Rheumatologic disease and the liver.
Rheumatologic diseases such as rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, and scleroderma are immunologically mediated disorders that typically have multisystem involvement. Although clinically significant liver involvement is rare, liver enzyme abnormalities may be observed in up to 43% of patients. The biochemical abnormalities are typically mild and transient and the histologic abnormalities are usually nonprogressive. Such biochemical and histologic findings are typically ascribed to the primary rheumatologic condition and require no specific management. In a subset of patients with rheumatologic conditions and liver test abnormalities, further evaluation identifies a coexisting, primary liver disease or medication-related liver toxicity as the cause of the biochemical abnormality. Liver test abnormalities in patients with a coexisting primary liver disease are more likely to be persistent. In such cases, further workup using serologic tests, appropriate imaging studies and liver biopsy may be needed to accurately identify the cause of liver test abnormalities. This article reviews the spectrum of liver-related abnormalities associated with several rheumatologic diseases. Hepatotoxicity related to medications commonly prescribed in such conditions is also discussed.
Department of Medicine, University of Washington, 1959 NE Pacific Street, UW Box Number 356424, Seattle, WA 98195, USA.
Christine
C
Schlenker
Timothy
T
Halterman
Kris V
KV
Kowdley
D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D012594:Scleroderma, Localized / Q000150:complications / Q000188:drug therapy / Q000473:pathology