title: Autoimmune liver disease in patients with systemic lupus erythematosus: a retrospective analysis of 147 cases.
abstract: OBJECTIVE
  We aimed to investigate the characteristics of autoimmune liver disease (AILD) developed in patients with systemic lupus erythematosus (SLE), including autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC) and the AIH/PBC overlap syndrome. We also evaluated the accuracy of diagnostic criteria and scoring systems for AILD in SLE.
  
  
  METHODS
  A retrospective analysis of patients attending the rheumatology and gastroenterology clinics in Ankara, Turkey, between 1999 and 2010. SLE patients with elevated liver enzymes were investigated for liver diseases.
  
  
  RESULTS
  A total of 147 SLE patients were identified and 36 of them had liver enzyme abnormalities. AILD was diagnosed in 4.7% of all SLE patients, in 19.4% of those with elevated liver enzymes. Of patients with liver enzyme abnormalities, 72.3% fulfilled the criteria for AIH proposed by the International Autoimmune Hepatitis Group (IAIHG), whereas 66.7% had AIH by using the simplified criteria. Yet, only 13.8% of these patients had liver biopsy findings consistent with AIH. Patients with AILD were treated with conventional therapy including ursodeoxycholic acid, prednisolone, azathioprine or combinations of these. Treatment failure and subsequent advanced liver disease developed in one patient.
  
  
  CONCLUSIONS
  AILD may occur during the course of SLE. Due to biochemical similarities between AIH and SLE, AIH could be considered very probable by using both IAIHG scoring system and simplified criteria. For definitive diagnosis of AIH, liver biopsy should be performed in all SLE patients with chronic enzyme abnormalities. The response to therapy is favorable in these patients, and early diagnosis is important for preventing advanced liver disease.
authors.affiliation: Department of Internal Medicine, Ankara Numune Research and Education Hospital, Ankara, Turkey. drcumi21@hotmail.com
authors.forename: Cumali
authors.initials: C
authors.lastname: Efe
authors.forename: Tugrul
authors.initials: T
authors.lastname: Purnak
authors.forename: Ersan
authors.initials: E
authors.lastname: Ozaslan
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Ozbalkan
authors.forename: Yasar
authors.initials: Y
authors.lastname: Karaaslan
authors.forename: Emin
authors.initials: E
authors.lastname: Altiparmak
authors.forename: Paolo
authors.initials: P
authors.lastname: Muratori
authors.forename: Staffan
authors.initials: S
authors.lastname: Wahlin
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000032:analysis; D001379:Azathioprine / Q000627:therapeutic use; D001706:Biopsy; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D015151:Immunoblotting; D007074:Immunoglobulin G / Q000032:analysis; D008105:Liver Cirrhosis, Biliary / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D015995:Prevalence; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D000974:Antibodies, Antinuclear; D007074:Immunoglobulin G; D006886:Hydroxychloroquine; D014580:Ursodeoxycholic Acid; D011239:Prednisolone; D001379:Azathioprine