Autoimmune liver disease in patients with systemic lupus erythematosus: A retrospective analysis of 147 cases

Efe, Cumali; Pürnak, Tuğrul; Özaslan, Ersan; Özbalkan, Zeynep; Karaaslan, Yaşar; Altıparmak, Emin; Muratori, Paolo; Wåhlin, Staffan

doi:10.3109/00365521.2011.558114

Cited by 59 publications

(58 citation statements)

References 29 publications

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“…We also examined factors associated with the response of SLE-AIH patients to treatment. SLE rarely involves the liver, but elevated liver enzymes have been reported in up to 60% of SLE patients (4)(5)(6)(23)(24)(25). Liver enzyme abnormalities in SLE patients may be caused by hepatotoxic drugs, viral hepatitis, fatty liver disease associated with steroid use, and (albeit less commonly) hepatic congestion, primary liver disease, or lupus hepatitis.…”

Section: Discussionmentioning

confidence: 99%

Immunoglobulin G Levels as a Prognostic Factor for Autoimmune Hepatitis Combined With Systemic Lupus Erythematosus

Lim

Lee

Ahn

et al. 2016

Arthritis Care & Research

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Objective. Autoimmune hepatitis (AIH) is a chronic progressive liver disease characterized by circulating autoantibodies and hyperglobulinemia. This study was conducted to identify the features of AIH accompanied by systemic lupus erythematosus (SLE-AIH) that differ from those of primary AIH (P-AIH), and to evaluate factors that affect the outcome for SLE-AIH patients. Methods. From May 1995 to April 2014, clinical data (including liver pathology) from 164 patients with P-AIH and 23 patients with SLE-AIH were collected from an electronic database at a tertiary referral center. AIH was diagnosed according to the diagnostic scoring system for AIH (revised in 1999). SLE patients fulfilled at least 4 of the 1997 revised American College of Rheumatology criteria. Progression was defined as occurrence of cirrhosis, hepatocellular carcinoma, liver transplantation, or death from hepatic failure. Results. The age at the time of AIH diagnosis was lower and initial levels of serum IgG were higher in SLE-AIH than in P-AIH patients. Progression was more common in P-AIH, and hepatocellular carcinoma, liver transplantation, or death occurred only in P-AIH patients. Among 23 patients with SLE-AIH, 8 with cirrhosis had higher levels of serum IgG than 15 patients without cirrhosis (mean 6 SD 4,077.4 6 1,641.0 mg/dl and 2,560.7 6 932.2 mg/dl, respectively; P 5 0.017). Moreover, a serum IgG level more than 2-fold the upper normal limit was associated with a high risk of cirrhosis in SLE-AIH (odds ratio 11.00 [95% confidence interval 1.420-85.201]; P 5 0.026). Conclusion. Initially high levels of serum IgG are a poor prognostic factor for SLE-AIH. Additionally, the long-term outcome for SLE-AIH might be better than for P-AIH.

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Section: Discussionmentioning

confidence: 99%

Immunoglobulin G Levels as a Prognostic Factor for Autoimmune Hepatitis Combined With Systemic Lupus Erythematosus

Lim

Lee

Ahn

et al. 2016

Arthritis Care & Research

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“…Piga et al reported 5.8% incidence of lupus hepatitis in their study of 242 patients of SLE during a mean follow-up of 72.2 months [4]. Efe et al reported 4.7% incidence of autoimmune liver disease in SLE patients [5]. Literature shows that anti-ribosomal Pproteins are strongly associated with "lupus hepatitis", while these antibodies are found in only 10% of patients with SLE without liver disease [6].…”

Section: Discussionmentioning

confidence: 99%

Lupus associated hepatitis in active lupus nephritis patient: A case report

Sunder¹,

Sathi²,

Mahapatra³

et al. 2014

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review

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“…In another study by Efe et al [35] , 36 SLE patients out of 147 (25%) had liver enzyme abnormalities, and 7 of them (4.7%) had SLE associated with another autoimmune liver disease. The rate rose to 19.4% when the subset of SLE patients having HLTs altered was considered and, from them, 72.3% fulfilled the criteria for AIH proposed by the International Autoimmune Hepatitis Group.…”

Section: Overlap Of Sle With Autoimmune Liver Diseases (Overlap Syndrmentioning

confidence: 91%

Challenge of liver disease in systemic lupus erythematosus: Clues for diagnosis and hints for pathogenesis

Bessone

Poles

Roma

2014

WJH

105

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Systemic lupus erythematosus (SLE) encompass a broad spectrum of liver diseases. We propose here to classify them as follows: (1) immunological comorbilities (overlap syndromes); (2) non-immunological comorbilities associated to SLE; and (3) a putative liver damage induced by SLE itself, referred to as "lupus hepatitis". In the first group, liver injury can be ascribed to overlapping hepatopathies triggered by autoimmune mechanisms other than SLE occurring with higher incidence in the context of lupus (e.g. , autoimmune hepatitis, primary biliary cirrhosis). The second group includes non-autoimmune liver diseases, such as esteatosis, hepatitis C, hypercoagulation state-related liver lesions, hyperplasic parenchymal and vascular lesions, porphyria cutanea tarda, and drug-induced hepatotoxicity. Finally, the data in the literature to support the existence of a hepatic disease produced by SLE itself, or the occurrence of a SLE-associated prone condition that increases susceptibility to acquire other liver diseases, is critically discussed. The pathological mechanisms underlying each of these liver disorders are also reviewed. Despite the high heterogeneity in the literature regarding the prevalence of SLE-associated liver diseases and, in most cases, lack of histopathological evidence or clinical studies large enough to support their existence, it is becoming increasingly apparent that liver is an important target of SLE. Consequently, biochemical liver tests should be routinely carried out in SLE patients to discard liver disorders, particularly in those patients chronically exposed to potentially hepatotoxic drugs. Diagnosing liver disease in SLE patients is always challenging, and the systematization of the current information carried out in this review is expected to be of help both to attain a better understanding of pathogenesis and to build an appropriate work-up for diagnosis.

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Autoimmune liver disease in patients with systemic lupus erythematosus: A retrospective analysis of 147 cases

Cited by 59 publications

References 29 publications

Immunoglobulin G Levels as a Prognostic Factor for Autoimmune Hepatitis Combined With Systemic Lupus Erythematosus

Immunoglobulin G Levels as a Prognostic Factor for Autoimmune Hepatitis Combined With Systemic Lupus Erythematosus

Lupus associated hepatitis in active lupus nephritis patient: A case report

Challenge of liver disease in systemic lupus erythematosus: Clues for diagnosis and hints for pathogenesis

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