Arthritis and arthralgia may be present in 4%-23% of patients with primary biliary cirrhosis. One report indicates that many more have radiologic abnormalities of erosive arthritis but have no symptoms. About 50% of patients with hemochromatosis and about 25% of patients with chronic active hepatitis develop arthritis or arthralgias; up to 40% of patients with hepatitis virus hepatitis have arthralgia (usually not true arthritis); and arthritis may occasionally be found in patients with viral infections of various etiology (e.g., rubella). Patients with cancer may develop joint symptoms due to direct extension from or a reaction to a nearby primary site or from joint area metastasis. Joint metastasis usually involves one of the knees and is most often due to carcinoma of the lung or breast. Metastasis to the hand is most often due to lung carcinoma. Childhood acute leukemia rather frequently appears to produce joint pain for a variety of reasons. Neoplasia have been associated with gout, vasculitis, and occasionally, syndromes resembling some of the collagen diseases. Occasionally, there may be arthritic symptoms without neoplastic joint involvement. Sarcoidosis may occasionally produce arthritis.
Tag: Primary Biliary Cirrhosis
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Primary Biliary Cirrhosis
Primary biliary cirrhosis is an uncommon type of biliary obstruction that should be briefly mentioned. It occurs predominantly in young or middle-aged women and typically is a slow process. On liver biopsy there is inflammation and destruction of small bile ducts within liver portal areas. Clinically there is pruritus with or without mild jaundice. Steatorrhea is sometimes present. Biochemically, there usually is an ALP and GGT increase more than 3 times the normal limit, increased serum cholesterol level, and normal or mildly increased AST levels. Serum antimitochondrial antibodies are elevated in 90% or more patients. Diagnosis is made on the basis of the clinical and biochemical pattern plus the presence of antimitochondrial antibodies. Liver biopsy may be necessary to differentiate the disease from chronic hepatitis, liver tumor, drug-induced cholestasis, or some other conditions associated with cholangitis.