Manifestações hepáticas no paciente com lúpus eritematoso sistêmico

Abstract

Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease that predominantly affects women. The diagnosis is based on the 2019 criteria from the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR). Clinical manifestations initially include constitutional, mucocutaneous, and musculoskeletal symptoms, although it can also affect specific organs such as the kidneys. Liver involvement in SLE is observed in 25-50% of patients, typically characterized by mild and transient alterations in liver enzymes. Hepatic injury can be primarily caused by SLE, represented by lupus hepatitis, as well as explained by overlap with other autoimmune liver diseases and other secondary non-autoimmune causes. Lupus hepatitis is characterized by asymptomatic elevation of transaminases, often associated with disease activity. The pathophysiology involves complement activation and vasculitis. Additionally, antiprotein P ribosomal antibody is commonly found, though it is also present in diseases such as autoimmune hepatitis (AIH). Another form of hepatic involvement includes overlap with other autoimmune diseases, such as AIH, primary biliary cholangitis, and primary sclerosing cholangitis. SLE and AIH share many common features, with histopathological diagnosis being crucial for differentiation. On the other hand, the coexistence of SLE with primary biliary cholangitis (PBC) is rare and confers a worse response to PBC treatment. There are few reports of SLE coexisting with primary sclerosing cholangitis. As for secondary non-autoimmune causes, drug-induced liver injury is common in this population, with medications like NSAIDs and immunosuppressants being the main culprits. Hepatitis B and C virus infections can also interact with SLE, complicating disease management. Finally, vascular liver diseases may also be related to SLE, particularly in the prothrombotic context associated with chronic inflammation and the increased incidence of conditions like Antiphospholipid Syndrome (APS). The prognosis of hepatic involvement in SLE varies depending on the specific cause of liver injury and the response to treatment, highlighting the importance of careful diagnosis and monitoring.