Lupus Erythematosus (SLE) is a systemic, multi organ, Autoimmune disease that more common
in women than men and is typically diagnosed during the reproductive age .1 Lupus affects
almost all organs and can present with awide variety of symptoms . Renal and skin
involvement are the most frequently encountered presentation ,however gastrointestinal
involvement is also seen in patients with SLE.2 involvement of liver in SLE is rare and
mostly presents as asymptomatic hepatomegaly subclinical adiposity, and/or increased
liver enzymes.3.4 Elevated transaminase levels may be observed in 15-55% of the patient
population and can be associated with disease activity.4,5 The most common causes are
drug-related liver injury (31%), lupus-associated hepatitis (29%), and fatty liver
disease (18%).6 drugs used in the treatment of SLE patient such as non-steroidal
anti-inflammatory drugs, glucocorticoids, cyclophosphamide ,mycophenolate mofetil,
azathioprine, and methotrexate can all cause hepatotoxicity.7 As such, it is important to
differentiate the etiology and determine whether hepatotoxicity is due to the medications
used or the disease itself.
Non-alcoholic fatty liver disease (NAFLD) and liver fibrosis may both progress to
cirrhosis and cause liver failure. NAFLD is also a risk factor for cardiovascular disease
in the general population, which is also one of the most important causes of morbidity
and mortality in lupus patients.8,9 Even though hepatomegaly and hepatosteatosis are
frequently observed in abdominal imaging performed for other reasons in SLE patients, the
majority of these cases are not evaluated further since the gold standard for diagnosis
is liver biopsy, an invasive procedure associated with a number of serious
complications.10 Therefore, the prognostic significance of NAFLD and liver fibrosis is
still largerly unknown in these patients.
Fibroscan (transient elastography ) is a non-invasive imaging method that evaluates
steatosis and fibrosis by measuring liver stiffness using ultrasonographic sound waves.
It is an acceptable alternative to liver biopsy and is fast , reliable, and reproducible,
enabling screening and disease follow-up.11 It is now widely used to assess liver
fibrosis in various liver diseases; however, currently there is no data on Fibroscan
assessment regarding hepatic involvement in SLE patients. The aim of this study was to
evaluate fatty liver and liver fibrosis in SLE patients using fibroscan and determine
associated factors such as immunosuppressive medications.
.Several non-invasive diagnostic scores for non-alcoholic fatty liver (NAFL) have been
developed one of the most recent scores is HSI score hepatic steatosis index Multivariate
analysis indicated that high serum alanine aminotransferase (ALT) to serum aspartate
aminotransferase (AST) ratio, high body mass index (BMI), and diabetes mellitus were
independent risk factors of NAFLD (all P < 0.001). Using these variables, a formula
was derived by a logistic regression model: hepatic steatosis index (HSI) = 8 × (ALT/AST
ratio) + BMI (+2, if female; +2, if diabetes mellitus). HSI had an area under
receiver-operating curve of 0.812 (95% confidence interval, 0.801-0.824). At values of
<30.0 or >36.0, HSI ruled out NAFLD with a sensitivity of 93.1%, or detected NAFLD
with a specificity of 92.4%, respectively. Of 2692 subjects with HSI <30.0 or >36.0
in the derivation cohort, 2305 (85.6%) were correctly classified. HSI was validated in
the subsequent validation cohort.
HSI is a simple, efficient screening tool for NAFLD that may be utilized for selecting
individuals for liver ultrasonography and for determining the need for lifestyle
modifications.12