American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment is part of classic therapy for severe cryoglobulinemia?

1. Antivirals

2. Glucocorticoids

3. Biologic agents

4. Vitamin D supplements

The correct answer is: Glucocorticoids

In the management of severe cryoglobulinemia, glucocorticoids play a crucial role as part of the classical therapeutic approach. Cryoglobulinemia often results from an underlying condition, such as infections (like hepatitis C), autoimmune diseases, or lymphoproliferative disorders, leading to inflammation and proliferation of cold-precipitating proteins in the blood. Glucocorticoids help by reducing inflammation and mitigating the immune response, which can alleviate symptoms associated with the condition, such as skin lesions, neuropathy, and renal impairment. While other treatments like antivirals may be employed, particularly in cases tied to viral infections (like hepatitis C), they do not constitute the mainstay of therapy for managing the severe manifestations of cryoglobulinemia itself. Biologic agents can be considered for resistant cases or specific underlying conditions but are not standardized first-line treatment. Vitamin D supplements, while generally beneficial for many patients, are not targeted therapies for cryoglobulinemia and do not address the underlying pathological processes. Glucocorticoids are thus central to stabilizing patients with severe symptoms, reflecting their prominent role in the therapeutic landscape for this condition.