The Liver in Pediatric Rheumatology: A Comprehensive Review

Liver involvement in pediatric rheumatologic diseases is an increasingly recognized but often underappreciated clinical issue. Systemic autoimmune and autoinflammatory disorders including juvenile idiopathic arthritis, systemic lupus erythematosus, juvenile dermatomyositis, systemic vasculitis, and mixed connective tissue disease can all affect hepatic structure and function. The mechanisms of injury are multifactorial, encompassing immune-mediated inflammation, macrophage activation, drug-induced toxicity, and metabolic alterations. Hepatic manifestations range from asymptomatic transaminase elevations to fulminant liver failure, frequently influenced by immunosuppressive therapy and comorbid infections. Early recognition through routine biochemical monitoring, imaging, and targeted autoantibody testing is essential for differentiating primary disease activity from treatment-related injury. Timely, multidisciplinary management involving pediatric rheumatology and hepatology teams can prevent progression to chronic liver disease and optimize outcomes. This review summarizes the current understanding of hepatic pathology in pediatric rheumatology, highlighting diagnostic algorithms, monitoring strategies, and emerging therapeutic considerations.