Only 1 1.2% of patients confirmed increased ALT levels 3 ULN, but most of them subsided spontaneously without discontinuation of the study drug [60]. Conclusions Abnormalities in liver function tests are very common in patients with rheumatic diseases. criteria, except adult onset Stills disease (AOSD), in which elevated aminotransferases are subsumed in minor criteria according to the Yamaguchi et al. [1] criteria. For this reason, AOSD will not be discussed in our article. Liver dysfunction occurs in 43% of patients with connective tissue disorders [2]. In some cases (27C37%) further investigation does not reveal other than rheumatological causes, the biochemical abnormalities are moderate or transient and no progressive and clinically relevant changes are found in liver biopsy [2, 3]. The diverse course of the autoimmune rheumatic diseases ranges from asymptomatic elevation of transaminases or cholestatic enzymes, jaundice, hepatomegaly, to hepatic cirrhosis or even to acute liver failure. In the histology of liver biopsy, you will find no specific features of connective tissue disease and the most frequent findings are: hepatic steatosis, chronic hepatitis, regenerative nodular hyperplasia, hepatic fibrosis, cirrhosis, granulomas, cholangitis, destruction of biliary canaliculus and vasculitis [4, 5]. This short article reviews various aspects of liver involvement only in the most common, immunologically mediated rheumatic diseases, which typically have multisystem involvement (Table I). Table I Rheumatic diseases and reported coexisting liver diseases thead th align=”left” rowspan=”1″ colspan=”1″ Rheumatic diseases /th th align=”center” rowspan=”1″ colspan=”1″ Indicators, liver test abnormalities /th th align=”center” rowspan=”1″ colspan=”1″ Reported coexisting liver diseases /th /thead Systemic lupus erythematosusArthralgia, jaundice, hepatomegaly, splenomegaly, presence of ANA, ALT and AST elevationDrug side effects br / NAFLD, NRHL, AIH, PBC Non-specific reactive changesAnti-phospholipid syndromeAbdominal pain, ascites, hepatomegalyBudd-Chiari syndrome NRHLRheumatoid arthritisCholestasis, GGT elevationNAFLD, unspecific histological findings, PBC, AIH, NRHLFeltys syndromeSplenomegaly, portal hypertension, esophageal variceal bleedingNRHLPrimary Sj?grens syndromeCholestasis, ALT, AST elevation, splenomegaly, portal hypertension, esophageal variceal bleedingPBC, PSC, AIH, NRHLSystemic sclerosisCholestasisPBCIdiopathic inflammatory myopathiesAST ALT, CK elevation, cholestasisPBCSystemic vasculitides: polyarteritis nodosa, Beh?ets diseaseHepatomegaly, jaundice, cholestasis, abdominal pain, ascites, hepatomegalyHepatitis B, Budd-Chiari syndrome Open in a separate windows ANA C anti-nuclear antibodies, ALT C alanine aminotransferase, AST C aspartate aminotransferase, GGT C -glutamyl transferase, CK C creatine kinase, NAFLD C nonalcoholic fatty liver disease, NRHL C nodular regenerative Rabbit Polyclonal to Collagen alpha1 XVIII hyperplasia of the liver, AIH C autoimmune hepatitis, PBC C main biliary cholangitis, PSC C main sclerosing cholangitis Systemic lupus erythematosus Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease TMA-DPH of unknown etiology. It affects mostly women in reproductive age. In the pathophysiology, defects in the apoptosis play the main role. This prospects to chronic inflammation in various tissues and organs. The connection between SLE and hepatitis was noticed in the 1950s and it was described as a lupoid hepatitis by Cowling et al. [6] in 1954. Lupoid hepatitis turned out to be one of the variants of autoimmune hepatitis (AIH) which affects young women and manifests with SLE-like symptoms such as arthralgia or arthritis, fever, loss of appetite, weakness, presence of anti-nuclear antibodies (ANA) or lupus anticoagulant and hypergammaglobulinemia. Nevertheless, AIH and SLE are two different diseases, rarely cooccurring with each other, despite common symptoms such as arthralgia, hypergammaglobulinemia and ANA [7, 8]. However, liver dysfunction is observed in 59.7% of the patients affected by TMA-DPH SLE. It can have multiple causes and it can be associated with exacerbation of the disease (28.5%), the drugs side effects TMA-DPH (30.9%) or coexistence of the primary hepatic disease TMA-DPH (fatty liver disease in 20%, AIH in 4.9%, primary biliary cholangitis (PBC) in 2.4%, cholangitis in 1.6%, alcohol in 1.6% or viral.