Primary biliary cholangitis (PBC) is often associated with other autoimmune diseases, as well as psychiatric disorders and sleep-related conditions.
PBC is a chronic autoimmune disease of the liver in which the small bile ducts become inflamed and are slowly destroyed. It mostly affects middle-aged women. The exact cause of PBC remains unknown, but it is not caused by alcohol or drug use. Its occurrence is thought to be related to genetic risk factors and environmental risk factors.
Previously known as primary biliary cirrhosis, this relatively rare disease progressively causes damage to the liver tissue. Common symptoms include fatigue and itchy skin, but many people have no symptoms when diagnosed. While these symptoms can be effectively managed and disease progression slowed, PBC eventually leads to liver fibrosis and liver failure, creating the need for a liver transplant, which is the only definitive treatment.
Learn more about PBC signs and symptoms
Comorbid autoimmune diseases
At least 50% of people affected by PBC have at least one other autoimmune disease, with 10%-20% having two or more. Symptoms, such as fatigue, can sometimes overlap, causing confusion in diagnosis and treatment.
The most common comorbid autoimmune conditions are as follows:
· Sjogren’s syndrome causes the mouth and eyes to dry out and is found in around 25% of people with PBC.
· Raynaud’s phenomenon is an often painful condition that affects the circulation of blood into the hands and other extremities of the body. It is found in up to 25% of people with PBC.
· Autoimmune thyroid disease causes chronic inflammation of the thyroid gland and is found in around 15% of people with PBC.
· Rheumatoid arthritis is an autoimmune inflammatory disorder. It is found in 1.8%-5.6% of people with PBC.
· Celiac disease is a chronic digestive and immune disorder triggered by eating gluten.
· Autoimmune hepatitis (AIH) has similar symptoms to PBC, and 2%-19% of people with PBC have features that overlap with AIH.
Management of these additional autoimmune diseases requires a personalized long-term treatment plan to prevent the progression of these conditions.
Other comorbidities
Depression and anxiety in people with PBC are associated with the significant symptom burden of PBC. Fatigue is the most common symptom and can be mild to intense. Pruritis (itching of the skin) occurs in 60%-70% of people with PBC and can heavily impact sleep, leading to fatigue, depression and even suicide ideation. Bone disease (osteoporosis) and vitamin deficiencies are also common.
Tips for managing symptoms
People with PBC are closely monitored by a healthcare team, with regular blood tests to check liver function. In addition to medication prescribed by doctors, the following tips will help manage PBC symptoms:
· A healthy diet and lifestyle.
· Reducing stress and emotional upset.
· Vitamin supplements.
· Cold baths and skin cream to help manage itching.
· Lubricating eye drops to ease dryness in the eyes.
· Wearing gloves to keep extremities warm.
