Prevalence of abnormal liver function tests in rheumatoid arthritis

A O-R, GO O, E K, E G, F O, E O. "Prevalence of abnormal liver function tests in rheumatoid arthritis." Afr J Rheumatol . 2017;5(1):70-75.


Objective: To determine the prevalence
of Abnormal Liver Function Tests (LFTs)
in patients with rheumatoid arthritis
at the rheumatology out-patient clinic,
Kenyatta National Hospital (KNH).
Design: Cross-sectional descriptive
Setting: Rheumatology out-patient clinic
at KNH.
Participants: One hundred and seven
RA patients.
Results: The overall prevalence of
abnormal LFTs in the study population
was 57%. The most common abnormal
LFTs were direct bilirubin and alkaline
phosphatase (ALP), which were elevated
in 34.6% and 15% of the study population,
respectively. Abnormal direct bilirubin
was associated with longer duration of
disease; adjusted Odds Ratio (OR) 0.54
(0.34, 0.86) p-value 0.009 and higher
disease activity, adjusted OR 2.79 (1.23,
6.25) p-value 0.014. Abnormal ALP
was significantly associated with BMI,
adjusted OR 0.205 (0.074, 0.57), p-value
0.002 as well as duration of disease,
adjusted OR 1.14 (1.013, 1.29), p-value
Conclusion: This study found the
prevalence of liver dysfunction in
patients with rheumatoid arthritis to be
high, at 57%, and recommends regular
monitoring of liver function tests in
patients with rheumatoid arthritis.
Rheumatoid Arthritis (RA) is a systemic,
chronic, progressive inflammatory
disease characterized by symmetric joint
polyarthritis that progresses to severe joint
. As a systemic illness, RA
has many extra-articular manifestations
and co-morbidities, many of which have
been studied in our local setting, and
have been found to correlate with disease
activity2-5. The liver has however been
overlooked as a target organ in patients
with RA. Rheumatoid arthritis can affect
the liver in many ways6,7; dysfunction
is thought to arise from the disease
itself, independent autoimmune disease,
infections such as viral hepatitis or as a
consequence of anti-inflammatory drugs
such as Non-Steroidal Anti-Inflammatory
Drugs (NSAIDs) or Disease Modifying
Anti-Rheumatic Drugs (DMARDs)6
The most common DMARDs used
in treatment of RA in our setting are
methotrexate and leflunomide, which can
be hepatotoxic. The risk of hepatotoxicity
while on treatment with DMARDs may
be increased in the presence of hepatitis
or alcohol intake.
LFTs may be abnormal in up to
50% of patients with RA and this has
been shown to correlate with disease
activity7,8. The ‘rheumatoid liver’ has
long been a topic of interest and previous
studies noted histological changes in
the liver of RA patients who were not
on treatment with DMARDs such as
fatty change, cellular necrosis, chronic
passive congestion and gross atrophy9-12.
Studies have also investigated use of
multiple DMARDs, which were thought
to predispose patients with RA to a higher
risk of developing hepatotoxicity13,14.
With increasing awareness and
knowledge of the RA, more patients
are being diagnosed early and started
on treatment, which may be life-long.
Effective treatment modalities may have
hepatotoxic effects. Abnormal LFTs are
in themselves an independent predictor
of mortality15. Due to high mortality
from both RA as well as abnormal LFTs,
such a subset of patients could therefore
be at a higher risk. This is especially so
because we currently have limited ways
of managing liver injury in our setting.
It is therefore important for us to monitor
liver dysfunction in patients with RA.

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