From the Guidelines
Hepatic steatosis and autoimmune diseases are distinct conditions that can be related, with patients having autoimmune diseases potentially developing fatty liver due to shared risk factors or as a complication, and management should involve treating both conditions simultaneously to improve overall liver health and prevent progression to more serious liver damage. The relationship between hepatic steatosis and autoimmune diseases is complex, with autoimmune diseases like lupus, rheumatoid arthritis, or autoimmune hepatitis potentially leading to the development of fatty liver [ 1 ].
Key Considerations
- Patients with autoimmune diseases should be monitored for the development of fatty liver, and vice versa, as the presence of one condition may increase the risk of developing the other.
- Management of both conditions simultaneously is crucial, with medications like prednisone, azathioprine, or mycophenolate mofetil prescribed for the autoimmune component, and lifestyle modifications such as weight loss, Mediterranean diet, regular exercise, and avoiding alcohol for fatty liver.
- According to the most recent guidelines, the management of metabolic dysfunction-associated steatotic liver disease (MASLD) should involve early recognition of the disease, risk stratification, and therapeutic management including non-pharmacological and pharmacological treatment [ 1 ].
Treatment Approach
- For fatty liver, lifestyle modifications are crucial, including:
- Weight loss of 7-10% if overweight
- Mediterranean diet rich in vegetables and olive oil
- Regular exercise (150 minutes weekly of moderate activity)
- Avoiding alcohol
- Vitamin E (800 IU daily) may benefit non-diabetic patients with non-alcoholic steatohepatitis.
- Regular monitoring of liver function tests every 3-6 months is recommended to prevent progression to more serious liver damage.
Important Considerations
- The current Clinical Practice Guidelines (CPGs) for the diagnosis, treatment, and follow-up of individuals with MASLD have been generated as a joint effort by the European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), and European Association for the Study of Obesity (EASO) [ 1 ].
- These CPGs provide a framework for the early identification of affected individuals, risk stratification, and therapeutic management, including non-pharmacological and pharmacological treatment.
From the Research
Relationship Between Hepatic Steatosis and Autoimmune Diseases
- Hepatic steatosis is closely related to obesity and the metabolic syndrome, and it can also be found in patients with autoimmune liver diseases (AILDs) such as autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) 2.
- The controlled attenuation parameter (CAP) can be used as a noninvasive diagnostic method to evaluate hepatic steatosis in patients with AILDs, and it has been shown to be significantly related to hepatic steatosis grade 2.
- Hepatic steatosis can impact the treatment response of autoimmune hepatitis, with patients having steatosis being more likely to have an insufficient biochemical response and long-term adverse outcomes 3.
- Lifestyle modifications, such as diet and exercise, can help manage hepatic steatosis and improve treatment response in patients with autoimmune hepatitis 4, 5.
- The presence of hepatic steatosis can also be associated with other metabolic disorders, such as type 2 diabetes and dyslipidemia, which can further complicate the treatment of autoimmune diseases 6.
Diagnostic Methods
- CAP is a useful diagnostic tool for evaluating hepatic steatosis in patients with AILDs, with an area under the receiver operating characteristic (AUROC) curve of 0.878 for the diagnosis of steatosis in AILDS 2.
- Liver stiffness measurement (LSM) can also be used in combination with CAP to identify patients with AIH concomitant with nonalcoholic fatty liver disease (NAFLD) from those with NAFLD with autoimmune phenomena 2.
Treatment Implications
- Hepatic steatosis can be effectively reduced through lifestyle modifications, such as diet and exercise, which can also improve treatment response in patients with autoimmune hepatitis 4, 5.
- The presence of hepatic steatosis should be taken into account when managing patients with autoimmune hepatitis, and routine CAP measurements can help guide treatment decisions 3.