Liver in systemic disease

Table 2 Connective tissue disease-associated abnormal liver function tests and liver diseases[1011]

Connective tissue disease	Abnormal liver function tests	Liver disease or histology
Juvenile rheumatoid arthritis	Elevated aminotransferases	Drug hepatotoxicity
		Massive hepatomegaly
		Infiltration of portal tracts by chronic inflammatory cells
		Acute necro-inflammatory disease
Felty syndrome	Elevated ALP and aminotransferases	Chronic hepatitis
		Drug hepatotoxicity
		Nodular regenerative hyperplasia
		Portal fibrosis
		Sinusoidal lymphocytosis
		Amyloidosis
		Macronodular cirrhosis
		Hepatomegaly
Rheumatoid arthritis	Elevated ALP, correlate with severity of arthritic activity	Drug hepatotoxicity
		Autoimmune chronic hepatitis (type 1)
		Nodular regenerative hyperplasia
		Primary biliary cirrhosis
		Amyloidosis
		Spontaneous hepatic rupture/Necrotizing arteritis
		Steatosis
Polymyalgia rheumatica	Elevated ALP and aminotransferases	Drug hepatotoxicity
		Steatosis
		Lymphocytic infiltration of portal tracts
		Granulomas
		Hyperplasia of perisinusoidal stellate cells
		Primary biliary cirrhosis
Sjögren’s syndrome	Elevated ALP and aminotransferases	Primary; 7% have liver dysfunction, mostly PBC
		Secondary; 40%-70% have PBC
Scleroderma	Hepatic involvement is low; Elevated ALP, mild elevation of aminotransferases and bilirubin	Drug hepatotoxicity
		CREST syndrome (PBC)
		Spotty calcification
		Idiopathic portal hypertension
		Cirrhosis
		Nodular regenerative hyperplasia
		Hepatomegaly
Systemic lupus erythematosus	Elevated aminotransferases in up to 50% of patients	Drug hepatotoxicity
		Autoimmune chronic hepatitis (type 1)
		Venous congestion
		Nodular regenerative hyperplasia
		Hepatic infarction
		Steatosis
		Venous thrombosis
		Granulomatous hepatitis
		Centrilobular necrosis
		Cirrhosis
Adult Still’s disease	Elevated ALP and aminotransferases	Moderate portal mononuclear cell infiltration with occasional focal hepatocyte necrosis