Clinical implications of liver biopsy findings in collagen-vascular disorders.

We surveyed over a 5-year period liver abnormalities in all patients with collagen-vascular disorders in whom liver histology was obtained, including 46 patients with systemic lupus erythematosus, rheumatoid arthritis, primary Sjogren's syndrome, periarteritis nodosa, mixed cryoglobulinemia, Wegener's granulomatosis, systemic sclerosis, and other conditions. Histological appearances diagnostic of the primary condition were only found in three patients, each of whom had periarteritis nodosa. 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 significant chronic liver disease was found predominantly in patients with mixed cryoglobulinemia or sicca syndrome. Seventeen percent of all biopsies suggested drug induced hepatitis. In patients with collagen-vascular diseases and abnormal liver function tests, histological examination 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 cryoglobulinemia, liver biopsy may be of value diagnostically, revealing serious liver disease with prognostic and therapeutic implications.