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AB0369 Associated Diseases and Lesions of the Liver in Rheumatoid Arthritis – a Postmortem Clinicopathologic Study of 161 Rheumatoid Arthritis Patients
  1. M. Bély1,
  2. Ά. Apáthy2
  1. 1Department of Pathology, Hospital of the Order of the Brothers of Saint John of God
  2. 2Department of Rheumatology, St. Margaret Clinic, Budapest, Hungary

Abstract

Background Hepatic insufficiency may be caused by various associated diseases accompanying rheumatoid arthritis (RA) or by complications of RA.

Objectives Tha aim of this study was to determine the associated diseases and lesions of the liver in RA.

Methods A randomized autopsy population of 161 in-patients with RA was studied. RA was confirmed clinically according to the criteria of ACR. Tissue samples of the liver were available for histologic evaluation in 153 of these 161 patients. The associated diseases, complication(s), and causes of death were determined on the basis of clinical protocols and autopsy findings, and confirmed by a detailed review of extensive histological material (1-30 tissue blocks) from each liver. In order to assess the influence and disease modifying effect of coexistent complications, the Youle's association coefficients were determined by c2 -test.

Results Associated diseases of the liver, and hepatic complications related to RA existed simultaneously. The incidence of associated liver diseases and hepatic complications in RA are summarized in Table 1.

Table 1

Vasculitis involved the liver in 13, out of 35 cases of systemic vasculitis (8.49%), amyloidosis was present in 26, out of 32 generalized secondary AA amyloidosis (16.99%) and sepsis (Septic hepatitis) in 5, out of 21patients with generalized septic infection (3.27%). RA was associated in 13 (8.49%) cases with fibrous-fibrocaseous pulmonary tuberculosis. In 6 of 13 (3.92%) patients tuberculosis was accompanied by miliary granulomatous dissemination. Out of 6 patiens with disseminated miliary tuberculosis, the liver was involved by epitheloid granulomatous hepatitis in 3 (1.96%) cases. Only 2 (1.31%) of 153 RA patients died of liver due to acute or subacute liver necrosis. Significant correlations were found between reactive hepatitis and systemic vasculitis (Q =0.4760, c2 =7.1429 - p<0.005), between reactive hepatitis and generalized secondary amyloidosis (Q =0.4970, c2 =5.8380 - p<0.005), furthermore between fatty liver and alcoholic hepatitis (Q =1, c2 =16.1923 - p<0.0005). There was no significant correlation between reactive hepatitis and generalized septic infection (Q =0.4286, c2 =0.0285), nor between reactive hepatitis and miliary epitheloid granulomatous hepatitis (Q =0.3506, c2 =0.0156).

Conclusions Specific rheumatoid liver diseases were not found in our autopsy population with RA. The characteristic eosinophilic hepatitis may exist in rheumatoid arthritis, like eosinophilic polymyositis, fascitis, myocarditis, eosinophilic pneumonia. RA associated PBC (granulomatous cholangitis) may accompany rheumatoid arthritis as a secondary autoimmune phenomenon

Disclosure of Interest None declared

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