Cirrhosis-related musculoskeletal disease: radiological review

Abstract

Musculoskeletal problems in patients with liver disease are common; however, they are not so well described in the literature. Therefore, there is a need to collate information on these disorders, as their incidence is on a constant rise and some of these pathologies can severely debilitate the patient's quality of life. These disorders are parietal wall varices with or without bleeding, spontaneous intramuscular haematoma (e.g. rectus sheath), abdominal wall hernia, anasarca, hepatic osteodystrophy, septic arthritis, osteomyelitis, necrotizing fasciitis, osseous metastases from hepatocellular carcinoma etc. While portal hypertension plays a key role in disorders, in others, dysregulation of the coagulation system or a compromised immune system are responsible. Imaging plays an essential role in the assessment of these complications and awareness of these musculoskeletal manifestations is vital for establishing a timely diagnosis and planning of appropriate therapy, as these disorders can significantly impact the morbidity and mortality and also influence candidacy for liver transplantation. We herein comprehensively appraise various musculoskeletal complications associated with chronic liver disease/liver cirrhosis especially from an imaging perspective which, to the best of our knowledge, have not been collectively described in English literature.

Temporal relationship between osteoarthritis and comorbidities: a combined case control and cohort study in the UK primary care setting

“…protopathic bias). Interestingly, the risk of OA in liver cirrhosis is reported to be high, but the reverse relationship has yet to be established [ 48 ].…”

Common musculoskeletal disorders in chronic liver disease patients

“…Therefore, in patients with CLD and fever and limitation of joint movements, we should have a high suspicion of septic arthritis to diagnose and treat it promptly. [22] In the study conducted by Hung et al [23] 35,106 adult cirrhosis patients without a history of septic arthritis or prosthetic joints and 33,457 non-cirrhotic patients were followed for three years. The incidence of septic arthritis was approximately two-fold higher in patients with cirrhosis than patients without cirrhosis (p=0.001).…”

“…For spondylodiscitis, MRI is the investigation of choice with the decreased signal intensity from the disc and adjoining vertebral bodies on T1 weighted images and signal enhancement on T2 weighted images. [22] Besides, tissue ischemia eventually leading to higher chances of peripheral gangrene and osteomyelitis can be observed in CLD patients as an adverse effect of advanced liver disease drugs, such as terlipressin. [26] The prevalence of skeletal tuberculosis is also higher in patients with cirrhosis.…”

“…Therefore, in patients with CLD and fever and limitation of joint movements, we should have a high suspicion of septic arthritis to diagnose and treat it promptly. [ 22 ]…”

“…For spondylodiscitis, MRI is the investigation of choice with the decreased signal intensity from the disc and adjoining vertebral bodies on T1 weighted images and signal enhancement on T2 weighted images. [ 22 ]…”