Does Lupus Affect the Liver? Making the Connection

Living with lupus, as it is a chronic disease, can oftentimes cause unexpected complications throughout its course. Many patients would wonder “does lupus affect the liver?” Making the connection can help you manage your condition well. Lupus can affect the liver in several ways. It can be a mild inflammation or rare blood vessel problems. The liver isn’t part of systemic lupus erythematosus’ (SLE or simply lupus) diagnostic criteria. But while this may be true up to 50% of lupus patients may present changes in the liver function tests (LFTs).

Key Takeaways

• Abnormal liver function test (as elevated liver enzymes) is present in up to 60% of lupus patients

• Lupus hepatitis (liver inflammation) can occur in up to 5.8% of lupus patients

• Most lupus-related liver problems are responding well to treatment and rarely cause damage

• Regular liver function tests are important even when you feel well

• Lifestyle changes, such as diet and avoidance of alcohol, can help support liver health

Does Lupus Cause Liver Damage?

Yes, lupus can cause liver damage. 

Lupus is a condition where your body is confused between self and nonself. Your body’s immune system attacks parts of your body as if it is a foreign entity. One of these body parts includes the liver. Lupus can affect your liver in several ways from mild to rare. 

The most common way that lupus affects your liver is through swelling or inflammation — lupus hepatitis. About 5.8% of patients with lupus have lupus hepatitis. About 16% of lupus patients experience a range of conditions that affect the liver, including:

• Cirrhosis

• Chronic active hepatitis

• Chronic persistent hepatitis

• Granulomatous hepatitis

• Fatty deposits in the liver (steatosis)

And, in rare instances, lupus patients may have nodular regenerative hyperplasia, which are nodules distributed throughout the liver without tissue scarring or fibrosis.

What is Lupus Hepatitis?

Lupus hepatitis can cause your liver to swell or get inflamed. It happens because your body starts making antibodies against the wrong target. And, this time, it happens to your liver.

This condition can happen in roughly 1 in 20 people (about 5%). It can happen in lupus patients but are not presenting symptoms of liver disease. So it is important to get screened and monitor your liver enzymes periodically.

Can lupus lead to autoimmune hepatitis?

Yes, lupus can lead to autoimmune hepatitis.

Lupus hepatitis is different from autoimmune hepatitis, although they may seem the same. Let’s take a look at their main differences.

* Lupoid hepatitis is a term in the 1950s describing young women with chronic active hepatitis. Later termed autoimmune hepatitis (AIH) in 1993. Only 10% of patients with AIH meet the diagnostic criteria for SLE.

However, lupus hepatitis and autoimmune hepatitis may be hard to tell apart in terms of manifestation since it’s the immune system that triggers the condition.

What is nodular regenerative hyperplasia in lupus?

Nodular regenerative hyperplasia (NRH) is a rare but serious liver condition as a complication of SLE. Patients will demonstrate diffuse nodules that are not cancerous in the liver parenchyma without causing significant fibrosis or scarring. It can disrupt blood flow to the liver, which could lead to portal hypertension. There is also a risk of bleeding from rupture of blood vessels. This condition is present in less than 3% of patients with lupus.

What Are the Symptoms of Lupus Affecting the Liver?

When lupus affects your liver, you may experience symptoms that aren’t your usual. Some of these symptoms may even overlap with the usual lupus symptoms like body malaise (feeling really tired). But there are symptoms that most likely point to a liver problem.

Liver Pain

Liver pain in lupus is essentially the same as with people who don’t have lupus. It often feels like a dull ache or pressure on the upper right side of your stomach, just under the right bottom rib cage. This occurs because the swelling causes stretching of the covering of your liver, which has a lot of nerve endings.

However, not all lupus patients have this type of liver pain. Some may notice this only after eating certain types of food like fatty foods or when their lupus is active. About 40-60% of patients have gastrointestinal (GI) involvement but this does not specifically refer to liver pain alone.

Jaundice

Yes, liver issues associated with lupus can cause jaundice (yellow discoloration of the skin and eyes). This happens when your liver cannot properly process the substance called bilirubin, which is yellow in color.

Nonetheless, only about 1-4% of lupus patients have jaundice as a manifestation. So it is a very rare manifestation but one that must not be ignored if it shows up. If you have jaundice, you need to consult your doctor immediately.

Elevated Liver Enzymes

Liver problems often manifest as elevation of liver enzymes, such as AST or ALT. These enzymes increase as the liver cells become damaged.

In a retrospective study, about 25-50% of hospitalized lupus patients had altered liver enzymes. The release of these enzymes often indicate that there is ongoing inflammation or damage of the liver.

Fatigue and Loss of Appetite

More often, this is an overlapping symptom of patients who have active lupus. If your condition has a waxing and waning property, there are times when you would feel fatigued and without desire to eat. Often, this is normal. But, in the face of an ongoing liver damage, fatigue may be experienced since the body’s energy reserves are depleted.

Itchiness

This may be experienced in some cases due to accumulation of bile salts in the blood. Also, bilirubin, when deposited on the skin, may cause itchiness.

More often, when these symptoms are present, your doctor will watch your progress closely. You will be given medications according to your symptoms. And, you will receive treatment plans that are added to your current regimen.

How is Lupus-Related Liver Disease Diagnosed?

If you have liver issues due to lupus, the diagnosis may take several ways. Often, it includes a mix of different diagnostic tests, liver imaging, and physical examination as well as medical history.

The diagnosis starts with blood tests to check your liver enzymes. If needed, further investigation may be warranted.

What Blood Tests Detect Liver Issues in Lupus?

The first laboratory request is to check your liver enzymes. The key tests include AST and ALT, which as mentioned previously, are enzymes that are released when the cells are damaged. Bilirubin levels are also measured and albumin levels, which determines if the liver is still functioning as it should. Albumin is the protein that the liver synthesizes.

Your doctor will recommend a specific timeline for you to get checked for this. You may be required to have it checked every 3-6 months as the case may be.

Are Imaging Tests Needed for Diagnosis?

Imaging tests include the following:

• Ultrasound

• CT-scan (computed tomography scan)

• MRI (magnetic resonance imaging)

These imaging modalities can demonstrate any changes in size, texture, or shape that blood tests don’t reveal. But doing all of these are not necessary when diagnosing liver issues in lupus. At times, even ultrasound is enough.

Imaging may not be needed for mild cases only. But if liver enzymes are persistently high or when symptoms are worrisome, doctors may request these modalities. Also, imaging can help rule out other causes of liver problems that may look like lupus damage on laboratory tests.

How do doctors confirm lupus-related liver damage?

To diagnose liver problems in lupus, doctors connect the dots — that is the results from blood tests and imaging, tying these up to the medical history and physical exam. However, when these become “inconclusive” or unsure, they often do tissue biopsy. Biopsy is a procedure where they take a small sample out of the liver and send it for examination in the laboratory.

A team of experts are often working together including your rheumatologist (lupus expert) and a liver specialist (hepatologist) to get to the bottom of your diagnosis. A team approach could be best in creating a better treatment plan, leading to a better outcome.

What Treatments Are Available for Lupus Liver Issues?

The primary treatment for lupus liver issues include immunosuppressants, which are drugs that will calm your immune system down. By calming your hyperactive immune system, it lessens the attack on your liver and allows your liver to heal.

What Medications Treat Lupus Liver Problems?

Most people respond well to treatment that could result in decreased swelling. Treatment with prednisone would generally be enough. However, there are cases that don’t respond to corticosteroids. In these cases, mycophenolate mofetil may be effective.

Other immunosuppressants, such as azathioprine, may also be used. You may have been given hydroxychloroquine, which is a common lupus drug, that helps in protecting the liver as well. The use of hydroxychloroquine (HCQ) is associated with lower risk for organ damage.

However, your doctor will craft out a treatment plan just right for you. Treatment plans may even vary between patients. So, make sure that you follow what your doctor has mapped out for you.

Are there side effects of lupus liver treatments?

Drugs that are given to lupus patients have their own issues. Steroids may cause weight gain, high blood sugar, and mood changes. Immunosuppressants may also put you at risk for infections. So you will need to protect yourself by wearing masks.

It will be helping your lupus problems including the liver issue. But it may be causing some other problems elsewhere in the body.

In a survey, 95% of patients taking steroids have at least one side effect. Other side effects include changes in appearance and insomnia.

Can natural remedies help with lupus liver issues?

Natural approaches can support your liver health. But they can’t replace the medical treatment for lupus liver problems.

However, some patients have been trying different approaches, including:

• Anti-inflammatory diet

• Stay well-hydrated

• Take milk thistle

You need to communicate with your doctor before you try any natural remedies. Some patients may experience flares or new problems when they are using herbs. When you have autoimmunity like SLE, you should listen to what your doctor tells you.

Can Lifestyle Changes Help Manage Lupus Liver Problems?

Making healthy choices on a daily basis can give your liver a health boost. Some of the simple things you can change include the food that you eat, your activity, and the beverages you drink.

These changes often work alongside your treatment.

How does diet affect lupus and liver health?

Eating the right way and the right foods can fight both liver problems and your lupus. Eat foods that are rich in fiber and fluids like fruits, vegetables, olive oil, and fish.

You should also cut back on processed foods, added sugars, and red meat. These add strain to the function of your liver. It has been shown that patients who follow an anti-inflammatory diet could lead to lower liver enzyme levels and lesser lupus-associated symptoms. Your food is like an extension of your medication. It can support or work against it, depending on your choice.

Can exercise improve liver function in lupus?

Yes, exercise can improve liver function especially when you have lupus. However, for patients who have consistent musculoskeletal issues associated with lupus, anything that overuses the joint and muscle could backfire.

Gentle exercising is the best way to do it like swimming and yoga. It improves blood flow to your liver and helps in controlling weight.

You know your body well. So you need to find the right balance between moving too much that might trigger lupus-related symptoms and being sedentary. If you are unsure of things, be sure to consult your doctor regarding it.

Should you avoid alcohol with lupus liver issues?

Yes, you should avoid alcohol not only when you have liver issues but also when you are taking medications for lupus like methotrexate.

Alcohol can act synergistically with the drug. Thus, amplifying its effect and causing even more problems than necessary. It could also exacerbate increasing liver enzyme levels.

What Are the Complications of Lupus on the Liver?

In rare cases, lupus can lead to serious liver consequences especially if left untreated. The complications could include:

• Liver cirrhosis or tissue scarring

• Severe blood flow problems

• Liver failure

Fortunately, these complications are rare and can only happen in a small fraction of patients.

Are you a patient with lupus? Keep track of your liver health through Ribbon Checkup kits. Start your healthy liver journey today!

Frequently Asked Questions

Does lupus affect the liver?

Yes, at some point lupus does affect the liver and it may be as trivial as an elevation of liver enzymes or as serious as lupus hepatitis. Fortunately, lupus hepatitis only occurs rarely.

What symptoms might I notice if lupus is affecting my liver?

The symptoms may be overlapping with your lupus symptoms. Therefore, it can be non-specific. However, symptoms like right upper abdomen pain could be attributed to liver pain among other symptoms like jaundice.

Can lupus liver problems be treated?

Yes, lupus liver problems often respond to treatment particularly immunosuppressants. There are rare instances, though, when these problems don’t resolve after the standard immunosuppressant treatment. So other immunosuppressants may be employed, such as Azathioprine and Methotrexate.

Written by Jaclyn P. Leyson-Azuela, RMT, MD, MPH
Jaclyn P. Leyson-Azuela, RMT, MD, MPH, is a licensed General Practitioner and Public Health Expert. She currently serves as a physician in private practice, combining clinical care with her passion for preventive health and community wellness.

 

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