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Aktuelle Rheumatologie 2017; 42(06): 518-528
DOI: 10.1055/s-0043-101522
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Die infektiöse Hepatitis: extrahepatische Manifestationen und der Einfluss auf die antirheumatische Therapie

Infectious Hepatitis: Extrahepatic Manifestations and the Influence on Antirheumatic Therapy
Marc Ringelhan
1   II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Fabian Geisler
1   II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Roland M. Schmid
1   II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
› Author Affiliations
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Publication History

Publication Date:
07 November 2017 (online)

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Zusammenfassung

Rheumatologische Beschwerden bei gleichzeitig vorliegender Infektion mit dem hepatotropen Hepatitis B (HBV) und Hepatitis C Virus (HCV) stellen häufig ein diagnostisches Dilemma dar, da beide Virusinfektionen neben einer Hepatitis, extrahepatische rheumatoide Manifestationen verursachen können. Beispielsweise ist das Auftreten von Arthralgien, einer Arthritis, einer Vaskulitis, als auch einer Sicca-Symptomatik möglich. Diese sprechen zumeist gut auf eine antivirale Therapie an. Als auslösende Pathomechanismen sind sowohl virusspezifische Faktoren, wie Immunkomplexe oder eine Stimulation von B-Zellen, als auch patientenspezifische Faktoren bekannt. Zugleich schließt eine HBV oder HCV Infektion eine zeitgleiche, nicht virusassoziierte rheumatische Erkrankung nicht aus, deren Diagnostik bei unspezifischer Erhöhung von Autoantikörpern im Rahmen einer HBV oder HCV Infektion häufig erschwert ist. Darüber hinaus stellen vor allem auch moderne antirheumatische Therapien im Falle einer chronischen Virushepatitis ein signifikantes Risiko für eine Reaktivierung bis hin zum fulminanten Leberversagen dar. Im Folgenden gehen wir daher auf häufige extrahepatische Manifestationen der Hepatitis B und C ein, welche eine relevante Differenzialdiagnose für die rheumatologische Praxis darstellen. Zudem werden aktuelle Empfehlungen und Risiken der Anwendung antirheumatischer Therapien bei Patienten mit rheumatologischen Erkrankungen und chronischer HBV oder HCV Infektion diskutiert.

Abstract

Rheumatologic symptoms and concurrent infections with the hepatotropic hepatitis B (HBV) and hepatitis C virus (HCV) often pose a diagnostic dilemma because both viral infections may cause extrahepatic rheumatoid manifestations in addition to hepatitis. For example, arthralgia, arthritis, vasculitis and sicca symptoms may occur, which usually respond well to antiviral therapy. Triggering pathomechanisms include virus-specific factors, e. g. immune complexes or stimulation of B cells, and patient-specific factors. However, a HBV or HCV infection does not rule out a concurrent, non-virus-associated rheumatic disease, which is difficult to diagnose as HBV or HCV infections are often associated with an unspecific elevation of autoantibody levels. Moreover, modern antirheumatic therapies pose a significant risk of reactivation or even fulminant hepatic failure in the case of chronic viral hepatitis. In the following, we will discuss frequent extrahepatic manifestations of HBV and HCV infections, which are a relevant differential diagnosis for rheumatologic practice. In addition, we will discuss current recommendations and risks regarding the use of antirheumatic therapies in patients with rheumatic diseases and chronic HBV or HCV infections.

Schlüsselwörter

Hepatitis B Virus - Hepatitis C Virus - extrahepatische Manifestationen - Reaktivierung - panarteritis nodosa

Key words

HBV - HCV - reactivation - extrahepatic manifestations - panarteritis nodosa
 

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