Hepatological Aspects of Immunosuppressive Therapy for Rheumatic Diseases

Immunosuppressive concepts are the basis of the modern therapy for inflammatory rheumatic diseases. Despite steadily improved tolerability of the drugs a scheduled supervision of patients is necessary, as side-effects are to be expected. Particular attention must be paid to the complex relationship between the liver and rheumatic diseases. For instance, in the course of systemic lupus erythematosus (SLE) severe liver damage can occur through the involvement of the hepatic vascular system. Autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis are also associated with rheumatic diseases. NSAIDs very frequently cause hepatotoxic effects. For patients suffering from a viral hepatitis, the use of classic DMARDs including biologics can be contraindicated. This particularly applies for Rituximab. Without a preceding effective antiviral therapy the danger of reactivation during immunosuppression is very high.