Clinical connection between rheumatoid arthritis and liver damage (original) (raw)
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Studies on the frequency and pathogenesis of liver involvement in rheumatoid arthritis
Annals of the Rheumatic Diseases, 1979
A systematic prospective survey of 100 outpatients with rheumatoid arthritis revealed that 45 had biochemical evidence of liver disease. In most cases this was due to increases in total serum alkaline phosphatase (ALP) and/or gammaglutamyl transpeptidase (GGT). Examination of serum ALP isoenzyme profiles in 50 of the patients showed that the liver isoenzyme was the sole or major component in 44 patients, including many with normal total ALP levels. 180% had raised serum
Archives of Gastroenterology and Hepatology
Background: Systemic rheumatoid vasculitis of autoimmune origin, systemic (secondary, inflammatory) AA amyloidosis and acute bacterial septic infection with lethal outcome are major complications of rheumatoid arthritis (RA), which may involve the liver. In addition to these complications of RA, a wide spectrum of liver diseases, such as reactive, viral, toxic or eosinophilic hepatitis, fatty liver changes, etc. with or without cirrhotic transformation may associate with RA. The aim of this study was to determine the prevalence of RA related complications and associated diseases of the liver, and to analyze the possible relationship between them. Patients and Methods: 152 random autopsy patients with RA were studied. RA was confirmed clinically according to the criteria of the ACR. The prevalence of complications and associated diseases of the liver were confirmed by a detailed review of extensive histological material. Results: There was a very strong statistical relationship between RA related complications and their manifestation in the liver. The links were also positive and significant between systemic rheumatoid vasculitis and eosinophilic hepatitis, furthermore between chronic passive hepatitis or alcoholic hepatitis and alcoholic steatosis. The statistical correlation between RA related complications and associated diseases of the liver were not significant, even in most of the cases inverse with negative colliquations coefficient. Conclusions: A distinct liver disease specific for RA was not found in our autopsy population. RA related systemic complications and associated diseases of the liver are independent entities. We found that the patients' life expectancy was declining with acute bacterial septic infection or hepatitis, and with amyloid A deposition in the liver, and these patients died earlier. The risk of chronic active hepatitis (with or without cirrhotic transformation) increased in the late stage of RA.
Rheumatology International, 2012
Tumour necrosis factor-alpha (TNF-a) inhibitors are widely used in the management of patients with rheumatoid arthritis (RA) and spondylarthritides. However, TNF-a inhibition may lead to adverse events, including liver injury. The RA patients are frequently treated with several potentially hepatotoxic drugs concomitantly; hence, a causative link between TNF-a inhibitors and liver injury is usually difficult to establish. We report two cases of RA patients who developed histologically manifest liver injury shortly after the introduction of treatment with two different TNF-a inhibitors. Furthermore, we present the analysis of the laboratory data from the BioRx.si registry (the Slovenian national registry of rheumatologic patients treated with biologicals) and provide evidence that elevated levels of serum aminotransferase can be observed in patients treated with TNF-a inhibitors. Additionally, our analysis suggests no significant differences between the impact of adalimumab and etanercept on aminotransferase levels. Although the use of TNF-alpha inhibitors is safe and efficient, we suggest that continuous careful monitoring of aminotransferase levels in patients treated with these agents is probably warranted.
Physiological Research, 2019
Drug-induced liver injury (DILI) is a common event in patients with rheumatic diseases (RD) on biological therapy (BT). We aimed at evaluating the prevalence and pattern of DILI. Consecutive RD patients treated with BT were followed for 6 months. ALT and ALP >the upper limit normal (ULN) and3xULN injury Grade 2. 582 liver function tests (LFTs) in 199 patients were evaluated, median age 53y, 59.3 % females, RA in 108, AS 49, and PsA 42 patients. ALT Grade 1 elevation was observed in 25.6 %, transient in 18.6 %, persisting in 7 %, Grade 2 in 1.5 %, ALP Grade 1 in 3.5 %, transient in 2 %, persisting in 1.5 %. We report no case of ALP Grade 2 or Hy´s law (ALT>3xULN, bilirubin>2xULN). Patients with persisting ALT elevation had higher BMI (28.23 vs. 25.74, p=0.016), lower DAS28 (2.22 vs. 5.28, p=0.046). ALT Grade 1 injury was more frequent with solo tocilizumab compared with other agents (27.5 % vs. 13.6 %, p=0.01). DILI was frequent, in 18.6 % transient, in 7 % persisting, Grade...
Liver Toxicity in Rheumatoid Arthritis Patients Treated With Methotrexate
Asia Pacific Journal of Medical Toxicology, 2015
Background:Methotrexate (MTX) is one of the most commonly used disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis (RA) which can be associated with toxic effects on different organs. This study was designed to investigate the hepatotoxic effects in RA patients treated with MTX. Methods: In this cross-sectional observational study, RA patients who received standard dose regimen of methotrexate (7.5-15 mg/week) for a minimum of 3 months were included. Liver function parameters including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin as well as prothrombin time (PT) were assessed for all patients. The patients were divided into two groups according to the MTX dose received: (1) low-dose group (≤ 7.5 mg/week) and (2) high-dose group (> 7.5 mg/week). Results:One-hundred patients (64% women) with mean age of 45.8 ± 7.5 years were studied. Eighty patients (80%) received low-dose MTX and the rest received high-dose MTX. Mean...
LiverToxicity in Patients with Rheumatoid arthritis on methotrexate therapy
Background: Rheumatoid arthritis (RA) is a chronic multisystem disease affecting joints, connective tissues and fibrous tissues. Methotrexate (MTX) is a folate antagonist used as a first line treatment in RA. Hepatotoxicity is a common side effect of MTX. This study was done to evaluate abnormalities of liver function with respect to cumulative dose and duration of MTX. Materials and methods: In this cross sectional analytical study 109 patients of RA aged ≥18years on methotrexate therapy were analyzed for abnormal liver profile by using Liver Function Test (LFT), Ultrasonography (USG) abdomen. The weekly dose, cumulative dose and duration of treatment were compared between patients with and without elevated liver enzymes. Results: Of 109 patients, transaminitis was observed in 22 patients (20.1%,95% CI: 13.3%-29.2%). The mean SGOT and SGPT were 44.04 ± 29.15 IU/L and 35.85 ± 23.26 IU/L respectively. The mean weekly dose, cumulative dose and duration of MTX therapy were 8.74 ±2.51 mg/wk, 2131.82 ± 1283.26 mg and 4.9 ± 2.47 years respectively. The mean weekly dose and cumulative dose of MTX was higher among the patients with transaminitis (11.19 ±2.18 mg/wk vs 8.15 ± 2.23 mg/wk and 3188.57 ± 1100.19 mg vs 1879.64 ±1196.71mg) which was statistically significant (p<0.001). Fatty liver was present in 15.6% of the study participants. Majority (87.1%) of the participants were females. Conclusion: transaminitis was the major abnormality observed, the prevalence of which was higher among patients with longer duration of treatment with MTX and with higher cumulative dose. However, there was no significant association for gender and age with transaminits. The prevalence of fatty liver was also higher among the patients receving higher dose of MTX.
Rheumatology, 1997
The objectives were to determine quantitative liver function prospectively in patients with rheumatoid arthritis (RA) treated with low-dose methotrexate (MTX), to search for risk factors for a loss of quantitative liver function and to assess the relationship between quantitative liver function and histological staging. A total of 117 patients with RA (ACR criteria, 85 women, mean age 59 yr) had measurements of galactose elimination capacity (GEC), aminopyrine breath test (ABT) and liver enzymes [aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase (AP), g-glutamyl transferase (GGT), bile acids, bilirubin, albumin] before treatment with weekly i.m. MTX injections and every year thereafter. In 16 patients, liver biopsies were performed. Before the introduction of MTX, mean GEC was 6.6 mg/min/kg [5th to 95th percentile (5-95 PC) 5.1-8.5; reference range 6.0-9.1] and mean ABT was 0.80%kg/mmol (5-95 PC 0.42-1.30; reference range 0.6-1.0). During treatment with MTX [mean weekly dose 11.8 mg (5-95 PC 5.4-20.2), mean observation period 3.8 yr (5-95 PC 0.4-6.9)], significant declines of GEC (−0.12 mg/min/kg per year, t = 3.30, P Q 0.002) and ABT (−0.06%kg/mmol per year, t = 4.81, P Q 0.001) were observed. Negative correlations were found between the annual change in GEC and GEC at baseline (RS = − 0.40, P Q 0.0001), and the annual change in ABT and ABT at baseline (RS = − 0.43, P Q 0.0001). No correlations were found between the annual change in GEC or ABT and weekly MTX dose, age or percentage of increased liver enzymes, and no effect of a history of alcohol consumption q30 g/week became evident. Two patients with Roenigk grade III had impaired quantitative liver function, while 14 patients with Roenigk grades I and II exhibited a high variability of GEC and ABT from normal to abnormal values. The continuous declines in GEC and ABT observed deserve attention in patients with prolonged treatment. Patients with a low GEC or ABT at baseline seem not to be at increased risk for a further loss of quantitative liver function. An impaired GEC or ABT does not necessarily concur with hepatic fibrosis on histological examination.