Hepatic manifestations of autoimmune rheumatic diseases

Abstract

Autoimmune rheumatic diseases including Systemic Lupus
Erythematosus, Rheumatoid Arthritis, Sjogrens syndrome,
Myositis, Antiphospholipid Syndrome, Behcets
syndrome, Scleroderma and Vasculitides have been associated
with hepatic injury by virtue of multisystem immune
and inflammatory involvement. Liver involvement prevalence,
significance and specific hepatic pathology vary. After
careful exclusion of potentially hepatotoxic drugs or coincident
viral hepatitis the question remains whether liver
involvement emerges as a manifestation of generalized connective
tissue disease or it reflects an underlying primary
liver disease sharing an immunological mechanism. Commonly
recognised features include mild elevation of liver
laboratory values and non specific histological images.
Hepatic steatosis, nodular regenerative hyperplasia, portal
vein obliteration and portal hypertension, features of
primary biliary cirrhosis, vascular disorders, granulomatous
reactions and rarely portal fibrosis with abnormal lobular
architecture are possible histological findings. Diagnosis
can be established on serological, histological and
clinical features and after careful exclusion of other possible
causes. Association between antirheumatic drugs and
hepatic dysfunction has been established in the past. Liver
involvement may vary from a mild asymptomatic elevation
of liver transaminases or cholestasis parameters to a fulminant
hepatitis. A review of the literature to determine
the association between primary autoimmune rheumatologic
disease and associated hepatic abnormalities and the
pharmaceutical interventions that are related to liver damage
are presented.
Key words: Connective Tissue Disease, Systemic Lupus Erythematosus,
Rheumatoid Arthritis, Sjogrens syndrome,
Myositis, Giant-Cell Arteritis, Antiphospholipid Syndrome,
Behcets syndrome, Scleroderma, Vasculitis, Steatosis, Nodular
Regenerative Hyperplasia, portal hypertension, Autoimmune
Hepatitis, Primary Biliary Cirrhosis, Primary Sclerosing
Cholangitis