusions:

  • MC etiology is often identifiable, offering insights into infection-immune system interactions.
  • Challenges remain in treating refractory CV, especially those linked to autoimmune diseases or classified as 'essential'.
Abstract

Keywords:
Autoimmune diseasesHCVSjögren’s syndromecryoglobulinsmixed cryoglobulinemiarituximabvasculitis

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