Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 70403, Taiwan.
Department of Pathology, National Cheng Kung University Hospital, Tainan 70403, Taiwan.
World J Gastroenterol. 2022 Jun 21;28(23):2527-2545. doi: 10.3748/wjg.v28.i23.2527.
Systemic rheumatic diseases (SRDs) are chronic, inflammatory, autoimmune disorders with the presence of autoantibodies that may affect any organ or system. Liver dysfunction in SRDs can be associated with prescribed drugs, viral hepatitis, alternative hepatic comorbidities and coexisting autoimmune liver diseases (AILDs), requiring an exclusion of secondary conditions before considering liver involvement. The patterns of overlap diseases depend predominantly on genetic determinants with common susceptible loci widely distributing in both disorders. In AILDs, it is important to identify the overlapping SRDs at an early stage since such a coexistence may influence the disease course and prognosis. Commonly co-occurring SRDs in AILDs are Sjögren syndrome (SS), rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) in autoimmune hepatitis (AIH), and SS, RA or systemic sclerosis in primary biliary cholangitis. Owing to different disease complications and therapies, it is imperative to differentiate between SLE liver involvement and SLE-AIH overlap disease. Therapeutic options can be personalized to control coexisting conditions of liver autoimmunity and rheumatic manifestations in AILD-SRD overlap diseases. The collaboration between hepatologists and rheumatologists can lead to significant advances in managing such a complex scenario. In this review, we provide a comprehensive overview on coexisting AILDs in different SRDs and the therapeutic approach in managing these overlap diseases.
系统性风湿病（SRD）是一种慢性、炎症性、自身免疫性疾病，存在自身抗体，可能影响任何器官或系统。SRD 中的肝功能障碍可能与处方药物、病毒性肝炎、替代肝脏合并症和共存的自身免疫性肝病（AILD）有关，在考虑肝脏受累之前需要排除继发性疾病。重叠疾病的模式主要取决于遗传决定因素，两个疾病中都广泛分布着共同的易感基因座。在 AILD 中，重要的是要在早期识别重叠的 SRD，因为这种共存可能会影响疾病的过程和预后。常见的 AILD 中与 SRD 同时发生的疾病有自身免疫性肝炎中的干燥综合征（SS）、类风湿关节炎（RA）或系统性红斑狼疮（SLE），原发性胆汁性胆管炎中的 SS、RA 或系统性硬化症。由于不同的疾病并发症和治疗方法，区分 SLE 肝脏受累和 SLE-AIH 重叠疾病至关重要。治疗选择可以个性化，以控制 AILD-SRD 重叠疾病中共存的肝脏自身免疫和风湿表现。肝科医生和风湿病医生之间的合作可以在管理这种复杂情况方面取得重大进展。在这篇综述中，我们全面概述了不同 SRD 中并存的 AILD 以及管理这些重叠疾病的治疗方法。
