Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

The Prevalence of Liver Abnormalities in Patients with Systemic Lupus Erythematosus.

Huang2,  Darryl, Aghdassi2,  Ellie, Su2,  Jiandong, Fortin1,  Paul R.

Toronto Western Hospital, Toronto, ON, Canada
University Health Network, Division of Rheumatology, Toronto, ON, Canada

Studies reporting on liver involvement in Systemic Lupus Erythematosus (SLE) are limited, often focused on liver transaminases and without inclusion of imaging procedures and/or liver biopsies. Furthermore, the etiology for the abnormal transaminases has not been investigated. This study determined in SLE patients: 1) the prevalence of abnormal liver function tests (LFTs) and whether further investigations were done; 2) the differences in SLE-related and/or metabolic factors in patients with and without abnormal LFTs. Patients who met at least 4 of the ACR classification criteria for SLE and had 1.5 times the upper limit for AST or ALT on two visits within a 2-year period were selected from the database registry of the University of Toronto Lupus Clinic. Demographic, and laboratory data at the time of the first appearance of LFTs abnormality were extracted from these patients as well as the age, gender and SLE duration matched controls who had normal LFTs. Disease activity and damage were assessed by SLE- Disease Activity Index (SLEDAI) and SLICC Damage Index (SDI). Chart review was performed to determine the contributing factors to these liver abnormalities. Data were analyzed using SPSS statistical program. Out of 1533 patients in the database, 135 (8.8%) with a mean (SD) ACR of 6.4 (1.5) met the inclusion criteria. The subjects had mean (SD): age of 40.1 (13.7) years, BMI of 25.9 (5.8) kg/m2, SLEDAI of 6.4 (5.4), SDI of 1.5 (1.8) and 83% were female. Among patients, 65% were Caucasian; 23% smoked; 30% consumed alcohol, 61% had hypertension, 7% had previous cardiovascular involvement and 68% had other autoimmune disorders. Medication profile of the two year period preceding the first abnormal LFT included: prednisone (67% of patients) with a mean (SD) dose of 12.1 (15.3) mg; antimalarial (63%), immunosuppressants (61%), statins (16%), hormone replacement therapy (13%) and anticoagulants (13%). Laboratory findings were normal for CBC, blood glucose and lipid profile except for serum triglycerides that was elevated (2.10 ± 2.04 mg/dl). The mean (SD) levels for AST and ALT were 73 (67) and 88 (79) respectively. Chart review completed in 60 of the patients, showed that only 12 patients were further evaluated by a Hepatologist, 30 had an abdominal ultrasound (US) (15 fatty liver, 3 fibrosis, 11 with suspected drug-induced hepatitis), and only 3 had a liver biopsy. However, only 15 of the US were done specifically for liver investigation. In the nested case control study of 134 matched subjects, cases had higher prevalence of: hypertension (60% VS. 46%, p=0.02); antiphospholipid syndrome (9% VS. 2% p=0.02); and immunosuppressants use (60% VS. 37%, p<0.001), especially azathioprine (39% VS. 22%, p<0.01) and methotrexate (22% VS. 10%, p<0.01) compared to controls. Although, BMI, SLEDAI and SDI were similar, blood biochemistry showed a significantly lower IgM (1.2 (0.7) vs 1.5 (1.0), p=0.03) and higher triglycerides (2.1 (2.1) vs 1.7 (1.2), p=0.05) among cases compared to the controls. Factors associated with the metabolic syndrome, such as obesity, insulin resistance, and hypertension, as well as side-effects of the drugs used in the treatment of SLE may contribute to liver abnormalities in SLE.

To cite this abstract, please use the following information:
Huang, Darryl, Aghdassi, Ellie, Su, Jiandong, Fortin, Paul R.; The Prevalence of Liver Abnormalities in Patients with Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1178
DOI: 10.1002/art.28944

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