Involvement of the liver in rheumatic diseases

Liver dysfunction is often observed in patients with rheumatic diseases. Underlying disease is the major cause of liver dysfunction associated with adult-onset Still's disease, polymyositis/dermatomyositis, and vasculitis syndrome, whereas drug-induced liver injury is common in rheumatoid arthritis and systemic lupus erythematosus. These diseases may be accompanied by autoimmune hepatitis and primary biliary cirrhosis (PBC). PBC is particularly common in CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactylia, and telangiectasia) syndrome and Sjögren's syndrome. The recent widespread use of biological drugs such as tumor necrosis factor inhibitors has raised concerns about reactivation of hepatitis B. Given the varying causes and degrees of liver dysfunction associated with rheumatic diseases, medical intervention should be undertaken with adequate understanding of the characteristics of each type of liver disease.