title: Liver injury correlates with biomarkers of autoimmunity and disease activity and represents an organ system involvement in patients with systemic lupus erythematosus.
abstract: Liver disease (LD), defined as ≥ 2-fold elevation of aspartate aminotransferase (AST) or alanine aminotransferase (ALT), was examined in a longitudinal study of systemic lupus erythematosus (SLE) patients. Among 435 patients, 90 (20.7%) had LD with a greater prevalence in males (15/39; 38.5%) than females (75/396; 18.9%; p = 0.01). SLE disease activity index (SLEDAI) was greater in LD patients (7.8 ± 0.7) relative to those without (5.8 ± 0.3; p = 0.0025). Anti-smooth muscle antibodies, anti-DNA antibodies, hypocomplementemia, proteinuria, leucopenia, thrombocytopenia, and anti-phospholipid syndrome were increased in LD. An absence of LD was noted in patients receiving rapamycin relative to azathioprine, cyclosporine A, or cyclophosphamide. An absence of LD was also noted in patients treated with N-acetylcysteine. LFTs were normalized and SLEDAI was diminished with increased prednisone use in 76/90 LD patients over 12.1 ± 2.6 months. Thus, LD is attributed to autoimmunity and disease activity, it responds to prednisone, and it is potentially preventable by rapamycin or N-acetylcysteine treatment.
authors.affiliation: Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA.
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA.
authors.forename: Jianghong
authors.initials: J
authors.lastname: Yu
authors.affiliation: Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Oaks
authors.affiliation: Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Marchena-Mendez
authors.affiliation: Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Francis
authors.affiliation: Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bonilla
authors.affiliation: Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Aleksiejuk
authors.affiliation: Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Patel
authors.affiliation: Division of Rheumatology, Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY, USA.
authors.forename: Katalin
authors.initials: K
authors.lastname: Banki
authors.affiliation: Division of Rheumatology, Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY, USA.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Landas
authors.affiliation: Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA. Electronic address: perla@upstate.edu.
authors.forename: Andras
authors.initials: A
authors.lastname: Perl
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000974:Antibodies, Antinuclear / Q000276:immunology*; D001219:Aspartate Aminotransferases / Q000097:blood; D001379:Azathioprine / Q000627:therapeutic use; D015415:Biomarkers; D015331:Cohort Studies; D003165:Complement System Proteins / Q000276:immunology; D016572:Cyclosporine / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008107:Liver Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D020123:Sirolimus / Q000627:therapeutic use
chemical_list: D000974:Antibodies, Antinuclear; D015415:Biomarkers; D016166:Free Radical Scavengers; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003165:Complement System Proteins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D009173:Mycophenolic Acid; D001379:Azathioprine; D011241:Prednisone; D020123:Sirolimus; D000111:Acetylcysteine
keywords: Autoimmunity; Disease activity; Liver disease; Lupus; Treatment