Systemic Lupus Erythematosus (lupus) is a chronic autoimmune disease affecting various organs and tissues. Hepatitis refers to inflammation of the liver. While lupus is recognized for its impact on areas like the kidneys, skin, and joints, its relationship with liver involvement, including hepatitis, needs clarification. This article aims to explain how lupus can contribute to liver problems.
How Lupus Affects the Liver
Lupus can directly lead to liver inflammation, sometimes called “lupus hepatitis.” This occurs when the dysregulated immune system in lupus mistakenly targets and attacks healthy liver cells, causing inflammation. This direct involvement can manifest as elevated liver enzymes, indicating damage.
Beyond direct lupus involvement, autoimmune hepatitis (AIH) is a distinct autoimmune liver disease frequently observed in individuals with lupus. AIH involves the immune system attacking liver cells, leading to chronic inflammation and potential damage. This co-occurrence is significant, as AIH can present with symptoms similar to lupus and often requires immunosuppressive treatment.
The immune system’s attack on liver cells in AIH can be characterized by specific antibodies, such as anti-smooth muscle antibodies (ASMA), and elevated immunoglobulin G levels. Liver involvement in lupus can range from mild, asymptomatic elevations in liver enzymes to more significant inflammation.
Other Liver Conditions in Lupus Patients
Liver problems in individuals with lupus are not always a direct consequence of the disease. Other factors can contribute to liver abnormalities. One common cause is drug-induced liver injury, as many medications used to manage lupus can affect the liver.
For example, drugs such as methotrexate, nonsteroidal anti-inflammatory drugs (NSAIDs), azathioprine, and corticosteroids can lead to liver damage. Liver enzyme elevations due to these medications are often mild and resolve once the offending drug is adjusted or discontinued.
Individuals with lupus may also develop non-alcoholic fatty liver disease (NAFLD), now often referred to as metabolic dysfunction-associated steatotic liver disease (MASLD). This condition, characterized by excess fat storage in the liver, can occur independently of lupus but is sometimes more prevalent in lupus patients, potentially influenced by factors like steroid use. Additionally, viral hepatitis, such as Hepatitis B or C, can affect lupus patients just as it does the general population. While the presence of autoantibodies in lupus can sometimes lead to false positive viral tests, true viral infections must be ruled out.
Diagnosing and Managing Liver Issues in Lupus
Diagnosing the precise cause of liver issues in lupus involves a comprehensive approach. Doctors typically begin with blood tests, including liver function tests (LFTs), which measure enzymes like alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT), as well as bilirubin levels. Elevated levels of these enzymes can signal liver inflammation or damage.
Further diagnostic steps often include testing for specific autoantibodies associated with liver diseases, such as anti-smooth muscle antibodies for AIH, and screening for viral hepatitis markers. Imaging studies like ultrasound or MRI can provide visual information about the liver’s structure and any abnormalities. In some cases, a liver biopsy, where a small tissue sample is examined under a microscope, becomes important to confirm the diagnosis and distinguish between lupus-related inflammation, drug-induced injury, or other conditions.
Management strategies for liver problems in lupus patients depend entirely on the underlying cause. If liver inflammation is directly due to lupus or co-occurring autoimmune hepatitis, immunosuppressive therapies, such as corticosteroids, are commonly used to calm the immune system’s attack. For drug-induced liver injury, adjusting or changing the implicated medication is the primary intervention. When viral hepatitis is identified, appropriate antiviral treatments are initiated. A multidisciplinary approach involving rheumatologists and hepatologists is important to ensure coordinated care and close monitoring of liver health.