Abstract
HE HEPATIC manifestations of the rheumatic diseases are not well described. The frequency, significance, and the specific hepatic pathology varies with each rheumatic illness. Abnormalities of liver tests in this setting may lead to diagnostic confusion and the need for extensive evaluation. Additionally, many of the drugs used in the treatment of these diseases are hepatotoxic. The aim of this contribution is to review the current published data regarding liver involvement in the rheumatic diseases and discuss the hepatic complications of medications commonly prescribed. RHEUMATOID ARTHRITIS Hepatic involvement in adult rheumatoid arthritis (RA) is incompletely described. Early observations included the apparent improvement in joint disease with the onset of jaundice. Still,’ in 1897, noted “catarrhal jaundice to be followed by distinct improvement of the joint symptoms” and Hench,’ in 1940, noted remission in articular symptoms when patients with “chronic infectious arthritis” became jaundiced. Because of these observations, attempts were made to induce jaundice in patients with RA. Oral ingestion of ox and human bile, and intravenous administration of liver extracts and jaundice blood were ineffective.3 Temporary improvement in joint symptoms occurred in 25 of 32 patients who were inoculated with serum from patients with hepatitis and became jaundiced.4 The joint improvement was transient and the mechanism for the improvement was not determined. Biochemical evidence of hepatic involvement in RA has been described in several studies. Elevation in serum transaminases (SGOT, SGPT) have not been noted but serum alkaline phosphatase elevation has been found in 25%50% of patients with RA.‘16 This elevation in serum alkaline phosphatase is hepatic in origin since simultaneous elevations in five prime nucleotidase and gamma glutamyl transpeptidase have been noted.’ Serum alkaline phosphatase elevation correlates with disease activity and decreases with improvement in the arthritis.’
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
