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Suez Canal University Medical Journal SCU-MJ


The Official Journal of Faculty of Medicine, Suez Canal University

Founded in 1998

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Current Issue Article, Volume 20, Issue 2, October 2017

Liver Involvement in Systemic Lupus Erythematosus Patients

Amira A. Shahin, Ghada S. Alazkalany, Maha S. Hasaballah, Al Shaymaa A. Ewiela*

Abstract

Background: Systemic lupus erythematosus (SLE) is a potentially severe, frequently disabling autoimmune disease with multi-organ involvement. Liver involvement in SLE is not uncommon. It is frequently asymptomatic and limited to liver tests abnormalities. Aim: To detect the frequency and nature of liver involvement in SLE patients and to correlate these with other organ involvement. Patients and Methods: A retrospective study included 200 SLE patients who had admitted at Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University. Patients were classified into two groups Group I (no liver affection) and Group II (with liver affection). These groups were subdivided into subgroups; A (6 patients with AIH), B (194 patients without AIH), C (13 patients with fatty changes), D ( 187 patients without fatty changes), E ( 6 patients with HCV) & F (194 patients without HCV). Patients were subjected to full history taking, clinical examination and laboratory investigations; the erythrocyte sedimentation rate (ESR), complete blood count (CBC), serum creatinine, alanine transaminases (ALT), aspartate transaminases (AST), Autoantibodies (ANA and Anti DNA, and Anti LKM), serum complement levels (C3, C4), urine analysis, total albumin in 24 hours urine and HCV by PCR. Liver and renal biopsies were done in selected patients. Patients were also subjected to plain X-ray and abdominal sonography. Assessment of disease damage was measured by using systemic lupus erythematosus international collaborating clinic (SLICC). Results: Liver involvement was found in 23 SLE patients (11%). We classified the 23 patients into 5 major groups: Autoimmune hepatitis in 6 patients (26%), Cholangitis in 1 patient (4.3%), portal venous thrombosis in 2 patients (8.6%), Cirrhosis in 1 patient (4.3%), Liver congestion in 1 patient (4.3%), fatty changes in 13 patients (56.6%), HCV in 6 patients (26%). A significant relationship between the age of onset, the presence of ascites and SLICC in group A compared to B (p=0.034, p=0.007 and p=0.010 respectively) was found. Conclusion: Liver in SLE is the least organ affected. The younger the age group of lupus patients with AIH, the more the organ damage. Keywords: AIH, nodular regenerative hyperplasia, Antiphospholipid syndrome