Editing Primary biliary cholangitis (section)

==Signs and symptoms==
People with PBC experience [[Fatigue (physical)|fatigue]] (80%); this is a nonspecific symptom and can be debilitating, with a huge impact on quality of life. Its pathogenesis is still unknown, and is quite challenging to explore its specificity and to treat. Comorbidities that could contribute to or worsen fatigue, such as depression, hypothyroidism, anaemia, obesity, or medication side effects, should be promptly identified and treated. Dry skin and dry eyes are also common. Itching ([[Itch|pruritus]]) occurs in 20–70% of cases,<ref name=Lancet2011/> and can develop at any stage of the disease. Textbooks tend to describe itching in the feet and hands, but patients may also experience itching of the scalp, face, back, or other areas. The itching is typically mild-to-moderate in intensity. It may manifest as a tingling, crawling or burning sensation, and can develop even with normal liver function tests. It does not correlate with progression of liver disease, and may even improve or disappear as the disease advances. Given the impact on quality of life and night sleep, pruritus is also correlated with fatigue. It can rarely be severe, non-responsive to medical therapy, and requiring liver transplant. Pruritus is characteristically intermittent, worse at night, and improves during summer.
People with more severe PBC may have jaundice (yellowing of the eyes and skin).<ref name=Lancet2011>{{cite journal | vauthors = Selmi C, Bowlus CL, Gershwin ME, Coppel RL | title = Primary biliary cirrhosis | journal = Lancet | volume = 377 | issue = 9777 | pages = 1600–1609 | date = May 2011 | pmid = 21529926 | doi = 10.1016/S0140-6736(10)61965-4 | s2cid = 2741153 }}</ref> PBC impairs [[bone density]] and the risk of [[bone fracture|fracture]] increases.<ref name=Lancet2011/> [[Xanthelasma]] (skin lesions around the eyes) or other [[xanthoma]] may be present as a result of increased cholesterol levels.<ref name="pmid=19554543">{{cite journal | vauthors = Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ | title = Primary biliary cirrhosis | journal = Hepatology | volume = 50 | issue = 1 | pages = 291–308 | date = July 2009 | pmid = 19554543 | doi = 10.1002/hep.22906 | quote = The AASLD Practice Guideline | s2cid = 439839 | doi-access = free }}</ref>

PBC can eventually progress to cirrhosis of the liver. This, in turn, may lead to a number of symptoms or complications, including:
* Fluid retention in the abdomen ([[ascites]]) in more advanced disease
* [[Hypersplenism|Enlarged spleen]] in more advanced disease
* [[Oesophageal varices]] in more advanced disease
* [[Hepatic encephalopathy]], including coma in extreme cases in more advanced disease.

People with PBC may also sometimes have the findings of an associated extrahepatic autoimmune disorder such as [[thyroid disease]] or [[rheumatoid arthritis]] or [[Sjögren's syndrome]] (in up to 80% of cases).<ref name="pmid=19554543"/><ref name="pmid25057958"/>