Materiały źródłowe

• #1 Cryoglobulinaemia

  https://dermnetnz.org/topics/cryoglobulinaemia

  Cryoglobulinaemia is a rare disorder characterised by the presence of abnormal immunoglobulin proteins in the blood that can precipitate out into tissues at low temperatures and causing inflammation and damage. […] The main aim of therapy is to find and treat the underlying cause and limit precipitation of cryoglobulins and the inflammation that results. Patients with cryoglobulinaemia should be advised to avoid cold environments to prevent triggering the precipitation of cryoglobulins. […] Identification and treatment of early symptoms such as skin lesions, fatigue or arthralgia, as a result of cryoglobulinaemia, will prevent further organ damage and improve patient outcomes.

• #2 How do I Deal with Cryoglobulinemia?

  https://www.iomcworld.com/open-access/how-do-i-deal-with-cryoglobulinemia-111971.html

  Cryoglobulinemia is a condition in which cryoglobulins are present in the bloodstream. […] Treatment is limited to symptomatic conditions and focuses on the underlying problem. […] It is imperative to educate patients on avoiding exposure to the cold by wearing gloves when using the freezer or refrigerator, wearing warm clothes in air-conditioned facilities, and relocating to a warmer climate during the winter months. Foot and leg care is important to prevent wound complications. […] Cryoglobulinemia is a very uncommon clinical condition. Because the presence of cryoglobulins in the serum aids diagnosis, it’s crucial to be aware of its clinical range. End-organ damage and repeated relapses make treatment difficult. […] Without any developing illness-specific therapies, all therapeutic approaches are now geared to either cure the underlying disease or provide immunosuppression. […] Because cryoglobulinemia is a varied illness in terms of signs and origin, it’s difficult to come up with a set of universal care guidelines, even though there are some parallels in therapy techniques, as previously mentioned.

• #3 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php?jid=jcnrc

  Cryoglobulinemic vasculitis is a complex and destructive disease process that affects multiple organ systems. The pathophysiology includes formation of immune complex deposits that create an inflammatory response in various organs, yielding distinct presentations such as purpura, arthralgias, neuropathy, fever, and pulmonary vasculitis. Over 30% of cryoglobulinemic vasculitis cases present with glomerulonephritis, which carries a worse prognosis. Treatment of cryoglobulinemic vasculitis involves treatment of underlaying HCV, as well as high doses of immunosuppressive agents such as steroids and rituximab, often for multiple months, but with resolution of symptoms. […] Cryoglobulinemic vasculitis is often precipitated by infectious etiologies and most commonly by hepatitis C virus (HCV) infection. Treatment of cryoglobulinemic vasculitis involves use of antiviral agents and high doses of immune suppressants, often for multiple months.

• #4 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php?jid=jcnrc

  Cryoglobulinemic vasculitis is a complex and destructive disease process that affects multiple organ systems. The pathophysiology includes formation of immune complex deposits that create an inflammatory response in various organs, yielding distinct presentations such as purpura, arthralgias, neuropathy, fever, and pulmonary vasculitis. Over 30% of cryoglobulinemic vasculitis cases present with glomerulonephritis, which carries a worse prognosis. Treatment of cryoglobulinemic vasculitis involves treatment of underlaying HCV, as well as high doses of immunosuppressive agents such as steroids and rituximab, often for multiple months, but with resolution of symptoms. […] Cryoglobulinemic vasculitis is often precipitated by infectious etiologies and most commonly by hepatitis C virus (HCV) infection. Treatment of cryoglobulinemic vasculitis involves use of antiviral agents and high doses of immune suppressants, often for multiple months.

• #5 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php?jid=jcnrc

  Cryoglobulinemic vasculitis is a complex and destructive disease process that affects multiple organ systems. The pathophysiology includes formation of immune complex deposits that create an inflammatory response in various organs, yielding distinct presentations such as purpura, arthralgias, neuropathy, fever, and pulmonary vasculitis. Over 30% of cryoglobulinemic vasculitis cases present with glomerulonephritis, which carries a worse prognosis. Treatment of cryoglobulinemic vasculitis involves treatment of underlaying HCV, as well as high doses of immunosuppressive agents such as steroids and rituximab, often for multiple months, but with resolution of symptoms. […] Cryoglobulinemic vasculitis is often precipitated by infectious etiologies and most commonly by hepatitis C virus (HCV) infection. Treatment of cryoglobulinemic vasculitis involves use of antiviral agents and high doses of immune suppressants, often for multiple months.

• #6 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Admit the patient to an inpatient medical service upon evidence of active vasculitis involving renal, cardiopulmonary, or neurologic systems that requires use of aggressive immunosuppressive therapy. Consider corticosteroid therapy for at least initial therapy in patients with more severe symptoms such as vasculitis, neurologic findings, severe cutaneous disease, or renal involvement or in those who otherwise meet criteria for inpatient medical care. These patients may require additional immunosuppressive therapy and are best treated by a specialist. Patients who develop end-organ compromise secondary to active vasculitis may need to be monitored in an intensive care unit setting. […] Outpatient management is reasonable in patients suspected of having mild vasculitis that is expected to respond to outpatient oral immunosuppressive therapy or in patients treated for vague symptoms of arthralgias, fatigue, or malaise without evidence of active vasculitis. Consider the use of NSAIDs in patients with mild symptoms without evidence of vasculitis.

• #7 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Admit the patient to an inpatient medical service upon evidence of active vasculitis involving renal, cardiopulmonary, or neurologic systems that requires use of aggressive immunosuppressive therapy. Consider corticosteroid therapy for at least initial therapy in patients with more severe symptoms such as vasculitis, neurologic findings, severe cutaneous disease, or renal involvement or in those who otherwise meet criteria for inpatient medical care. These patients may require additional immunosuppressive therapy and are best treated by a specialist. Patients who develop end-organ compromise secondary to active vasculitis may need to be monitored in an intensive care unit setting. […] Outpatient management is reasonable in patients suspected of having mild vasculitis that is expected to respond to outpatient oral immunosuppressive therapy or in patients treated for vague symptoms of arthralgias, fatigue, or malaise without evidence of active vasculitis. Consider the use of NSAIDs in patients with mild symptoms without evidence of vasculitis.

• #8 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Admit the patient to an inpatient medical service upon evidence of active vasculitis involving renal, cardiopulmonary, or neurologic systems that requires use of aggressive immunosuppressive therapy. Consider corticosteroid therapy for at least initial therapy in patients with more severe symptoms such as vasculitis, neurologic findings, severe cutaneous disease, or renal involvement or in those who otherwise meet criteria for inpatient medical care. These patients may require additional immunosuppressive therapy and are best treated by a specialist. Patients who develop end-organ compromise secondary to active vasculitis may need to be monitored in an intensive care unit setting. […] Outpatient management is reasonable in patients suspected of having mild vasculitis that is expected to respond to outpatient oral immunosuppressive therapy or in patients treated for vague symptoms of arthralgias, fatigue, or malaise without evidence of active vasculitis. Consider the use of NSAIDs in patients with mild symptoms without evidence of vasculitis.

• #9 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  The following specialist consultations are beneficial: Rheumatologist or clinical immunologist, Nephrologist upon evidence of renal disease (ie, hypertension, abnormal findings on urinalysis), Hematologist upon evidence of underlying hematological disease or for plasmapheresis, Gastroenterologist or hepatologist for patients with underlying hepatitis.

• #10 Cryoglobulinemic vasculitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/cryoglobulinemic-vasculitis/

  Cryoglobulinemic vasculitis is a type of small-vessel vasculitis characterized by the deposition of cryoglobulins. […] Management includes specific treatment of the underlying etiology (e.g., direct-acting antivirals for HCV infection), in addition to management of cryoglobulinemic vasculitis, which usually involves immunosuppressive agents (e.g., glucocorticoids plus rituximab) and is guided by disease severity. […] Patients with rapidly progressive glomerulonephritis, CNS involvement, GI ischemia, or alveolar hemorrhage should receive prompt treatment with a combination of glucocorticoid pulses, rituximab, and plasmapheresis. […] Consult rheumatology for all patients. […] Start specific therapy for the underlying etiology (e.g., direct-acting antivirals for hepatitis C infection).

• #11 Vasculitic emergencies in the intensive care unit: a special focus on cryoglobulinemic vasculitis | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-2-31

  CV-related cardiac disease is a rare but life-threatening manifestation of CV. […] Acute cardiac involvement should be distinguished from long-term cardiovascular complications, which are among the leading causes of death in patients with CV. […] Gastrointestinal involvement is rare in patients with CV. […] Early diagnosis and management can lead to a favorable outcome. […] In clinical practice, particularly in the ICU, the management of life-threatening vasculitis is challenging. […] A timely and accurate diagnosis is mandatory for the appropriate treatment to be implemented. […] In critically ill patients, the first-line treatment focuses on organ support and prevention of long-term organ dysfunction. […] Identification of the underlying cause is mandatory and an etiology-based treatment is the mainstay of the long-term management.

• #12 Vasculitic emergencies in the intensive care unit: a special focus on cryoglobulinemic vasculitis | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-2-31

  Vasculitis is characterized by the infiltration of vessel walls by inflammatory leukocytes with reactive damage and subsequent loss of vessel integrity. […] Among the systemic vasculitides, cryoglobulinemic vasculitis (CV) has been rarely studied in an ICU setting. […] The diagnosis of CV in the ICU may be delayed or completely unrecognized. A high level of suspicion is critical to obtain a timely and accurate diagnosis and to initiate appropriate treatment. […] That all six patients survived suggests the benefit of prompt ICU admission of patients with severe CV. […] Renal involvement is the most common, severe, CV-related visceral manifestation, seen in more than one-third of cases. […] The main renal biopsy finding is type 1 membranoproliferative glomerulonephritis. […] The main short-term complications are AKI, oliguria, fluid overload with acute respiratory distress, and metabolic disorders.

• #13 Less Than Half of Cryoglobulin Tests Ordered at a Tertiary Hospital Network Are Successfully Completed: An Opportunity for Improvement – ACR Meeting Abstracts

  https://acrabstracts.org/abstract/less-than-half-of-cryoglobulin-tests-ordered-at-a-tertiary-hospital-network-are-successfully-completed-an-opportunity-for-improvement/

  Less Than Half of Cryoglobulin Tests Ordered at a Tertiary Hospital Network Are Successfully Completed: An Opportunity for Improvement […] Cryoglobulin detection is essential for the diagnosis of cryoglobulinemic vasculitis, a condition leading to high healthcare use, organ damage, and even death. Successful cryoglobulin testing requires specific sample collection, transport, and preparation procedures, leading tests to be cancelled if appropriate conditions are not met. […] At our institution, cryoglobulin tests are cancelled more than half the time they are ordered, potentially leading to delayed diagnoses and repeat patient visits or blood draws. Optimizing systems of sample collection and transportation in the context of busy inpatient and emergency environments might increase successful cryoglobulin testing, saving precious resources and reducing potentially dangerous diagnostic delays.

• #14 Less Than Half of Cryoglobulin Tests Ordered at a Tertiary Hospital Network Are Successfully Completed: An Opportunity for Improvement – ACR Meeting Abstracts

  https://acrabstracts.org/abstract/less-than-half-of-cryoglobulin-tests-ordered-at-a-tertiary-hospital-network-are-successfully-completed-an-opportunity-for-improvement/

  Less Than Half of Cryoglobulin Tests Ordered at a Tertiary Hospital Network Are Successfully Completed: An Opportunity for Improvement […] Cryoglobulin detection is essential for the diagnosis of cryoglobulinemic vasculitis, a condition leading to high healthcare use, organ damage, and even death. Successful cryoglobulin testing requires specific sample collection, transport, and preparation procedures, leading tests to be cancelled if appropriate conditions are not met. […] At our institution, cryoglobulin tests are cancelled more than half the time they are ordered, potentially leading to delayed diagnoses and repeat patient visits or blood draws. Optimizing systems of sample collection and transportation in the context of busy inpatient and emergency environments might increase successful cryoglobulin testing, saving precious resources and reducing potentially dangerous diagnostic delays.

• #15 Shining a Warm Light on Cryoglobulinemia

  https://www.cancernetwork.com/view/shining-warm-light-cryoglobulinemia

  We recommend screening for cryoglobulinemia in all patients with HCV infection, livedo reticularis, vasculitic cutaneous ulcers, positive rheumatoid factor or rheumatoid vasculitis, membranoproliferative glomerulonephritis, or atypical Waldenstrm macroglobulinemia. […] When testing for cryoglobulinemia, neither serum protein electrophoresis (SPEP) nor serum immunofixation (IF) are adequate screening tests. […] If treatment is indicated for symptomatic disease, then we agree with Dr. Ramos-Casals and colleagues that treatment should be directed at the underlying cause. […] For refractory disease we continue to use chemotherapy, usually cyclophosphamide and high-dose corticosteroids or fludarabine-based therapy. […] If a patient has life-threatening vasculitis or renal failure, we continue to employ plasmapheresis to acutely lower the cryocrit while initiating high-dose corticosteroids, cyclophosphamide, and anti-CD20 therapy. […] Importantly, anti-CD20 therapy with rituximab has been reported in HCV-positive cryoglobulinemia without clinically significant exacerbations of the HCV infection.

• #16 Shining a Warm Light on Cryoglobulinemia

  https://www.cancernetwork.com/view/shining-warm-light-cryoglobulinemia

  We recommend screening for cryoglobulinemia in all patients with HCV infection, livedo reticularis, vasculitic cutaneous ulcers, positive rheumatoid factor or rheumatoid vasculitis, membranoproliferative glomerulonephritis, or atypical Waldenstrm macroglobulinemia. […] When testing for cryoglobulinemia, neither serum protein electrophoresis (SPEP) nor serum immunofixation (IF) are adequate screening tests. […] If treatment is indicated for symptomatic disease, then we agree with Dr. Ramos-Casals and colleagues that treatment should be directed at the underlying cause. […] For refractory disease we continue to use chemotherapy, usually cyclophosphamide and high-dose corticosteroids or fludarabine-based therapy. […] If a patient has life-threatening vasculitis or renal failure, we continue to employ plasmapheresis to acutely lower the cryocrit while initiating high-dose corticosteroids, cyclophosphamide, and anti-CD20 therapy. […] Importantly, anti-CD20 therapy with rituximab has been reported in HCV-positive cryoglobulinemia without clinically significant exacerbations of the HCV infection.

• #17 Study Looks at Cryoglobulin Detection & Immunological Characteristics – Page 2 of 3 – The Rheumatologist

  https://www.the-rheumatologist.org/article/study-looks-at-cryoglobulin-detection-immunological-characteristics/2/

  Nurses and technicians must receive training in the proper way to transport and handle blood samples intended for cryoglobulin testing. Proper sampling, transport and care are critical to lower the chances of a false negative test result. Here are a few tips to follow: […] Use preheated tubes during blood collection; […] The sample tube should be carried to the lab in a container that maintains a temperature of 37C. This is particularly important for the detection of type I cryoglobulins; […] A preheated centrifuge creates the best conditions for the detection of cryoglobulins at low concentrations; and […] Allow the serum to cryoprecipitate at 4C for at least three, and preferably seven, days.

• #18 Cryoglobulinemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cryoglobulinemia/diagnosis-treatment/drc-20449756

  Our caring team of Mayo Clinic experts can help you with your cryoglobulinemia-related health concerns. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return. […] If you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Do not do anything that seems to make your symptoms worse.

• #19 Cryoglobulinemia | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/cryoglobulinemia?content_id=CON-20371235

  When you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. Watchful waiting might be a choice if you have no symptoms. Treatment may include medicines that calm the immune system or fight viral infections. For severe symptoms, a treatment that swaps blood plasma for donor plasma or another fluid might be used. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return.

• #20 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Treatment of cryoglobulinemia varies according to the disease type and should be tailored according to clinical severity, underlying conditions, and prior therapies. The goal of therapy is to treat underlying conditions, as well as to limit the precipitant cryoglobulin and the resultant inflammatory effects. […] Asymptomatic cryoglobulinemia does not require treatment. Some authors recommend intervening as little as possible except when faced with severe deterioration of renal or neurologic function. […] Immunosuppressive medications (eg, corticosteroid therapy and/or cyclophosphamide or azathioprine) are indicated upon evidence of organ involvement such as vasculitis, renal disease, progressive neurologic findings, or disabling skin manifestations. […] Plasmapheresis is indicated for severe or life-threatening complications related to in vivo cryoprecipitation or serum hyperviscosity. Concomitant use of high-dose corticosteroids and cytotoxic agents is recommended for reduction of immunoglobulin production. Some authors recommend using concomitant cytotoxic medications or corticosteroids to reduce a rebound phenomenon that may develop after plasmapheresis.

• #21 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Treatment of cryoglobulinemia varies according to the disease type and should be tailored according to clinical severity, underlying conditions, and prior therapies. The goal of therapy is to treat underlying conditions, as well as to limit the precipitant cryoglobulin and the resultant inflammatory effects. […] Asymptomatic cryoglobulinemia does not require treatment. Some authors recommend intervening as little as possible except when faced with severe deterioration of renal or neurologic function. […] Immunosuppressive medications (eg, corticosteroid therapy and/or cyclophosphamide or azathioprine) are indicated upon evidence of organ involvement such as vasculitis, renal disease, progressive neurologic findings, or disabling skin manifestations. […] Plasmapheresis is indicated for severe or life-threatening complications related to in vivo cryoprecipitation or serum hyperviscosity. Concomitant use of high-dose corticosteroids and cytotoxic agents is recommended for reduction of immunoglobulin production. Some authors recommend using concomitant cytotoxic medications or corticosteroids to reduce a rebound phenomenon that may develop after plasmapheresis.

• #22 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Admit the patient to an inpatient medical service upon evidence of active vasculitis involving renal, cardiopulmonary, or neurologic systems that requires use of aggressive immunosuppressive therapy. Consider corticosteroid therapy for at least initial therapy in patients with more severe symptoms such as vasculitis, neurologic findings, severe cutaneous disease, or renal involvement or in those who otherwise meet criteria for inpatient medical care. These patients may require additional immunosuppressive therapy and are best treated by a specialist. Patients who develop end-organ compromise secondary to active vasculitis may need to be monitored in an intensive care unit setting. […] Outpatient management is reasonable in patients suspected of having mild vasculitis that is expected to respond to outpatient oral immunosuppressive therapy or in patients treated for vague symptoms of arthralgias, fatigue, or malaise without evidence of active vasculitis. Consider the use of NSAIDs in patients with mild symptoms without evidence of vasculitis.

• #23 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Treatment of cryoglobulinemia varies according to the disease type and should be tailored according to clinical severity, underlying conditions, and prior therapies. The goal of therapy is to treat underlying conditions, as well as to limit the precipitant cryoglobulin and the resultant inflammatory effects. […] Asymptomatic cryoglobulinemia does not require treatment. Some authors recommend intervening as little as possible except when faced with severe deterioration of renal or neurologic function. […] Immunosuppressive medications (eg, corticosteroid therapy and/or cyclophosphamide or azathioprine) are indicated upon evidence of organ involvement such as vasculitis, renal disease, progressive neurologic findings, or disabling skin manifestations. […] Plasmapheresis is indicated for severe or life-threatening complications related to in vivo cryoprecipitation or serum hyperviscosity. Concomitant use of high-dose corticosteroids and cytotoxic agents is recommended for reduction of immunoglobulin production. Some authors recommend using concomitant cytotoxic medications or corticosteroids to reduce a rebound phenomenon that may develop after plasmapheresis.

• #24 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Admit the patient to an inpatient medical service upon evidence of active vasculitis involving renal, cardiopulmonary, or neurologic systems that requires use of aggressive immunosuppressive therapy. Consider corticosteroid therapy for at least initial therapy in patients with more severe symptoms such as vasculitis, neurologic findings, severe cutaneous disease, or renal involvement or in those who otherwise meet criteria for inpatient medical care. These patients may require additional immunosuppressive therapy and are best treated by a specialist. Patients who develop end-organ compromise secondary to active vasculitis may need to be monitored in an intensive care unit setting. […] Outpatient management is reasonable in patients suspected of having mild vasculitis that is expected to respond to outpatient oral immunosuppressive therapy or in patients treated for vague symptoms of arthralgias, fatigue, or malaise without evidence of active vasculitis. Consider the use of NSAIDs in patients with mild symptoms without evidence of vasculitis.

• #25 Cryoglobulinemic vasculitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/cryoglobulinemic-vasculitis/

  Management is guided by disease severity. […] Patients receiving plasmapheresis to remove circulating cryoglobulins still always require treatment with immunosuppressants to prevent formation of new cryoglobulins. […] Prevent complications of glucocorticoid therapy. […] Monitor for adverse effects of immunosuppressants. […] Consider pneumocystis pneumonia prophylaxis.

• #26 Cryoglobulinemic vasculitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/cryoglobulinemic-vasculitis/

  Cryoglobulinemic vasculitis is a type of small-vessel vasculitis characterized by the deposition of cryoglobulins. […] Management includes specific treatment of the underlying etiology (e.g., direct-acting antivirals for HCV infection), in addition to management of cryoglobulinemic vasculitis, which usually involves immunosuppressive agents (e.g., glucocorticoids plus rituximab) and is guided by disease severity. […] Patients with rapidly progressive glomerulonephritis, CNS involvement, GI ischemia, or alveolar hemorrhage should receive prompt treatment with a combination of glucocorticoid pulses, rituximab, and plasmapheresis. […] Consult rheumatology for all patients. […] Start specific therapy for the underlying etiology (e.g., direct-acting antivirals for hepatitis C infection).

• #27 Cryoglobulinemic vasculitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/cryoglobulinemic-vasculitis/

  Cryoglobulinemic vasculitis is a type of small-vessel vasculitis characterized by the deposition of cryoglobulins. […] Management includes specific treatment of the underlying etiology (e.g., direct-acting antivirals for HCV infection), in addition to management of cryoglobulinemic vasculitis, which usually involves immunosuppressive agents (e.g., glucocorticoids plus rituximab) and is guided by disease severity. […] Patients with rapidly progressive glomerulonephritis, CNS involvement, GI ischemia, or alveolar hemorrhage should receive prompt treatment with a combination of glucocorticoid pulses, rituximab, and plasmapheresis. […] Consult rheumatology for all patients. […] Start specific therapy for the underlying etiology (e.g., direct-acting antivirals for hepatitis C infection).

• #28 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Treatment of cryoglobulinemia varies according to the disease type and should be tailored according to clinical severity, underlying conditions, and prior therapies. The goal of therapy is to treat underlying conditions, as well as to limit the precipitant cryoglobulin and the resultant inflammatory effects. […] Asymptomatic cryoglobulinemia does not require treatment. Some authors recommend intervening as little as possible except when faced with severe deterioration of renal or neurologic function. […] Immunosuppressive medications (eg, corticosteroid therapy and/or cyclophosphamide or azathioprine) are indicated upon evidence of organ involvement such as vasculitis, renal disease, progressive neurologic findings, or disabling skin manifestations. […] Plasmapheresis is indicated for severe or life-threatening complications related to in vivo cryoprecipitation or serum hyperviscosity. Concomitant use of high-dose corticosteroids and cytotoxic agents is recommended for reduction of immunoglobulin production. Some authors recommend using concomitant cytotoxic medications or corticosteroids to reduce a rebound phenomenon that may develop after plasmapheresis.

• #29 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Treatment of cryoglobulinemia varies according to the disease type and should be tailored according to clinical severity, underlying conditions, and prior therapies. The goal of therapy is to treat underlying conditions, as well as to limit the precipitant cryoglobulin and the resultant inflammatory effects. […] Asymptomatic cryoglobulinemia does not require treatment. Some authors recommend intervening as little as possible except when faced with severe deterioration of renal or neurologic function. […] Immunosuppressive medications (eg, corticosteroid therapy and/or cyclophosphamide or azathioprine) are indicated upon evidence of organ involvement such as vasculitis, renal disease, progressive neurologic findings, or disabling skin manifestations. […] Plasmapheresis is indicated for severe or life-threatening complications related to in vivo cryoprecipitation or serum hyperviscosity. Concomitant use of high-dose corticosteroids and cytotoxic agents is recommended for reduction of immunoglobulin production. Some authors recommend using concomitant cytotoxic medications or corticosteroids to reduce a rebound phenomenon that may develop after plasmapheresis.

• #30 Cryoglobulinemia Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/329255-treatment

  Treatment of cryoglobulinemia varies according to the disease type and should be tailored according to clinical severity, underlying conditions, and prior therapies. The goal of therapy is to treat underlying conditions, as well as to limit the precipitant cryoglobulin and the resultant inflammatory effects. […] Asymptomatic cryoglobulinemia does not require treatment. Some authors recommend intervening as little as possible except when faced with severe deterioration of renal or neurologic function. […] Immunosuppressive medications (eg, corticosteroid therapy and/or cyclophosphamide or azathioprine) are indicated upon evidence of organ involvement such as vasculitis, renal disease, progressive neurologic findings, or disabling skin manifestations. […] Plasmapheresis is indicated for severe or life-threatening complications related to in vivo cryoprecipitation or serum hyperviscosity. Concomitant use of high-dose corticosteroids and cytotoxic agents is recommended for reduction of immunoglobulin production. Some authors recommend using concomitant cytotoxic medications or corticosteroids to reduce a rebound phenomenon that may develop after plasmapheresis.

• #31 Cryoglobulinemic vasculitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/cryoglobulinemic-vasculitis/

  Management is guided by disease severity. […] Patients receiving plasmapheresis to remove circulating cryoglobulins still always require treatment with immunosuppressants to prevent formation of new cryoglobulins. […] Prevent complications of glucocorticoid therapy. […] Monitor for adverse effects of immunosuppressants. […] Consider pneumocystis pneumonia prophylaxis.

• #32 Vasculitic emergencies in the intensive care unit: a special focus on cryoglobulinemic vasculitis | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-2-31

  In case of HCV-related CV, the eradication of HCV infection is crucial. […] Patients should be monitored closely for immune-mediated side effects of interferon therapy or ribavirin. […] The natural course of systemic vasculitis may be punctuated by acute and life-threatening manifestations that require management in an intensive care unit (ICU). […] A high level of suspicion is essential, and all CV patients should be monitored closely to ensure a timely and accurate diagnosis and to initiate appropriate treatment.

• #33 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php?jid=jcnrc

  Treatment of cryoglobulinemic vasculitis involves antiviral agents if there is active HCV infection, with successful clinical responses seen in up to 78% of patients. […] Literature reports a 10-year survival rate of 74% after HCV treatment. However, the presence of glomerulonephritis portends a worse prognosis, with 15% of patients advancing to end stage renal disease and 40% of patients experiencing subsequent cardiac disease, liver failure, or infection. […] Due to the morbidity and mortality associated with cryoglobulinemic vasculitis, clinicians must be aware of this disease phenomenon, diagnostic modalities and associated treatments.

• #34 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php

  Cryoglobulinemic vasculitis is a complex and destructive disease process that affects multiple organ systems. […] Treatment of cryoglobulinemic vasculitis involves treatment of underlaying HCV, as well as high doses of immunosuppressive agents such as steroids and rituximab, often for multiple months, but with resolution of symptoms. […] Treatment of cryoglobulinemic vasculitis involves use of antiviral agents and high doses of immune suppressants, often for multiple months. […] Treatment of cryoglobulinemic vasculitis involves antiviral agents if there is active HCV infection, with successful clinical responses seen in up to 78% of patients. […] Other studies compared the use of pegylated interferon therapy with or without the anti-CD20 agent rituximab (375 mg/m2/week for four weeks) in patients with active HCV and cryoglobulinemia.

• #35 Vasculitic emergencies in the intensive care unit: a special focus on cryoglobulinemic vasculitis | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-2-31

  In case of HCV-related CV, the eradication of HCV infection is crucial. […] Patients should be monitored closely for immune-mediated side effects of interferon therapy or ribavirin. […] The natural course of systemic vasculitis may be punctuated by acute and life-threatening manifestations that require management in an intensive care unit (ICU). […] A high level of suspicion is essential, and all CV patients should be monitored closely to ensure a timely and accurate diagnosis and to initiate appropriate treatment.

• #36 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php

  Cryoglobulinemic vasculitis is a complex and destructive disease process that affects multiple organ systems. […] Treatment of cryoglobulinemic vasculitis involves treatment of underlaying HCV, as well as high doses of immunosuppressive agents such as steroids and rituximab, often for multiple months, but with resolution of symptoms. […] Treatment of cryoglobulinemic vasculitis involves use of antiviral agents and high doses of immune suppressants, often for multiple months. […] Treatment of cryoglobulinemic vasculitis involves antiviral agents if there is active HCV infection, with successful clinical responses seen in up to 78% of patients. […] Other studies compared the use of pegylated interferon therapy with or without the anti-CD20 agent rituximab (375 mg/m2/week for four weeks) in patients with active HCV and cryoglobulinemia.

• #37 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php

  Data from the French Autoimmunity and Rituximab Registry showed a significant clinical response with complete remission in patients with non-HCV mixed cryoglobulinemic vasculitis after six months of treatment with rituximab 375 mg/m2/week for four doses and low-dose prednisone tapering to 5 mg/day. […] Many patients with SVR return to their previous baseline after treatment with rituximab, but more data need to be collected to further quantify this. […] Due to the morbidity and mortality associated with cryoglobulinemic vasculitis, clinicians must be aware of this disease phenomenon, diagnostic modalities and associated treatments.

• #38 Shining a Warm Light on Cryoglobulinemia

  https://www.cancernetwork.com/view/shining-warm-light-cryoglobulinemia

  We recommend screening for cryoglobulinemia in all patients with HCV infection, livedo reticularis, vasculitic cutaneous ulcers, positive rheumatoid factor or rheumatoid vasculitis, membranoproliferative glomerulonephritis, or atypical Waldenstrm macroglobulinemia. […] When testing for cryoglobulinemia, neither serum protein electrophoresis (SPEP) nor serum immunofixation (IF) are adequate screening tests. […] If treatment is indicated for symptomatic disease, then we agree with Dr. Ramos-Casals and colleagues that treatment should be directed at the underlying cause. […] For refractory disease we continue to use chemotherapy, usually cyclophosphamide and high-dose corticosteroids or fludarabine-based therapy. […] If a patient has life-threatening vasculitis or renal failure, we continue to employ plasmapheresis to acutely lower the cryocrit while initiating high-dose corticosteroids, cyclophosphamide, and anti-CD20 therapy. […] Importantly, anti-CD20 therapy with rituximab has been reported in HCV-positive cryoglobulinemia without clinically significant exacerbations of the HCV infection.

• #39 Shining a Warm Light on Cryoglobulinemia

  https://www.cancernetwork.com/view/shining-warm-light-cryoglobulinemia

  We recommend screening for cryoglobulinemia in all patients with HCV infection, livedo reticularis, vasculitic cutaneous ulcers, positive rheumatoid factor or rheumatoid vasculitis, membranoproliferative glomerulonephritis, or atypical Waldenstrm macroglobulinemia. […] When testing for cryoglobulinemia, neither serum protein electrophoresis (SPEP) nor serum immunofixation (IF) are adequate screening tests. […] If treatment is indicated for symptomatic disease, then we agree with Dr. Ramos-Casals and colleagues that treatment should be directed at the underlying cause. […] For refractory disease we continue to use chemotherapy, usually cyclophosphamide and high-dose corticosteroids or fludarabine-based therapy. […] If a patient has life-threatening vasculitis or renal failure, we continue to employ plasmapheresis to acutely lower the cryocrit while initiating high-dose corticosteroids, cyclophosphamide, and anti-CD20 therapy. […] Importantly, anti-CD20 therapy with rituximab has been reported in HCV-positive cryoglobulinemia without clinically significant exacerbations of the HCV infection.

• #40 American Society of Nephrology | Kidney Week – Abstract Details (2017)

  https://www.asn-online.org/education/kidneyweek/2017/program-abstract.aspx?controlId=2784928

  IgA cryoglobulinemia is a rare entity with scarce literature regarding its pathogenesis and management. […] The presence of frequent glomerular neutrophils and C3 staining of higher intensity than IgA should raise concern for infection-related glomerulonephritis. […] Management should focus on supportive care while treating the primary infectious process.

• #41 Cryoglobulinemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cryoglobulinemia/diagnosis-treatment/drc-20449756

  Our caring team of Mayo Clinic experts can help you with your cryoglobulinemia-related health concerns. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return. […] If you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Do not do anything that seems to make your symptoms worse.

• #42 Cryoglobulinemia | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/cryoglobulinemia?content_id=CON-20371235

  When you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. Watchful waiting might be a choice if you have no symptoms. Treatment may include medicines that calm the immune system or fight viral infections. For severe symptoms, a treatment that swaps blood plasma for donor plasma or another fluid might be used. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return.

• #43 Cryoglobulinemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cryoglobulinemia/diagnosis-treatment/drc-20449756

  Our caring team of Mayo Clinic experts can help you with your cryoglobulinemia-related health concerns. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return. […] If you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Do not do anything that seems to make your symptoms worse.

• #44 Cryoglobulinemia | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/cryoglobulinemia?content_id=CON-20371235

  When you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. Watchful waiting might be a choice if you have no symptoms. Treatment may include medicines that calm the immune system or fight viral infections. For severe symptoms, a treatment that swaps blood plasma for donor plasma or another fluid might be used. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return.

• #45 Cryoglobulinemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cryoglobulinemia/diagnosis-treatment/drc-20449756

  Our caring team of Mayo Clinic experts can help you with your cryoglobulinemia-related health concerns. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return. […] If you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Do not do anything that seems to make your symptoms worse.

• #46 How do I Deal with Cryoglobulinemia?

  https://www.iomcworld.com/open-access/how-do-i-deal-with-cryoglobulinemia-111971.html

  Cryoglobulinemia is a condition in which cryoglobulins are present in the bloodstream. […] Treatment is limited to symptomatic conditions and focuses on the underlying problem. […] It is imperative to educate patients on avoiding exposure to the cold by wearing gloves when using the freezer or refrigerator, wearing warm clothes in air-conditioned facilities, and relocating to a warmer climate during the winter months. Foot and leg care is important to prevent wound complications. […] Cryoglobulinemia is a very uncommon clinical condition. Because the presence of cryoglobulins in the serum aids diagnosis, it’s crucial to be aware of its clinical range. End-organ damage and repeated relapses make treatment difficult. […] Without any developing illness-specific therapies, all therapeutic approaches are now geared to either cure the underlying disease or provide immunosuppression. […] Because cryoglobulinemia is a varied illness in terms of signs and origin, it’s difficult to come up with a set of universal care guidelines, even though there are some parallels in therapy techniques, as previously mentioned.

• #47 You have What? 10 years of Living with Cryoglobulinemia. – Alliance for Cryoglobulinemia

  https://allianceforcryo.org/you-have-what-10-years-of-living-with-cryoglobulinemia/

  Interested in Cryoglobulinemia? […] Cryoglobulinemia, the basics. […] As for advice about living with Cryo on a daily basis, the best I’ve had in 10 years was to perhaps move somewhere warm! […] Prevention and planning are my best Cryo survival tactics. […] And listening to what my body is telling me. […] Don’t let it catch you out. […] I’ve also learned that prevention is a great tactic but sometimes things go awry and that is when it’s time to listen to your body, bale out and get warmed up asap! […] The biggest lesson tho has been that suffering may be unavoidable but that misery is optional!

• #48 You have What? 10 years of Living with Cryoglobulinemia. – Alliance for Cryoglobulinemia

  https://allianceforcryo.org/you-have-what-10-years-of-living-with-cryoglobulinemia/

  Interested in Cryoglobulinemia? […] Cryoglobulinemia, the basics. […] As for advice about living with Cryo on a daily basis, the best I’ve had in 10 years was to perhaps move somewhere warm! […] Prevention and planning are my best Cryo survival tactics. […] And listening to what my body is telling me. […] Don’t let it catch you out. […] I’ve also learned that prevention is a great tactic but sometimes things go awry and that is when it’s time to listen to your body, bale out and get warmed up asap! […] The biggest lesson tho has been that suffering may be unavoidable but that misery is optional!

• #49 Cryoglobulinemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cryoglobulinemia/diagnosis-treatment/drc-20449756

  Our caring team of Mayo Clinic experts can help you with your cryoglobulinemia-related health concerns. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return. […] If you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Do not do anything that seems to make your symptoms worse.

• #50 Cryoglobulinemia | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/cryoglobulinemia?content_id=CON-20371235

  When you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. Watchful waiting might be a choice if you have no symptoms. Treatment may include medicines that calm the immune system or fight viral infections. For severe symptoms, a treatment that swaps blood plasma for donor plasma or another fluid might be used. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return.

• #51 How do I Deal with Cryoglobulinemia?

  https://www.iomcworld.com/open-access/how-do-i-deal-with-cryoglobulinemia-111971.html

  Cryoglobulinemia is a condition in which cryoglobulins are present in the bloodstream. […] Treatment is limited to symptomatic conditions and focuses on the underlying problem. […] It is imperative to educate patients on avoiding exposure to the cold by wearing gloves when using the freezer or refrigerator, wearing warm clothes in air-conditioned facilities, and relocating to a warmer climate during the winter months. Foot and leg care is important to prevent wound complications. […] Cryoglobulinemia is a very uncommon clinical condition. Because the presence of cryoglobulins in the serum aids diagnosis, it’s crucial to be aware of its clinical range. End-organ damage and repeated relapses make treatment difficult. […] Without any developing illness-specific therapies, all therapeutic approaches are now geared to either cure the underlying disease or provide immunosuppression. […] Because cryoglobulinemia is a varied illness in terms of signs and origin, it’s difficult to come up with a set of universal care guidelines, even though there are some parallels in therapy techniques, as previously mentioned.

• #52 Cryoglobulinaemia

  https://dermnetnz.org/topics/cryoglobulinaemia

  Cryoglobulinaemia is a rare disorder characterised by the presence of abnormal immunoglobulin proteins in the blood that can precipitate out into tissues at low temperatures and causing inflammation and damage. […] The main aim of therapy is to find and treat the underlying cause and limit precipitation of cryoglobulins and the inflammation that results. Patients with cryoglobulinaemia should be advised to avoid cold environments to prevent triggering the precipitation of cryoglobulins. […] Identification and treatment of early symptoms such as skin lesions, fatigue or arthralgia, as a result of cryoglobulinaemia, will prevent further organ damage and improve patient outcomes.

• #53 Cryoglobulinemic vasculitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/cryoglobulinemic-vasculitis/

  Management is guided by disease severity. […] Patients receiving plasmapheresis to remove circulating cryoglobulins still always require treatment with immunosuppressants to prevent formation of new cryoglobulins. […] Prevent complications of glucocorticoid therapy. […] Monitor for adverse effects of immunosuppressants. […] Consider pneumocystis pneumonia prophylaxis.

• #54 Cryoglobulinemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cryoglobulinemia/diagnosis-treatment/drc-20449756

  Our caring team of Mayo Clinic experts can help you with your cryoglobulinemia-related health concerns. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return. […] If you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Do not do anything that seems to make your symptoms worse.

• #55 Cryoglobulinemia | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/cryoglobulinemia?content_id=CON-20371235

  When you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. Watchful waiting might be a choice if you have no symptoms. Treatment may include medicines that calm the immune system or fight viral infections. For severe symptoms, a treatment that swaps blood plasma for donor plasma or another fluid might be used. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return.

• #56 Cryoglobulinemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cryoglobulinemia/diagnosis-treatment/drc-20449756

  Our caring team of Mayo Clinic experts can help you with your cryoglobulinemia-related health concerns. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return. […] If you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Do not do anything that seems to make your symptoms worse.

• #57 Cryoglobulinemia | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/cryoglobulinemia?content_id=CON-20371235

  When you have cryoglobulinemia, it’s important to stay out of cold temperatures. Protect your fingers and toes. You may want to wear gloves when using the freezer or refrigerator. Check your feet daily for sores. Cryoglobulinemia can make it harder for foot damage to heal. […] Treatment depends on the cause of cryoglobulinemia and how bad it is. Watchful waiting might be a choice if you have no symptoms. Treatment may include medicines that calm the immune system or fight viral infections. For severe symptoms, a treatment that swaps blood plasma for donor plasma or another fluid might be used. […] Even with treatment, cryoglobulinemia often returns. You might need regular follow-up visits with your health care professional to watch for its return.

• #58 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php?jid=jcnrc

  Treatment of cryoglobulinemic vasculitis involves antiviral agents if there is active HCV infection, with successful clinical responses seen in up to 78% of patients. […] Literature reports a 10-year survival rate of 74% after HCV treatment. However, the presence of glomerulonephritis portends a worse prognosis, with 15% of patients advancing to end stage renal disease and 40% of patients experiencing subsequent cardiac disease, liver failure, or infection. […] Due to the morbidity and mortality associated with cryoglobulinemic vasculitis, clinicians must be aware of this disease phenomenon, diagnostic modalities and associated treatments.

• #59 Essential Mixed Cryoglobulinemia: Symptoms, Treatment

  https://www.medicinenet.com/essential_mixed_cryoglobulinemia/article.htm

  Cryoglobulinemia is a medical condition that is caused by proteins called cryoglobulins, which are present in the blood. […] Essential mixed cryoglobulinemia is characterized by joint pains and swelling (arthritis), enlargement of the spleen, skin vasculitis with purplish patches, and nerve and kidney disease. This can lead to recurrent pain in the abdomen, heart attack, and bleeding in the lungs. Weight loss can occur as well as poor appetite. […] Essential mixed cryoglobulinemia is treated with combinations of medications which reduce inflammation and suppress the immune system. Medications used include nonsteroid antiinflammatory drugs (ibuprofen, aspirin, and others), steroids (prednisone, prednisolone), cyclophosphamide (Cytoxan), chlorambucil (Leukeran), and azathioprine (Imuran). Plasmapheresis (hemapheresis), a procedure whereby the blood’s serum is filtered to remove the cryoglobulins, is also performed for severe symptoms. […] The prognosis and natural history of the illness is not predictable. Kidney damage can be serious and some reports state that permanent failure of the kidney occurs in approximately 10% of patients. Death can occur, usually from serious heart disease, infection, or brain hemorrhage.

• #60 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php

  Data from the French Autoimmunity and Rituximab Registry showed a significant clinical response with complete remission in patients with non-HCV mixed cryoglobulinemic vasculitis after six months of treatment with rituximab 375 mg/m2/week for four doses and low-dose prednisone tapering to 5 mg/day. […] Many patients with SVR return to their previous baseline after treatment with rituximab, but more data need to be collected to further quantify this. […] Due to the morbidity and mortality associated with cryoglobulinemic vasculitis, clinicians must be aware of this disease phenomenon, diagnostic modalities and associated treatments.

• #61 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php?jid=jcnrc

  Treatment of cryoglobulinemic vasculitis involves antiviral agents if there is active HCV infection, with successful clinical responses seen in up to 78% of patients. […] Literature reports a 10-year survival rate of 74% after HCV treatment. However, the presence of glomerulonephritis portends a worse prognosis, with 15% of patients advancing to end stage renal disease and 40% of patients experiencing subsequent cardiac disease, liver failure, or infection. […] Due to the morbidity and mortality associated with cryoglobulinemic vasculitis, clinicians must be aware of this disease phenomenon, diagnostic modalities and associated treatments.

• #62 A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

  https://clinmedjournals.org/articles/jcnrc/journal-of-clinical-nephrology-and-renal-care-jcnrc-6-050.php

  Data from the French Autoimmunity and Rituximab Registry showed a significant clinical response with complete remission in patients with non-HCV mixed cryoglobulinemic vasculitis after six months of treatment with rituximab 375 mg/m2/week for four doses and low-dose prednisone tapering to 5 mg/day. […] Many patients with SVR return to their previous baseline after treatment with rituximab, but more data need to be collected to further quantify this. […] Due to the morbidity and mortality associated with cryoglobulinemic vasculitis, clinicians must be aware of this disease phenomenon, diagnostic modalities and associated treatments.

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