Autoimmune hepatitis in the context of systemic lupus erythematosus: A narrative review of overlap syndrome and lupus-associated hepatitis

Table 3 Summary of key published studies on lupus hepatitis and autoimmune hepatitis-systemic lupus erythematosus overlap syndrome

Ref.	Country	Design	n	Diagnostic criteria	Key clinical/serological findings	Treatment	Outcomes
Liu et al[1], 2015	United States	Prospective cohort	435	≥ 2-fold AST/ALT elevation	Liver disease in 20.7%; correlated with SLEDAI	SLE-directed therapy	Improved with SLE disease control
Takahashi et al[11], 2013	Japan	Retrospective cohort	206	Clinical/biochemical	Liver dysfunction 59.7% (DILI: 30.9%, SLE: 28.5%, fatty liver: 17.9%, AIH: 4.9%, PBC: 2.4%)	Etiology-directed	Variable by cause
Piga et al[12], 2010	Italy	Retrospective cohort	242	Clinical/biochemical	LFT abnormalities 18.6%; lupus hepatitis 5.8%	SLE-directed therapy	Not specified
Heijke et al[3], 2021	Sweden	Retrospective cohort	287	Simplified IAIHG criteria	2.8% biopsy-confirmed AIH; 13.9% met probable AIH criteria serologically	Immunosuppression per AIH diagnosis	Highlights poor IAIHG specificity in SLE
Efe et al[4], 2011	Türkiye	Retrospective cohort	147	Simplified IAIHG criteria + biopsy	72.3% met serologic IAIHG criteria; only 13.8% biopsy-confirmed AIH	Immunosuppression if biopsy-confirmed	Underscores need for histologic confirmation
Wang et al[19], 2024	Taiwan (hospitalized cohort)	Retrospective cohort	805	Clinical + biopsy where available	AIH overlap in 0.6%	Standard AIH therapy	Rare true overlap in hospitalized SLE
Beisel et al[5], 2014	Germany	Case series + literature review	Case series	Clinical, serological, histological	Reviewed reported AIH-SLE overlap cases	Glucocorticoids ± immunosuppressants	Generally favorable with treatment
Adiga and Nugent[6], 2017	United States	Narrative review	Review	Historical/clinical	Clarified “lupoid hepatitis” nomenclature confusion	N/A	Conceptual framework for overlap vs lupus hepatitis

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; SLE: Systemic lupus erythematosus; DILI: Drug-induced liver injury; AIH: Autoimmune hepatitis; PBC: Primary biliary cholangitis; LFT: Liver function test; IAIHG: International Autoimmune Hepatitis Group; N/A: Not applicable.