Rheumatology Advance Access originally published online on May 8, 2007
Rheumatology 2007 46(7):1171-1173; doi:10.1093/rheumatology/kem108
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A comparison of autoimmune liver disease in juvenile and adult populations with systemic lupus erythematosus—a retrospective review of cases
Centre for Rheumatology, University College London Hospitals, 250 Euston Road, 3rd Floor Central Wing, London NW1 2PG, 1Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH and 2Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, UK.
Correspondence to: Prof. DA Isenberg, Centre for Rheumatology, University College London Hospitals, 250 Euston Rd, 3rd floor Central Wing, London NW1 2PG, UK. Email: d.isenberg{at}ucl.ac.uk
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Abstract |
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Objective. To compare the prevalence and type of autoimmune liver disease in adult and juvenile patients with systemic lupus erythematosus (SLE) in a large UK cohort.
Methods. A retrospective analysis was performed of patients attending the adult and juvenile lupus clinics at University College Hospital and Great Ormond Street Hospital, respectively, between January 1978 and December 2004. Patients with autoimmune liver disease were identified by searching an existing database (adults) and by case note review (juveniles). Histological diagnosis and autoantibody profile was noted and the time that had elapsed in months between the two diagnoses calculated.
Results. Of 377 adult patients and 92 juvenile patients, 5 and 9 respectively, had histologically confirmed autoimmune liver disease. This corresponds to a statistically significant (P < 0.001) greater prevalence in juvenile onset patients of 9.8% compared with 1.3% in adult patients. The juvenile patients were all positive for smooth muscle antibody and had histological changes consistent with autoimmune hepatitis. The adult patients had a variable antibody profile and one patient had histological changes consistent with primary biliary cirrhosis. In all of the juvenile patients, but notably in none of the adult patients, the liver disease predated the diagnosis of SLE (P < 0.001).
Conclusions. Our study confirms that autoimmune liver disease occurs infrequently in adult lupus patients but should be considered in a patient with persistent liver enzyme abnormalities. However, in our study there is a significantly higher prevalence in juvenile lupus patients. This association is previously unreported.
KEY WORDS: Systemic lupus erythematosus, Juvenile, Autoimmune hepatitis, Liver disease
Submitted 22 October 2006;
revised version accepted 21 March 2007.
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