Complications of Rheumatoid Arthritis and Associated Diseases of the Liver - A Postmortem Clinicopathologic Study of 152 Patients

Background: Systemic rheumatoid vasculitis of autoimmune origin, systemic (secondary, inflammatory) AA amyloidosis and acute bacterial septic infection with lethal outcome are major complications of rheumatoid arthritis (RA), which may involve the liver.

In addition to these complications of RA, a wide spectrum of liver diseases, such as reactive, viral, toxic or eosinophilic hepatitis, fatty liver changes, etc. with or without cirrhotic transformation may associate with RA.

The aim of this study was to determine the prevalence of RA related complications and associated diseases of the liver, and to analyze the possible relationship between them.

Patients and Methods: 152 random autopsy patients with RA were studied. RA was confirmed clinically according to the criteria of the ACR.

The prevalence of complications and associated diseases of the liver were confirmed by a detailed review of extensive histological material.

Results: There was a very strong statistical relationship between RA related complications and their manifestation in the liver.

The links were also positive and significant between systemic rheumatoid vasculitis and eosinophilic hepatitis, furthermore between chronic passive hepatitis or alcoholic hepatitis and alcoholic steatosis.

The statistical correlation between RA related complications and associated diseases of the liver were not significant, even in most of the cases inverse with negative colliquations coefficient.

Conclusions: A distinct liver disease specific for RA was not found in our autopsy population.

RA related systemic complications and associated diseases of the liver are independent entities.

We found that the patients’ life expectancy was declining with acute bacterial septic infection or hepatitis, and with amyloid A deposition in the liver, and these patients died earlier.

The risk of chronic active hepatitis (with or without cirrhotic transformation) increased in the late stage of RA.

Apart from these exceptions RA related complications or associated diseases of the liver developed in both sexes, and at any time in the course of RA; onset or duration of RA did not influence the prevalence of RA related complications or associated diseases of the liver.

Keywords: Rheumatoid arthritis, autoimmune (rheumatoid) vasculitis, AA amyloidosis, lethal septic infection, associated diseases of the liver.