Abnormal liver function tests in inflammatory arthritis: think beyond the DMARDs

Abnormal liver function tests are often seen in patients with inflammatory arthritis. These are commonly associated with disease-modifying anti-rheumatic drugs, however, clinicians must hold a high index of suspicion for less common causes. This article details two of such cases where hereditary haemochromatosis and acute hepatitis E infection were actually responsible for deranged serum liver enzymes. Correct identification of these conditions leads to disease specific management and improved patient outcomes.