Lupus hepatitis: an under-recognized disease feature associated with autoantibodies to ribosomal P

To determine the frequency and clinical manifestations of systemic lupus erythematosus (SLE)-related liver disease and to establish whether this disease feature correlates with circulating autoantibodies to ribosomal P proteins.

A retrospective chart review of a large lupus cohort searching for laboratory and clinical manifestations of liver disease. A case-control study with testing of stored serum for antiribosomal P antibodies using immunoblotting, an enzyme-linked immunosorbent assay, and immunodiffusion in cases of lupus with liver involvement, and in randomly selected and ethnically-matched controls with lupus but without liver involvement.

Of 131 patients with SLE, 4 (3%) had liver involvement that could only be ascribed to the disease itself, and 2 additional cases from elsewhere were also studied. The clinical picture of the liver involvement resembled chronic active hepatitis, but there was no serological evidence of hepatitis B or C infections. Only 1 patient had low-titer antismooth muscle antibodies, and none had antimitochondrial antibodies. Antiribosomal P antibodies were present in all 6 patients with lupus hepatitis, compared to only 2 (10%) of 20 of controls with lupus but no liver disease (P = 0.0001, odds ratio 96).

Lupus hepatitis appears to be an infrequent but distinct manifestation of SLE which correlates strongly with the presence of antiribosomal P antibodies. Its course and prognosis are variable, ranging from chronic biochemical abnormalities of liver function to acute clinical hepatitis to hepatic failure.