Liver involvement in polymyalgia rheumatica

Abstract

The incidence of abnormal results in liver function tests was determined in 37 of 51 patients with polymyalgia rheumatica (PMR) or temporal arteritis. Fine-needle biopsies fo the liver were performed on 6 of these patients and the bile canalicular network and liver cytology were studied in the aspirate by enzyme-cytochemical methods. Of the 37 patients in whom it was measured, 23 (62%) had elevated concentrations of serum alkaline phosphatases (AP), mainly of hepatic origin. The concentrations of other serum enzymes associated with hepatic function were normal in all 37 patients. BSP retention was studied in 13 patients and was abnormal in 6 (46%). Three of the 4 patients for whom smears were stained for AP activity had an increase in this activity in their bile canaliculi that corresponded to a rise in the serum concentration of AP. In one of these 3 patients, smears stained for naphthylamidase showed that bile canaliculi had a calibre wider than normal and had granular walls. A second biopsy performed 10 days showed a partial reversal of these changes. Mild fatty infiltration of the liver cells was seen in 2 patients; one patient whose serum concentration of AP was normal also had normal liver cells and bile canaliculi. The structural changes in the bile canaliculi detected in one patient may be evidence of a subclinical hepatic disease associated with PMR. The cholestatic hepatic dysfunction, common in PMR and manifested in over half of our patients by elevated serum AP levels, can easily be confirmed with special staining methods for visualizing the bile canaliculi in cytological liver specimens.