Evaluation of liver function tests in scleroderma patients

Abstract

Systemic sclerosis is a clinically heterogeneous, systemic disorder which affects the connective tissue of the skin, internal organs, and the walls of blood vessels. It is characterized by alterations of the microvasculature, disturbances of the immune system and by massive deposition of collagen and other matrix substances in the connective tissue. This study was done to evaluate the frequency of liver disease in patients with scleroderma and, secondarily, to study the frequency of infection of hepatitis B and C virus in these patients and determine frequency of serum auto-antibodies in this disease. We studied patients with scleroderma, localized or systemic, in the outpatient clinic of rheumatology and dermatology departments, at King Khalid University Hospital. As for a comparison, healthy persons coming to the clinic with the same mean age were considered as control group. Forty patients with the diagnosis of scleroderma included in this work, 35% had elevated gamma-glutamyl-transferase (γ-GT), 30% had elevated alkaline phosphatase (AP) and in 17.5%, the alanine-amino-transferase (ALT) was above the reference values. The ALT had changed to be more in scleroderma patients than in controls. Twenty percent (20%) of the patients tested positive for anti-smooth muscle antibodies (anti-SMA) and only one patient had anti-mitochondrial antibodies (AMA). There was no statistical difference between the two groups regarding antibody testing. Anti-HCV antibodies were observed in one patient, and HBsAg was detected in another scleroderma patient. There was no patient with clinically significant hepatic disease. In this study, although changes in liver enzymes in patients with scleroderma were not uncommon, there was no scleroderma patient with clinical manifestations of liver disease.

Incidence and Predictors of an Abnormal Liver Function Test Among 674 Systemic Sclerosis Patients: A Cohort Study

“… 6 , 41 Liver abnormalities included primary biliary cirrhosis (PBC), 6 , 41 primary sclerosing cholangitis (PSC), 9 and gallbladder dysmotility. 42 Salem et al 3 reported ALP increasing by 30% and ALT increasing above reference values by 17.5% in SSc patients compared to controls. Salem et al 3 also found that gamma-glutamyl transferase (GGT) trended to be higher in patients with SSc.…”

“… 42 Salem et al 3 reported ALP increasing by 30% and ALT increasing above reference values by 17.5% in SSc patients compared to controls. Salem et al 3 also found that gamma-glutamyl transferase (GGT) trended to be higher in patients with SSc. Our study revealed many patients with abnormal LFT by routine screening during follow-up (430 of 674 SSc cases), which seemed higher than in previous reports, although a direct comparison is not possible.…”

“…Previous clinical studies reported abnormal liver function tests (LFTs) in SSc patients ranging from 1% to 37%, 1 , 2 with cholestasis being the most common, followed by hepatitis. 3 Long-lasting drug-induced liver injury, active organ involvement, and fatty liver 2 can induce liver fibrosis and cirrhosis. 2 , 4 In most cases, cholestasis or hepatitis in scleroderma do not progress to the point of requiring a liver transplant or death.…”

Serum H‐ficolin levels: Clinical association with interstitial lung disease in patients with systemic sclerosis

“…Notably, we found the correlation of decreased serum H‐ficolin levels with active alveolitis in SSc‐ILD. Considering that H‐ficolin is produced in the lung and liver, and that the liver is basically resistant to fibrosis in SSc, H‐ficolin seems to be selectively involved in SSc‐ILD development.…”