Skip to main content

Advertisement

SpringerLink
Log in

Inflammatorische Erkrankungen mit Leber- und Gelenkbeteiligung

Eine differenzialdiagnostische Herausforderung

Inflammatory diseases with liver and joint involvement

A differential diagnostic challenge

  • Schwerpunkt
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Erhöhte Leberwerte bei Patienten mit rheumatischen Beschwerden erfordern ein umfangreiches differenzialdiagnostisches Denken. Zum einen kann es sich um die hepatische Beteiligung einer primär rheumatologischen Erkrankung handeln. Dies ist allerdings der seltenere Fall. Häufiger ist ein medikamentös-toxischer Leberschaden im Rahmen der Behandlung der Gelenkerkrankung. Zum anderen können Arthralgien auch das Begleitsymptom einer primären Lebererkrankung sein. Die Hämochromatose und die autoimmune Hepatitis sind Beispiele. Weiterhin sind einige Hepatopathien mit Erkrankungen aus dem rheumatischen Formenkreis assoziiert. Insbesondere gilt dies für die primär biliäre Zirrhose (PBC) und die chronische Virushepatitis C (HCV). Erst nach exakter Diagnosestellung kann dem Patienten eine Therapie angeboten werden, die seine Symptome lindert und die Prognose verbessert.

Abstract

Elevated levels of liver enzymes in patients with rheumatic symptoms require a comprehensive differential diagnostic thought process. On the one hand there can be hepatic involvement of primarily rheumatological diseases but this is quite rare. Drug-induced liver injury by antirheumatic medication is more frequent. On the other hand arthralgia can be a sign of primary hepatopathy whereby hemochromatosis and autoimmune hepatitis (AIH) are typical examples. Furthermore, some liver diseases are associated with rheumatological diseases, such as primary biliary cirrhosis (PBC) and chronic hepatitis C infection (HCV). Only an exact diagnosis will lead to specific treatment which will improve the symptoms and course of disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Auguet T, Barragan P, Ramírez R et al (2007) Lamivudine in the treatment of hepatitis B virus-related polyarteritis nodosa. J Clin Rheumatol 13:298–299

    Google Scholar 

  2. Avşar E, Savaş B, Tözün N et al (1998) Successful treatment of polyarteritis nodosa related to hepatitis B virus with interferon alpha as first-line therapy. J Hepatol 28:525–526

    Google Scholar 

  3. Bessone F (2010) Non-steroidal anti-inflammatory drugs: What is the actual risk of liver damage? World J Gastroenterol 16:5651–5661

    Article  PubMed  Google Scholar 

  4. Blendis LM, Ansell ID, Jones KL et al (1970) Liver in Felty’s syndrome. Br Med J 1:131–135

    Article  Google Scholar 

  5. Blendis LM, Lovell D, Barnes CG et al (1978) Oesophageal variceal bleeding in Felty’s syndrome associated with nodular regenerative hyperplasia. Ann Rheum Dis 37:183–186

    Article  PubMed  CAS  Google Scholar 

  6. Blich M, Edoute Y (2004) Clinical manifestations of sarcoid liver disease. J Gastroenterol Hepatol 19:732–737

    Google Scholar 

  7. Carroll GJ, Breidahl WH, Olynyk JK (2012) Characteristics of the arthropathy described in hereditary hemochromatosis. Arthritis Care Res (Hoboken) 64:9–14

    Article  Google Scholar 

  8. Czaja AJ, Morshed SA, Parveen S, Nishioka M (1997) Antibodies to single-stranded and double-stranded DNA in antinuclear antibody-positive type 1-autoimmune hepatitis. Hepatology 26:567–572

    Article  PubMed  CAS  Google Scholar 

  9. Dino O, Provenzano G, Giannuoli G et al (1996) Fulminant hepatic failure in adult onset Still’s disease. J Rheumatol 23:784–785

    Google Scholar 

  10. Geyer JT, Deshpande V (2011) IgG4-associated sialadenitis. Curr Opin Rheumatol 23:95–101

    Article  PubMed  CAS  Google Scholar 

  11. Harvey AM, Shulman LE, Tumulty PA et al (1954) Systemic lupus erythematosus: review of the literature and clinical analysis of 138 cases. Medicine (Baltimore) 33:291–437

    Google Scholar 

  12. Hennes EM, Zeniya M, Czaja AJ et al (2008) Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology 48:169–176

    Article  PubMed  Google Scholar 

  13. Ibn Yacoub Y, Amine B, Bensabbah R, Hajjaj-Hassouni N (2012) Assessment of fatigue and its relationships with disease-related parameters in patients with systemic sclerosis. Clin Rheumatol 31:655–660

    Article  Google Scholar 

  14. Iwai M, Harada Y, Ishii M et al (2003) Autoimmune hepatitis in a patient with systemic lupus erythematosus. Clin Rheumatol 22:234–236

    Article  PubMed  CAS  Google Scholar 

  15. Jones DE, Al-Rifai A, Frith J et al (2010) The independent effects of fatigue and UDCA therapy on mortality in primary biliary cirrhosis: results of a 9 year follow-up. J Hepatol 53:911–917

    Google Scholar 

  16. Laharie D, Seneschal J, Schaeverbeke T et al (2010) Assessment of liver fibrosis with transient elastography and FibroTest in patients treated with methotrexate for chronic inflammatory diseases: a case-control study. J Hepatol 53:1035–1040

    Google Scholar 

  17. Laine L, Goldkind L, Curtis SP et al (2009) How common is diclofenac-associated liver injury? Analysis of 17,289 arthritis patients in a long-term prospective clinical trial. Am J Gastroenterol 104:356–362

    Article  PubMed  Google Scholar 

  18. Lohse AW, Mieli-Vergani G (2011) Autoimmune hepatitis. J Hepatol 55:171–182

    Google Scholar 

  19. Mazzaro C, Monti G, Saccardo F et al (2011) Efficacy and safety of peginterferon alfa-2b plus ribavirin for HCV-positive mixed cryoglobulinemia: a multicentre open-label study. Clin Exp Rheumatol 29:933–941

    PubMed  Google Scholar 

  20. Pavy S, Constantin A, Pham T et al (2006) Methotrexate therapy for rheumatoid arthritis: clinical practice guidelines based on published evidence and expert opinion. Joint Bone Spine 73:388–395

    Article  PubMed  CAS  Google Scholar 

  21. Pease CT, Shattles W, Barrett NK, Maini RN (1993) The arthropathy of Sjögren’s syndrome. Br J Rheumatol 32:609–613

    Article  PubMed  CAS  Google Scholar 

  22. Pistiner M, Wallace DJ, Nessim S et al (1991) Lupus erythematosus in the 1980s: a survey of 570 patients. Semin Arthritis Rheum 21:55–64

    Article  PubMed  CAS  Google Scholar 

  23. Pomeroy C, Knodell RG, Swaim WR et al (1984) Budd-Chiari syndrome in a patient with the lupus anticoagulant. Gastroenterology 86:158–161

    PubMed  CAS  Google Scholar 

  24. Rau R, Pfenninger K, Boni A (1975) Proceedings: Liver function tests and liver biopsies in patients with rheumatoid arthritis. Ann Rheum Dis 34:198–199

    Article  PubMed  CAS  Google Scholar 

  25. Rigamonti C, Shand LM, Feudjo M et al (2006) Clinical features and prognosis of primary biliary cirrhosis associated with systemic sclerosis. Gut 55:388–394

    Article  PubMed  CAS  Google Scholar 

  26. Sahinbegovic E, Dallos T, Aigner E et al (2010) Musculoskeletal disease burden of hereditary hemochromatosis. Arthritis Rheum 62:3792–3798

    Article  PubMed  Google Scholar 

  27. Salliot C, Heijde D van der (2009) Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann Rheum Dis 68:1100–1104

    Article  PubMed  CAS  Google Scholar 

  28. Stone JH, Zen Y, Deshpande V (2012) IgG4-related disease. N Engl J Med 366:539–551

    Google Scholar 

  29. Tsianos EV, Hoofnagle JH, Fox PC et al (1990) Sjögren’s syndrome in patients with primary biliary cirrhosis. Hepatology 11:730–734

    Article  PubMed  CAS  Google Scholar 

  30. Yamaguchi M, Ohta A, Tsunematsu T et al (1992) Preliminary criteria for classification of adult Still’s disease. J Rheumatol 19:424–430

    Google Scholar 

Download references

Danksagung

Wir bedanken uns bei Alexander Quaas, Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, für die Bereitstellung der histologischen Bilder.

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    M. Sebode, C. Schramm & A.W. Lohse

Authors
  1. M. Sebode
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Schramm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A.W. Lohse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Sebode.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sebode, M., Schramm, C. & Lohse, A. Inflammatorische Erkrankungen mit Leber- und Gelenkbeteiligung. Internist 54, 441–448 (2013). https://doi.org/10.1007/s00108-012-3191-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-012-3191-6

Schlüsselwörter

Keywords

Search

Navigation