From the Guidelines
Systemic lupus erythematosus (SLE) is associated with an increased risk of liver disease, including autoimmune hepatitis (AIH) and chronic hepatitis.
Relationship between SLE and Liver Disease
- Approximately 2.8-3% of patients with AIH have SLE, and 2.7-4.7% of patients with SLE have AIH 1.
- A significant proportion of SLE patients with high liver enzyme levels (19.4%) are associated with AIH 1.
- SLE patients are also at risk of developing chronic hepatitis, with 1.7% of those who undergo liver biopsy due to suspected liver disease being diagnosed with chronic hepatitis or liver cirrhosis (LC) 1.
- The presence of SLE in AIH patients is associated with higher IgG levels and a poor prognosis 1.
- These findings suggest a complex relationship between SLE and liver disease, with a significant overlap between the two conditions.
From the Research
Relationship Between Systemic Lupus Erythematosus (SLE) and Liver Disease
- Systemic lupus erythematosus (SLE) is a multisystem autoimmune inflammatory disease that may involve any organs, including the liver 2.
- Liver involvement in SLE is relatively rare and usually mild, manifesting as subtle elevation of liver enzymes 2, 3.
- Jaundice and hepatomegaly can be seen in some patients, but advanced liver disease with cirrhosis is extremely rare 2, 4.
Types of Liver Disease Associated with SLE
- Liver disease in SLE patients can be classified into three groups: immunological comorbidities, non-immunological comorbidities, and lupus hepatitis 5.
- Immunological comorbidities include overlap syndromes such as autoimmune hepatitis and primary biliary cirrhosis 5.
- Non-immunological comorbidities include non-autoimmune liver diseases such as steatosis, hepatitis C, and drug-induced hepatotoxicity 5.
- Lupus hepatitis is a putative liver damage induced by SLE itself, but its existence is still debated 5.
Diagnosis and Management of Liver Disease in SLE Patients
- Diagnosing liver disease in SLE patients is challenging and requires careful clinical and histologic evaluation 6, 5.
- 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 5.
- Corticosteroids may expedite the recovery process, but may also lead to non-alcoholic fatty liver disease and liver damage 2.
- The prognosis of liver disease in SLE patients is generally favorable, and patients do not frequently progress to advanced chronic liver disease 4, 3.