Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2021; 27(18): 2073-2089
Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2073
Immune disorders and rheumatologic manifestations of viral hepatitis
Roman Maslennikov, Vladimir Ivashkin, Irina Efremova, Elena Shirokova
Roman Maslennikov, Vladimir Ivashkin, Irina Efremova, Elena Shirokova, Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow 119435, Russia
Roman Maslennikov, The Interregional Public Organization “Scientific Community for the Promotion of the Clinical Study of the Human Microbiome”, Moscow 119435, Russia
Roman Maslennikov, Department of Internal Medicine 1, Сonsultative and Diagnostic Center 2 of the Moscow City Health Department, Moscow 107564, Russia
Author contributions: Ivashkin V and Maslennikov R thought idea of the review; all authors searched original publications; Maslennikov R written the draft; all authors made the draft editing.
Conflict-of-interest statement: No conflict of interest for declaration.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Roman Maslennikov, MD, PhD, Assistant Professor, Professor, Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Pogodinskaya Street, 1, bld. 1, Moscow 119435, Russia. mmmm00@yandex.ru
Received: January 16, 2021
Peer-review started: January 16, 2021
First decision: February 28, 2021
Revised: February 28, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: May 14, 2021
Abstract

Infection with hepatotropic viruses is not limited to the liver and can lead to the development of various immunological disorders (the formation of cryoglobulins, rheumatoid factor, antinuclear antibodies, autoantibodies specific for autoimmune hepatitis and primary biliary cholangitis, and others), which can manifest as glomerulonephritis, arthritis, uveitis, vasculitis (cryoglobulinemic vasculitis, polyarteritis nodosa, Henoch-Schonlein purpura, isolated cutaneous necrotizing vasculitis), and other rheumatologic disorders, and be a trigger for the subsequent development of autoimmune hepatitis and primary biliary cholangitis. A further study of the association between autoimmune liver diseases and hepatotropic virus infection would be useful to assess the results of treatment of these associated diseases with antiviral drugs. The relationship of these immune disorders and their manifestations with hepatotropic viruses is best studied for chronic hepatitis B and C. Only isolated cases of these associations are described for hepatitis A. These links are least studied, and are often controversial for hepatitis E, possibly due to their relatively rare diagnoses. Patients with uveitis, glomerulonephritis, arthritis, vasculitis, autoimmune liver diseases should be tested for biomarkers of viral hepatitis, and if present, these patients should be treated with antiviral drugs.

Keywords: Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis E, Vasculitis, Rheumatoid factor

Core Tip: Infection with hepatotropic viruses is not limited to the liver and can lead to the development of various immunological disorders, which can manifest itself as glomerulonephritis, arthritis, uveitis, vasculitis, and other rheumatologic disorders, and be a trigger for the subsequent development of autoimmune hepatitis and primary biliary cholangitis. These associations are best studied for chronic hepatitis B and C. Only isolated cases of these are described for hepatitis A. These links are least studied, and are often controversial for hepatitis E. Patients with uveitis, glomerulonephritis, arthritis, vasculitis, autoimmune liver diseases should be tested for biomarkers of viral hepatitis.