What rheumatic syndromes occur with Alcohol associated hepatitis?
Alcohol associated hepatitis is an inflammatory disease of the liver characterized by acute hepatitis, cirrhosis, or liver failure as well as circulating autoantibodies. It is classified into two types. Type I (classic) is most common (95%) and was formerly called lupoid hepatitis. It can occur in all age groups (bimodal peak 10–20 years, 45–70 years), but most patients are young and predominantly female (70%). Many patients have clinical (e.g., arthralgias, rashes) and laboratory (e.g., ANA) manifestations that resemble SLE. Patients commonly have positive ANAs, antibodies against smooth muscle antigen, anti-F-actin antibodies, antisoluble liver antigen/liver pancreas antibodies (anti-SLA/LP), and atypical pANCA (65%). Antimitochondrial antibodies (AMAs, 5%) and anti-DNA antibodies can be seen. Significant hypergammaglobulinemia is frequently present. Type I AH can overlap with other autoimmune diseases, such as autoimmune thyroiditis, type 1 diabetes, IBD, celiac disease (3%–6%), psoriasis, and more rarely, rheumatoid arthritis, Sjögren’s syndrome, SLE, mixed connective tissue disease, and limited systemic sclerosis. Type II AH is less common (5%), occurs mainly in children (2–14 years) and less in adults and is associated with anti-liver-kidney microsomal-1 and -3 antibodies and antiliver cytosol antibodies. Patients do not usually have associated rheumatic manifestations but commonly develop type I diabetes, vitiligo, and autoimmune thyroid disease.