Liver Disturbance

liver411

Journal of Gastroenterology
ISSN: 0944-1174 (printed version)
ISSN: 1435-5922 (electronic version)
Abstract Volume 37 Issue 8 (2002) pp 617-625
DOI 10.1007/s005350200098

Clinical features of liver disturbance in rheumatoid diseases:
clinicopathological study with special reference to the cause of liver
disturbance

Hideyuki Kojima (1), Masahito Uemura (1), Shinya Sakurai (1), Tatsuichi Ann
(1), Yoshinobu Ishii (1), Hiroo Imazu (1), Masahide Yoshikawa (2), Kunio
Ichijima (3), Hiroshi Fukui (1)
(1) Third Department of Internal Medicine, Nara Medical University, 840
Shijo-cho, Kashihara 634-8522, Japan
(2) Department of Parasitology, Nara Medical University, Kashihara, Japan
(3) First Department of Pathology, Nara Medical University, Kashihara, Japan

Received: August 27, 2001 / Accepted: January 7, 2002

Background: Liver disturbance in rheumatoid diseases results not only from
liver disease associated with the rheumatoid diseases themselves but also
from various other causes. This study aimed to elucidate the clinical
features of liver disturbance in rheumatoid diseases, focusing on the cause
of this disturbance. Methods: A clinicopathological study was performed in
306 patients (106 with systemic lupus erythematosus, 71 with Sj鰃ren's
syndrome, 59 with rheumatoid arthritis, 27 with scleroderma, 30 with
polymyositis, and 13 with polyarteritis nodosa). Results: Liver disturbance
occurred in 43% of these patients and resulted from various causes. Its
degree and duration varied from one cause to another. Liver disease
associated with rheumatoid diseases was the leading cause of the liver
disturbance in these patients and was characterized by mild and transient
liver disturbance (maximum alanine aminotransferase [ALT] level during the
study period, 68 ?8 IU/ml; maximum alkaline phosphatase [ALP] level, 410 ?
31 IU/ml; duration of liver disturbance, 6 ?2 months). Most patients with
this type of liver disease showed minimal change in liver histology,
although two-thirds of those evaluated by the international scoring system
for autoimmune hepatitis (AIH) were classified as "probable" or "definite".
Eight of 14 patients with histologically proven chronic hepatitis or
cirrhosis were infected with hepatotropic virus (7 with hepatitis C virus
[HCV] and 1 with hepatitis B virus [HBV]). Five of 9 patients in whom the
hepatic lesion progressed had hepatotropic virus infection (4 with HCV and 1
with HBV), and the other 4 patients suffered from autoimmune liver diseases.
Conclusions: Liver disease associated with rheumatoid diseases was the
leading cause of liver disturbance in these patients and was characterized
by mild and transient liver disturbance, whereas progressive liver diseases
were often associated with hepatotropic virus, mainly HCV, or autoimmune
liver diseases. Liver histology is indispensable for differentiating AIH
from liver disease associated with rheumatoid diseases.