High liver enzymes can be a result of lupus, and my rheumatologist said some of this is not uncommon in lupus patients. Although it is uncommon, lupus can also attack a patient’s liver, causing a more pronounced elevation in liver enzymes, such as ASTs and ALTs. When this happened to me, my symptoms included pervasive malaise, nausea, itching, and worsening of my overall health and lupus activity.
My family doctor was persistent in finding an answer, and wouldn’t let my rheumatologist rest until they found one. They consulted and referred me to a gastroenterologist. Many tests were completed to determine if perhaps my chemo drugs (methotrexate or imuran) were the culprit, or perhaps infection such as hepatitis. Imuran is sometimes used to treat liver involvement in lupus, but I was already taking it!
When everything else was ruled out, the specialist determined that lupus was indeed damaging my liver. In my situation, it ended up being a mixed blessing. I had to stop taking the chemotherapy drugs that were contraindicated with liver problems that somewhat had been controlling my CNS lupus symptoms. Steroids were used as a short-term intervention, and I became a candidate for a phase III clinical trial of rituxan.
Lupus patients with elevated liver enzymes should keep in close touch with their doctors and continue to follow up with recommended lab work. My doctor monitored my liver enzymes closely for over a year, since alternately they would appear normal, but elevated the next time. When levels stopped returning to normal, my doctor thought it wasn’t just normal lupus activity.
Two rituxan infusions put me into a near 5-year remission, stopped the lupus attack on my liver, and controlled many of my most severe lupus problems. My ALTs and ASTs have been normal ever since, and I was able to cut my lupus medications back to just the basics – plaquenil, low dose maintenance steroids and folic acid.
Although now the long-lasting near remission is ending, some new rituxan infusions may be in the works. However, liver enzymes have still been behaving nicely so far.