Summary
Definition
History and exam
Key diagnostic factors
- arthralgia
- weakness
- vasculitis
- lower-extremity vascular purpura
Other diagnostic factors
- peripheral neuropathy
- sicca symptoms
- hypertension
- Raynaud phenomenon
- lower extremity skin ulcers
- diplopia
- ataxia
- headache
- confusion
- retinal hemorrhage/retinal vein thrombosis
- acrocyanosis
Risk factors
- hepatitis C virus (HCV) infection
- other viral infections
- autoimmune disorders
- lymphoproliferative disorders
Diagnostic investigations
1st investigations to order
- fasting qualitative serum cryoglobulins
- CBC
- comprehensive chemistry panel
- erythrocyte sedimentation rate, CRP
- urinalysis
- ECG
- CXR
- rheumatoid factor
- complement CH50, C3, C4
- hepatitis C virus (HCV) antibody
- hepatitis B virus antibody
Investigations to consider
- HIV antibody
- antinuclear antibody (ANA), Sjogren syndrome antigens, extractable nuclear antigen (ENA) antibody
- skin biopsy
Treatment algorithm
mixed cryoglobulinemia
malignancy-associated cryoglobulinemia (type I)
Contributors
Authors
Gurjit S. Kaeley, MBBS, MRCP
Professor of Medicine
Chief, Division of Rheumatology and Clinical Immunology
Medical Director, Musculoskeletal Ultrasound Program
Program Director, Rheumatology Fellowship
University of Florida College of Medicine - Jacksonville
Jacksonville
FL
Disclosures
GSK declares that he has no competing interests.
Peer reviewers
Dina Titova, MD, PhD
Rheumatologist
Road Clinic
Lakewood
WA
Disclosures
DT has received a fee from an educational grant from the Center of Excellence for organizing CME South Sound Bond Club conference.
Antonio Palumbo, MD
Associate Professor
University of Turin
Chief
Myeloma Unit
Ospedale Molinette
Turin
Italy
Disclosures
AP declares that he has no competing interests.
Xavier Leleu, MD, PhD
Instructor in Hematology
Department of Hematology
Hopital Huriez CHRU
Lille
France
Disclosures
XL has received lecture fees and research funding from Janssen-Cilag, Celgene, Chugai, Amgen, Novartis, Mundipharma, and Roche. XL is an author of a number of references cited in this topic.
Rajan Madhok, MD, FCRP
Consultant Physician and Rheumatologist
Centre for Rheumatic Diseases
Glasgow Royal Infirmary
Glasgow
UK
Disclosures
RM declares that he has no competing interests.
Differentials
- Small to medium vessel vasculitis
- Cryofibrinogenemia
More DifferentialsGuidelines
- The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver
- Recommendations on treatment of hepatitis C 2018
More GuidelinesPatient leaflets
Hepatitis C: what is it?
Hepatitis C: what treatments work?
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