CLINICAL IMPLICATIONS OF LIVER-BIOPSY FINDINGS IN COLLAGEN-VASCULAR DISORDERS

We surveyed over a 5-year period liver abnormalities in all patients w ith collagen-vascular disorders in whom liver histology was obtained, including 46 patients with systemic lupus erythematosus, rheumatoid ar thritis, primary Sjogren's syndrome, periarteritis nodosa, mixed cryog lobulinemia, Wegener's granulomatosis, systemic sclerosis, and other c onditions. Histological appearances diagnostic of the primary conditio n were only found in three patients, each of whom had periarteritis no dosa. Significant chronic liver disease was found in 11 patients (24%) , in five of whom a strong clinical suspicion of severe chronic liver disease already existed. Clinically inapparent but potentially signifi cant chronic liver disease was found predominantly in patients with mi xed cryoglobulinemia or sicca syndrome. Seventeen percent of all biops ies suggested drug induced hepatitis. In patients with collagen-vascul ar diseases and abnormal liver function tests, histological examinatio n of the liver is most frequently of value in indicating drug-induced liver damage. Significant chronic liver disease is common but usually clinically apparent. In patients with periarteritis nodosa and mixed c ryoglobulinemia, liver biopsy may be of value diagnostically, revealin g serious liver disease with prognostic and therapeutic implications.