Liver involvement is a frequent but often underrecognized manifestation in systemic lupus erythematosus (SLE). The aim of this study was to determine the prevalence, etiological spectrum, clinical-laboratory correlations, diagnostic challenges, and outcomes of liver damage in a cohort of SLE patients. This retrospective observational cohort study included 87 adult SLE patients with documented liver function test abnormalities from a rheumatology-hepatology referral center. Data were collected on demographics, SLE activity (SLEDAI-2K), laboratory parameters, medication history, imaging, and liver biopsy results (available in 38 patients). Etiological diagnosis was assigned by consensus of a rheumatologist and hepatologist after exclusion of alternative causes. Statistical analysis included descriptive statistics, group comparisons, and multivariate logistic regression. Liver involvement was detected in 27.9% of screened SLE patients. The median age was 38 years (IQR 29–47), with female predominance (94.3%). The most common etiologies were drug-induced liver injury (39.1%, mainly methotrexate and azathioprine), lupus hepatitis (20.7%), autoimmune hepatitis overlap (13.8%), and non-alcoholic fatty liver disease (12.6%). Most cases presented with mild asymptomatic transaminitis (78.2%). Liver biopsy showed macrovesicular steatosis (68.4%), lobular inflammation (55.3%), and mild interface hepatitis (42.1%); advanced fibrosis/cirrhosis occurred exclusively in the AIH-SLE overlap group. Lupus hepatitis was associated with higher SLEDAI scores (median 14 vs. 8, p=0.002) and anti-ribosomal P positivity (38.9% vs. 9.1%, p=0.011). Drug-induced cases had higher cumulative glucocorticoid exposure and high reversibility after drug withdrawal (88.2%).

systemic lupus erythematosus, lupus hepatitis, liver damage, drug-induced liver injury, autoimmune hepatitis overlap, non-alcoholic fatty liver disease, antiphospholipid syndrome, liver biopsy, differential diagnosis, glucocorticoid therapy

Tareev EM. Collagenoses. M.;1965:380. [Tareev E.M. Collagenoses. Moscow;1965:380 (In Russ.)].

Runyon BA, LaBrecque DR, Anuras S. The spectrum of liver dysfunction in systemic lupus erythematosus. Report of 33 histologically proved cases and review of the literature. Am J Med. 1980;69(2):187-194. doi: 10.1016/0002-9343(80)90378-2

Piga M, Vacca A, Porru G, Cauli A, Mathieu A. Liver involvement in systemic lupus erythematosus: incidence, clinical course and outcome of lupus hepatitis. Clin Exp Rheumatol. 2010;28(4):504-510.

Chowdhary VR, Crowson CS, Poterucha JJ, Moder KG. Liver involvement in systemic lupus erythematosus: case review Original studies of 40 patients. J Rheumatol. 2008;35(11):2159-2164. doi: 10.3899/jrheum.080336

Bessone F, Poles N, Roma MG. Challenge of liver disease in systemic lupus erythematosus: Clues for diagnosis and hints for pathogenesis. World J Hepatol. 2014;6(6):394-409. doi: 10.4254/ wjh.v6.i6.394

Brewer BN, Kamen DL. Gastrointestinal and hepatic disease in systemic lupus erythematosus. Rheum Dis Clin North Am. 2018;44(1):165-175. doi: 10.1016/j.rdc.2017.09.011

Zheng RH, Wang JH, Wang SB, Chen J, Guan WM, Chen MH. Clinical and immunopathological features of patients with lupus hepatitis. Chin Med J (Engl). 2013;126(2):260-266. doi: 10.3760/cma.j.issn.0366-6999.20121153

Khalifa M, Benjazia E, Rezgui A, Ghannouchi N, Alaoua A, Braham A, et al. Lupus hepatitis: A case series of 12 patients. Rev Med Interne. 2011;32(6):347-349. doi: 10.1016/j. revmed.2010.10.357

Li C, Zhao J, Zhao Y. Hepatic infarction caused by antiphospholipid syndrome secondary to systemic lupus erythematosus. 2019;46(7):755-756. doi: 10.3899/jrheum.181241

Maruoka M, Tsunoda S, Furukawa T, Honda O, Yoshikawa T, Fujita K, et al. A case of HELLP syndrome at 34w-pregnancy with systemic lupus erythematosus and antiphospholipid antibody syndrome; Importance of measurement of VW factor. Nihon Rinsho Meneki Gakkai Kaishi. 2015;38(2):121-126. doi: 10.2177/jsci.38.121

Uthman I, Khamashta M. The abdominal manifestations of the antiphospholipid syndrome. Rheumatology (Oxford). 2007;46(11):1641-1647. doi: 10.1093/rheumatology/kem158

Sakhel K, Usta IM, Hannoun A, Arayssi T, Nassar AH. Liver infarction in a woman with systemic lupus erythematosus and secondary anti-phospholipid and HELLP syndrome. Scand J Rheumatol. 2006;35(5):405-408. doi: 10.1080/03009740600588343

Efe C, Purnak T, Ozaslan E, Ozbalkan Z, Karaaslan Y, Altiparmak E, et al. Autoimmune liver disease in patients with systemic lupus erythematosus: A retrospective analysis of 147 cases. Scand J Gastroenterol. 2011;46(6):732-737. doi: 10.3109/00365521.2011.558114

Isoda N, et al. Systemic lupus erythematosus with steroid induced non-alcoholic steatohepatitis: A case report. Ryumachi. 2003;43(4):667-671.

Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725. doi: 10.1002/art.1780400928

Gazkhanovna, M. A., Makhmatovich, A. K., & Utkirovich, D. U. (2022). Clinical efficacy of extracorporeal and intravascular hemocorrection methods in psoriasis. ACADEMICIA: An International Multidisciplinary Research Journal, 12(2), 313-318.

Madasheva, A. G., & Abdiev, K. M. (2023). Blood transfusion therapy in patients with vitamin B12 deficiency anemia after resection of 2/3 of the stomach. Science and Education, 4(5), 407-412.

Мадашева, А. Г. (2022). Коррекция диффузной алопеции при железодефицитной анемии. Science and Education, 3(12), 231-236.

Мадашева, А. Г. (2022). Клинико-неврологические изменения у больных гемофилией с мышечными патологиями. Science and Education, 3(12), 175-181.

МАДАШЕВА, А., БЕРГЕР, И., МАХМУДОВА, А., АБДИЕВ, К., & АМЕРОВА, Д. (2025). ЛАБОРАТОРНАЯ ДИАГНОСТИКА. ВОСТОЧНАЯ ЕВРОПА. ЛАБОРАТОРНАЯ ДИАГНОСТИКА, 14(1), 87-96.

Мадашева, А. Г., & Махмудова, А. Д. (2021). Биохимические показатели у больных гемофилией с мышечными патологиями до и после лечения. Форум молодых ученых, (4 (56)), 233-238.

Мадашева, А. Г., Дадажанов, У. Д., Абдиев, К. М., Маматкулова, Ф. Х., & Махмудова, А. Д. (2019). Динамика электронейромиографических показателей и эффективность электрической стимуляции мышц у больных гемофилией с мышечными атрофиями. Достижения науки и образования, (10 (51)), 26-30.