The screening of liver function enzymes may be useful in detecting occult hepatitis, cholestasis, and cholestatic hepatitis in patients with systemic sclerosis, according to a study published in Open Access Rheumatology: Research and Reviews. 

Complications involving the liver can occur without symptoms in patients with systemic sclerosis. The most common liver pathologies detected via liver function test (LFT) are cholestasis and hepatitis; combined, they affect around one-quarter of the patient population. However, these disorders usually do not progress to the point at which liver transplantation is necessary.

Liver pathology in systemic sclerosis ranges from the benign to the malignant; reports indicate that the prevalence of liver cancer is higher among individuals with this disorder compared with the general population. The authors of the study thus sought to better understand how LFT screening can inform a diagnosis of liver disease and whether clinicians are able to use the information gathered to predict various disease parameters.

They analyzed the data of adult patients with systemic scleroderma who were seen at the Scleroderma Clinic of Khon Kaen University in Thailand between January 2012 and November 2019. Patients with incomplete liver function data were excluded. The research team then accessed key parameters, such as laboratory data, history of infection, concomitant medications, the diagnosis of liver disease(s), and the progression of said disease(s).

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They reviewed the data of 674 patients with systemic sclerosis. Among them, 439 had abnormal LFTs that resulted in a diagnosis of hepatitis, cholestasis, or cholestatic hepatitis. Hepatitis had the highest occurrence among the 3 liver pathologies. Statistically, the incidence of abnormal LFTs among patients with systemic sclerosis was 10.2 per 100 person-years, and the median time to first detection of abnormal LFTs was 7.0 years. The research team also reported a number of factors that were predictive of abnormal LFTs: old age, alcohol consumption, and the use of immunosuppressive drugs, among others. 

The authors suggested that more longitudinal research is needed to validate the long-term outcomes of this study. 


Sawadpanich K, Promasen P, Mairiang P, et al. Incidence and predictors of an abnormal liver function test among 674 systemic sclerosis patients: a cohort studyOpen Access Rheumatol. Published online May 16, 2023. doi:10.2147/OARRR.S410165