Does Lupus Affect the Liver?

Lupus, also called systemic lupus erythematosus (SLE), is a chronic autoimmune condition in which the body’s immune system generates autoantibodies against various self-antigens. This leads to the targeting and destruction of various tissues and organ systems, which can cause severe symptoms and, in some cases, death. In this article, we provide a brief overview of lupus, discuss which organ systems are typically affected by the disease, and address the question of whether the liver is affected in patients with lupus.
Faith Wershba

Faith Wershba

Postgraduate researcher at the University of Cambridge.

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What is Lupus?

Lupus is a chronic autoimmune disease characterized by inflammation and immune-mediated damage of healthy tissues [1]. Lupus pathogenesis is facilitated by the presence of autoantibodies: proteins which target various self-antigens and facilitate targeted immune activation and damage. In lupus, autoantibodies frequently target nuclear antigens such as double-stranded (ds) DNA and nuclear binding proteins (NBPs) [1]. Lupus may manifest as a localized disease; for example, cutaneous lupus predominantly affects the skin [1]. In patients with systemic lupus, however, multiple organ systems are targeted, leading to system-wide damage [1].

What Organs are Impacted by Lupus?

Various tissues and organ systems may be impacted in lupus, including [1]:

  • Skin
  • Joints
  • Blood
  • Heart
  • Kidney
  • Brain
  • Intestines
  • Pancreas
  • Liver

Can Lupus Affect the Liver?

Lupus can affect the liver, although this occurs relatively rarely. It is estimated that somewhere between 8-23% of patients with systemic lupus experience liver dysfunction [2]. However, it is unclear whether these liver abnormalities are caused by the disease itself or are caused by other factors, such as medications or hepatitis infection [2]. Some researchers have reported a positive association between levels of anti-dsDNA antibodies and lupus-induced hepatic dysfunction [2]; however, further research is needed to elucidate whether there is an underlying biological mechanism which explains this association. In order to determine whether liver inflammation is likely caused by lupus (rather than simply co-occurring with it), differential diagnoses such as alcohol consumption, drug use, viral infection, metabolic disease, and other common causes of liver disease should be eliminated [3].

Symptoms of Liver Damage in Lupus

Lupus patients suffering liver damage may present with [4, 3]:

  • Jaundice
  • Hepatomegaly (liver enlargement)
  • Elevated liver enzymes
  • Cirrhosis
  • Autoimmune hepatitis (identified via biopsy)

Conclusion

Some patients with lupus do experience liver abnormalities, although it is unclear whether such damage is caused by the disease itself or other factors. More commonly, lupus affects organs such as the skin, joints, blood, and kidneys. Some studies have linked increased levels of anti-dsDNA autoantibodies to cases of liver disease, suggesting a compelling area for further study. If anti-dsDNA autoantibodies in lupus patients reliably correlate with liver pathology, these autoantibodies could serve as a useful diagnostic marker for potential cases of liver involvement. Ultimately, further research is needed to determine whether the mechanisms underlying lupus pathogenesis play a causal role in the development of liver dysfunction in patients.

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Faith Wershba

Faith Wershba

Faith obtained her Honour’s Bachelor Degree in Human Biology, Immunology and History & Philosophy of Science at the University of Toronto. Currently, she is a postgraduate researcher at the University of Cambridge, focusing on the philosophy of medicine, science, biomedical research methods, and bioethics.