Hepatic manifestations of autoimmune rheumatic diseases

Autoimmune rheumatic diseases including Systemic Lupus Erythematosus, Rheumatoid Arthritis, Sjogren's syndrome, Myositis, Antiphospholipid Syndrome, Behcet's 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.