Hepatic manifestations in systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) is a multi-organic autoimmune disease with a wide variety of clinical manifestations. However, hepatic dysfunction is not included in the diagnostic criteria for the disease and has not been recognized properly. The spectrum of hepatic involvement described in these patients ranges from abnormalities in liver function tests (LFTs) to fulminant hepatic failure. Usually, abnormalities in LFTs are only mild and transient, have a hepatocellular pattern and are not related to SLE but rather are mostly drug related. The most frequent finding on liver biopsy is steatosis (non-alcoholic fatty liver disease). Patients do not frequently progress to advanced chronic liver disease, and their outcome is favourable. Those who develop cirrhosis have traditional risk factors, such as other non-SLE-related conditions. In this work, we aim to review hepatic manifestations in patients with SLE, as well as the diagnostic and therapeutic approaches used for different liver diseases in these patients.

Usefulness of Clinical and Laboratory Criteria for Diagnosing Autoimmune Liver Disease among Patients with Systemic Lupus Erythematosus: An Observational Study

“…However, to the best of our knowledge, their performance has not systematically been evaluated in a population of well-characterized SLE cases. Basically, our findings confirm the observation by Efe et al and emphasize that liver biopsy is often needed for a definitive diagnosis of AIH among patients with SLE [31]. The PPV of reaching "probable AIH" herein was only 17%.…”

“…The prevalence rates achieved in our study population for established AIH (2.8% among all, and 4.4% among those with elevated LFTs) and PBC (1.4% among all, and 2.2% among those with elevated LFTs) are in line with, or close to, what previously has been published. The recent review by González-Regueiro et al mentions a prevalence of AIH of approximately 5-10% among SLE patients with abnormal LFTs [31]. For PBC, a lower prevalence (2.5-5%) has been observed [38].…”

“…Efe et al found that up to two thirds of SLE patients with abnormal LFTs fulfilled the simplified AIH criteria whereas only approximately 14% had histopathology compatible with AIH [7]. This illustrates that a liver biopsy is often necessary for a definitive diagnosis of AIH among patients with SLE [31].…”

Autoantibodies associated with primary biliary cholangitis are common among patients with systemic lupus erythematosus even in the absence of elevated liver enzymes

“…Although AIH may be regarded as part of the autoimmune umbrella of SLE, we were surprised of the scarce literature on AILD-associated autoantibodies, especially with emphasis on the multitude of different autoantibodies described and frequently detected in SLE [39]. SLE with concomitant AIH/lupus hepatitis has a reported prevalence of 2-4% [18]. To differentiate between AIH and lupus hepatitis remains challenging both clinically and by histopathology, and we cannot entirely exclude that any of the SLE/pSS cases diagnosed with AIH in fact had lupus hepatitis.…”

“…Lupus hepatitis is a liver dysfunction with a reported frequency of 3-6% in SLE patients [7,[16][17][18]. It is a diagnosis of exclusion, distinct from AIH, and is characterized by fluctuations in alanine transaminase (ALT) [19].…”