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Prevalence and risk factors of liver biochemical abnormalities in patients with systemic lupus erythematosus

Abstract

Aim of the work

The aim of this work was to study the prevalence and risk factors of liver biochemical abnormalities in patients with systemic lupus erythematosus (SLE) and to investigate the cause of these abnormalities .

Patients and methods

A total of 200 SLE patients attending the Rheumatology and Rehabilitation Department, Cairo University, were subjected to full medical history, assessment of disease activity using SLE disease activity index, calculation of BMI, laboratory investigations including complete blood count (CBC), erythrocyte sedimentation rate, C3, C4, liver and kidney functions, lipid profile, antinuclear antibodies, and anti-dsDNA. Patients with alteration of liver functions had further laboratory tests including viral hepatitis markers, hepatitis C virus (HCV) antibodies, hepatitis B virus surface antigen and hepatitis A virus antibodies, PCR for patients who had HCV-positive tests, autoimmune hepatitis (AIH) profile (antimitochondrial antibodies, antismooth muscle antibodies, and anti-liver–kidney microsomal antibodies), antiphospholipid profile (anticardiolipin, lupus anticoagulant, and B2 glycoproteins), creatine phoshokinase (CPK), and abdominal ultrasound.

Results

The prevalence of liver biochemical abnormalities was 6.5% two patients (15.4%) had HCV-positive antibodies, two patients (15.4%) had probable AIH, five patients (38.5%) had fatty liver, four patients (30.8%) had drug-induced hepatotoxicity, and two patients (15.4%) had no cause other than SLE itself. Hypertension, diabetes mellitus, and hyperlipidemia were more frequent in patients with elevated liver enzymes.

Conclusion

The prevalence of elevated liver enzymes among SLE patients attending the Rheumatology and Rehabilitation Department during the time of the study was 6.5%. The most common liver abnormality was found to be fatty liver, affecting 38.5% of the patients, followed by drug-induced hepatotoxicity (30.8%), and then HCV infection, AIH, and SLE (each 15.4%).

References

  1. Daca A, Czuszyńska Z, Smoleńska Ż, Zdrojewski Z, Witkowski JM, Bryl E. Two systemic lupus erythematosus (SLE) global disease activity indices — the SLE Disease Activity Index and the Systemic Lupus Activity Measure — demonstrate different correlations with activation of peripheral blood CD4+ T cells. Hum Immunol 2011; 72:1160–1167.

    CAS  Article  Google Scholar 

  2. Selmi C, De Santis M, Gershwin ME. Liver involvement in subjects with rheumatic disease. Arthritis Res Ther 2011; 13:226.

    Article  Google Scholar 

  3. Abraham S, Begun S, Isenberg D. Hepatic manifestations of autoimmune rheumatic diseases. Ann Rheum Dis 2004; 69:187–194.

    Google Scholar 

  4. Fix OK, Damon LE, Bass NM. Amyloidosis localized to the liver. Clin Gastroenterol Hepatol 2007; 5:e7.

    Article  Google Scholar 

  5. Chowdhary VR, Crowson CS, Poterucha JJ, Moder KG. Liver involvement in systemic lupus erythematosus: case review of 40 patients. J Rheumatol 2008; 35:2159–2164.

    CAS  Article  Google Scholar 

  6. Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of systemic lupus international collaborating classification criteria for systemic lupus erythematosus clinics. Arthritis Rheum 2012; 64:2677–2686.

    Article  Google Scholar 

  7. Gladman DD, Ibanez D, Urowitz MB. Systemic Lupus Erythematosus Disease Activity Index 2000. J Rheumatol 2002; 29:288–291.

    Google Scholar 

  8. Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology 2008; 48:169–176.

    Article  Google Scholar 

  9. Huang D, Aghdassi E, Su J, Fortin Paul R. Prevalence and risk factors of liver biochemical abnormalities in patients with systemic lupus erythematosus. J Rheumatol 2012; 39:254–261.

    Article  Google Scholar 

  10. Khalifa M, Benjazia E, Rezgui A, Ghannouchi N, Alaoua A, Braham A. Lupus hepatitis: a case series of 12 patients. Rev Med Interne 2011; 32:347–349.

    CAS  Article  Google Scholar 

  11. Efe C, Purnak T, Ozaslan E, Ozbalkan Z, Karaaslan Y, Altiparmak E, et al. Autoimmune liver disease in patients with systemic lupus erythematosus: a retrospective analysis of 147 cases. Scand J Gastroenterol 2011; 46:732–737.

    CAS  Article  Google Scholar 

  12. Her M, Lee Y, Jung E, Kim T, Kim D. Liver enzyme abnormalities in SLE: a focus on toxic hepatitis. Rheumatol Int 2011; 31:79–84.

    CAS  Article  Google Scholar 

  13. Bruce AR, Douglas RL, Sinn A. The spectrum of liver disease in systemic lupus erythematosus. Am J Med 1980; 69–167.

  14. El-Garf A, Shaheen N, Gaber W, Sobhy N. Prevalence and impact of chronic hepatitis C virus infection on the clinical manifestations and disease activity among patients suffering from systemic lupus erythematosus. Egypt Rheumatol 2013; 35:9–14.

    Article  Google Scholar 

  15. Vaidehi RC, Cynthia SC, John JP, Kevin GM. Liver Involvement in systemic lupus erythematosus: case review of 40 patients. J Rheumatol 2008; 35:2159–2164.

    Article  Google Scholar 

  16. Liu Y, Cheng Z, Ding L, Fang F, Cheng K-A, Fang Q, et al. Atorvastatin-induced acute elevation of hepatic enzymes and the absence of cross-toxicity of pravastatin. Int J Clin Pharmacol Ther 2010; 48:798–802.

    CAS  Article  Google Scholar 

  17. Altuntas Y, Ozturk B, Erdem L, et al. Phenytoin-induced toxic cholestatic hepatitis in a patient with skin lesions: case report. South Med J 2003; 96:201–203.

    Article  Google Scholar 

  18. Jeffrey LA, Allan T. Handbook of psychiatric drugs. Chichester, UK: John Wiley and Sons Ltd.; 2006. 34.

  19. Pandit A, Tarun S, Pallavi B. Drug-induced hepatotoxicity: a review. J Appl Pharm Sci 2012; 02:233–243.

    Google Scholar 

  20. Piga M, Vacca A, Porru G, Cauli A, Mathieu A. Liver involvement in systemic lupus erythematosus. Clin Exp Rheumatol 2010; 28:504–510.

    CAS  PubMed  Google Scholar 

  21. Caramaschi P, Biasi D, Botto M, Bambara LM, Manzo T. Liver involvement in systemic lupus erythematosus. Recenti Prog Med 1993; 84:673–678.

    CAS  PubMed  Google Scholar 

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Correspondence to Reem Ismail El Shazly MD, PhD.

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El Shazly, R.I., Mohammed, W.H.S., Mohamed, S.F. et al. Prevalence and risk factors of liver biochemical abnormalities in patients with systemic lupus erythematosus. Egypt Rheumatol Rehabil 41, 139–147 (2014). https://doi.org/10.4103/1110-161X.147352

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  • DOI: https://doi.org/10.4103/1110-161X.147352

Keywords

  • drugs
  • liver
  • prevalence
  • systemic lupus erythematosus