Predictive value of rheumatoid factor titre in cryoglobulinemia in Hepatitis C positive patients

Abstract

Background/objective: HCV viremia has been known to provoke a plethora of autoimmune syndromes as well as nonspecific rheumatologic manifestations. HCV is the most frequent cause of mixed cryoglobulinemia, which is characterized by endothelial deposition of rheumatoid factor containing immune complexes and endorgan vasculitis. Rheumatoid factor positivity is found to be more prevalent among patients with HCV infection compared to the general population. The aim of the study was to ascertain the relationship of rheumatoid factor titer with cryoglobuliemia in hepatitis C virus positive patients and to assess its relation with different disease characteristics. Methods: A cross sectional study was carried out through one year. Fifty patients known to suffer from HCV were subjects of the study. Patients were interviewed and demographic, clinical and serologic data were recorded. All patients were tested for cryoglobulins by crude method and rheumatoid factor titer was determined in all patients. Child-Pugh classification was used for assessment of liver cell failure. Data were analyzed by the Statistical Package for the Social Sciences (SPSS, version 17). Data analysis is done by using Chi-Squared test (χ2) test and Fisher’s exact test as appropriate. Associations between interval, ordinal and dichotomous variables were tested by Pearson`s Product Moment Correlation Coefficients (r). Results: Cryoglobulinemia was detected in 36 (72%) patients out of the 50 HCV patients. Rheumatoid Factor (RF) was positive in 38% patients (76%). All HCV patients who were positive for cryoglobulin had a positive RF. Presence of RF found to be positively significantly correlated with the presence of cryogloulins in HCV patients. Conclusions: HCV infection is a major contributing factor of mixed cryoglobulinemia with elevation in RF titre. Positive anti-HCV antibodies together with highly positive RF titre in the presence of musculoskeletal, neurological and cutaneous manifestations strongly suggest the diagnosis of mixed cryoglobulinemia.