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Lupus and the Liver

Those with lupus / SLE  have a 25-50% chance of developing abnormal liver values in their lifetime.  Read on to find out more about the liver, how it can be affected by lupus and what you can do to take care of this vital organ!

 

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Introduction

Does the health and well-being of your liver pop into your mind when you’re not feeling well?
Chances are, probably not. The liver isn’t exactly the first thing you think of when considering
lupus and its many symptoms and potential complications. The liver is complex; we know it is
there (though maybe not always exactly where “there” is) and we know that it is vital to life, but that’s
probably about it. The following explores this critical organ: its functions, symptoms when affected by lupus, and what can be done to keep it healthy.

Function of the Liver

The darkish-red liver is on the right side of your body, under the diaphragm, on top of the
stomach, kidney, and intestines. Its two lobes and eight segments are host to thousands of lobules,
which connect small ducts to larger ducts that eventually form the hepatic duct. The hepatic duct is
responsible for transporting bile produced by liver cells to the gallbladder and eventually, the duodenum.

The liver does an incredible number of things, including:

  • Excreting bile which breaks down fats and prepares them for digestion and absorption.
  • The balance and creation of nutrients for the body to use.
  • The metabolism of drugs and clearing of harmful substances from the blood.
  • Production of proteins for blood plasma.
  • Production of cholesterol and proteins that carry fat through the body.
  • Storage and release of glucose.
  • Processing hemoglobin for iron storage.
  • The conversion of harmful ammonia into urea which is excreted in urine.
  • Regulating blood clotting.
  • Producing immune factors and removing bacteria from the bloodstream.
  • Clearing out bilirubin which can turn the skin and eyes yellow if there is too much of it in the system.

 

 Conditions of the Liver, Diagnostics, Treatment

While liver test abnormalities are typically common for individuals with lupus due to medication
side effects (which is why you receive routine blood tests while on medication to test for any
drug implications), individuals with lupus typically do not suffer from adverse liver conditions.
However, if active inflammation of the liver does occur, several medical conditions may be the
culprits. Just like with anything else, knowledge is key, and it is good to have a general
understanding of these conditions should you or someone you know experience new symptoms
or receive a diagnosis or treatment options.

Lupus Hepatitis

“Hepatitis” simply means inflammation of the liver. Inflammation of the liver can also occur
from medications, viral hepatitis B and C, alcohol, and genetic disorders. If an individual with
lupus is tested for a liver disorder and the testing comes out negative for any of the
aforementioned causes yet inflammation still exists, the inflammation may be due to lupus
hepatitis; the body sees its own liver as a foreign object and attacks it. Lupus hepatitis occurs in
roughly 5% of individuals with lupus and is more common in children than adults. A liver biopsy
can determine if an individual is experiencing lupus hepatitis. Typically, the inflammation is
mild, resulting in no significant problems or discomfort. Sometimes, however, inflammation can
be more pervasive and include fatigue, loss of appetite, pain, fluid in the abdomen, jaundice, and
even cirrhosis. Cirrhosis symptoms can include fatigue, easy bleeding and bruising, jaundice,
swelling of the legs, redness in the palms of hands, and spider like vessels appearing on the skin.
Cirrhosis can cause irreversible damage and scarring to the liver, but it’s very rare in lupus
hepatitis.

Treatment includes corticosteroids and/or immunosuppressant medications.

Small Vessel and Hepatic Vasculitis

Vasculitis is the inflammation and damage of the blood vessels or blood vessel walls. Depending
on what organ the vasculitis may affect determines the type of vasculitis which is occurring.
When vasculitis affects the liver, the condition is considered small vessel vasculitis because it
affects the capillaries and smaller vessels of the liver. While the cause of vasculitis is still
unknown, autoimmunity is thought to be one of the underlying causes of these vascular
disorders. Biopsies, blood test, x-rays, urinalysis, and even angiograms may determine the onset
of the disorder.

Though rare, hepatic vasculitis may also occur when the arteries (the large blood vessels) of the
liver become inflamed. Liver enzyme levels may increase as well as the occurrence of abdominal
discomfort.

Treatment includes corticosteroids and/or immunosuppressant medications.

 

Antiphospholipid Syndrome

Though rare and primarily affecting young women when it does occur, antiphospholipid
syndrome is an autoimmune disorder which arises when abnormal proteins called antiphospholipid autoantibodies are present in the blood. This causes improper blood flow and dangerous clotting that may occur in the veins and arteries. This can even result in miscarriage during pregnancy. Most commonly, this complication occurs when the blood of the large veins that drain blood from the liver clots, resulting in the condition doctors call Budd-Chiari syndrome.

Budd-Chiari typically occurs when a clot blocks or narrows the hepatic veins. The liver enlarges,
and the spleen may as well, with a backup of fluid and blood. This increased pressure (called
portal hypertension) along with an enlarged and potentially damaged liver, may lead to fluid
accumulation in the abdomen. The kidneys may also contribute to this condition, as they will
retain salt and water.

Individuals who have Budd-Chiari may experience fatigue, edema (swelling), and/or abdominal
pain. Diagnosing this condition includes blood tests, magnetic resonance imaging of blood
vessels, CT scans, Doppler ultrasonography, and/or liver biopsy.

Treatment includes fibrinolytic (thrombolytic) drugs, anticoagulant/blood thinning drugs,
angioplasty, stent insertion, and/or a procedure called, a transjugular intrahepatic portal-system
shunting (to bypass blood flow away from the liver). This last one involves no scars, but
requires a radiologist to approach the liver from the jugular vein of the neck.

 

Keeping Healthy

Here are some things to consider when keeping your liver healthy:

  • Always avoid smoking, vaping, etc. It only serves to increase the possibility for health complications that may be avoidable for not only yourself, but those around you as well.
  • Avoid heavy consumption of alcohol. Toasting in the new year or your birthday is fine (as long as you don’t have underlying issues with alcohol), but consuming more than a fair share on a daily basis or attending one-to-many happy hours every week can be detrimental to your health and well-being.
  • Eat  greens…and reds…and oranges…and blues. A diet high in antioxidants, fiber, vitamins, and nutrients can help with inflammation throughout the body. It is okay to occasionally have a piece of cake or ice cream sundae, but the scale should always tip in favor of your leafy greens, sumptuous blueberries, and crunchy carrots. Remember to drink plenty of water!
  • Maintain a healthy weight and get up and move when you can. Movement, combined with a healthy diet, will help maintain a healthy weight which will stave off other health complications for the liver.
  • Live as stress-free a life as possible (we know; easier said than done). Engage in activities that bring you peace such as a hobby you love (reading, crafting, painting) or as your time and health allows, volunteer for a cause you are passionate about and love to support. Enjoy time with friends and family; laugh at your dad’s silly jokes, go on a date night with your partner, celebrate a friend’s new job, play Minecraft with the kids. Some hospitals offer health and wellness classes such as stress management; take advantages of these wonderful opportunities to disengage with the frenetic outside world and enjoy what and who you love!

 

In Conclusion

The liver is one of the most complex organs of the body.  It performs dozens of tasks necessary for a healthy life, and lupus can affect it many ways.  It is critical for anyone with lupus to carefully look for symptoms that might indicate liver disease and inflammation and to contact their healthcare team if something is noticed.  Knowing the signs, maintaining proper nutrition and exercise and following your lupus treatment plan are the best way to keep your liver in good condition.

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References

Beisel, C., Lohse A., Teufel, A., & Weiler-Normann, C. (2014) Association of autoimmune hepatitis and systemic lupus erythematodes: A case series and review of the literature.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168105/
Lahita, R. G., &  Phillips, R.H. (2014). Lupus: Everything you need to know (3rd ed.).  Garden City Park, NY: Avery Pub. Group.
Mayo Clinic Staff (2018). Cirrhosis. Retrieved from  https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487
Nabili, S. (2018). Vasculitis. Retrieved from  https://www.emedicinehealth.com/vasculitis/article_em.htm#what_is_the_prognosis_for_v
asculitis
Orfanidis, N. T. (2018). Budd-chiari syndrome. Retrieved from  https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/blood-vessel-disorders-of-the-liver/budd-chiari-syndrome
Stanford Children’s Health (2018). Anatomy and function of the liver. Retrieved from:  https://www.stanfordchildrens.org/en/topic/default?id=anatomy-and-function-of-the-liver-90-P03069
Thomas, D. E. (2014). The lupus encyclopedia: A comprehensive guide for patients and families. Baltimore, MD: Johns Hopkins University Press.
Weselman, K. (2017). Antiphospholipid syndrome. Retrieved from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Antiphospholipid-Syndrome

 

Author:  Liz Heintz

Revised by KFL Team (2021)

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Marylhurst, Oregon. She most recently worked for several years in the healthcare industry. A native of San Fransisco, California, Liz now calls the beautiful Pacific Northwest home.

All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at [email protected] for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus.

All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.

 

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