Figure 9

Therapeutic strategy according to activity/severity of mixed cryoglobulinemia (MC) syndrome (2). Therapeutic strategy of mixed cryoglobulinemia (MC) syndrome (or cryoglobulinemic vasculitis) should be decided on the basis of the activity/severity of clinical symptoms and tailored for the single patient: in asymptomatic patients a careful monitoring is often sufficient; in those with moderate-severe manifestations, mainly in the presence of active chronic hepatitis, an attempt to eradicate the HCV infection should be carried out; particularly severe, rapidly progressive complications must be treated with more aggressive treatments, as in other systemic vasculitides. Sequential treatment schedules can be employed in individuals with particularly aggressive manifestations and/or partial response (clinical, pathological, or virological) to traditional treatments (see also Fig. 8 and 10). Purp.: purpura; weak.: weakness; arthr.: arthralgias; CPX: cyclophosphamide; CS: corticosteroids; LAC-diet, low-antigen-content diet; MPGN, membranoproliferative glomerulonephritis; peg-IFN: pegylated interferon-alpha; RIBA: ribavirin.