Nodular regenerative hyperplasia of the liver in rheumatic diseases: report of seven cases and review of the literature.

Nodular regenerative hyperplasia (NRH) of the liver is an uncommon pathologic finding associated, in most cases, with rheumatic and hematologic diseases. Although its pathogenesis remains unclear, NRH probably results from liver regeneration to maintain its functional capacity after ischemia-induced injury. An intrahepatic microvascular occlusive mechanism has been considered most likely pathogenetically. NRH may lead to portal hypertension. Thus, the diagnosis of Felty's syndrome must be considered with caution in patients with rheumatoid arthritis (RA) and NRH of the liver. We report seven additional cases of NRH in patients with rheumatic disorders and review the literature to determine the patterns of clinical presentation and natural history of this condition. We also report four patients (three systemic lupus erythematosus [SLE] and one primary antiphospholipid syndrome [PAPS]) in whom antiphospholipid antibodies may have played a role in the genesis of NRH.

[Anti-DNA determination using Crithidia luciliae. Specificity and clinical usefulness in systemic lupus erythematosus]. / Anti-DNA par Crithidia luciliae. Spécificité et utilité clinique dans le lupus érythémateux systémique.

The authors determined the existence of native anti-DNA antibodies by the crithidia lucilae (anti-DNA-CL) test in 44 patients suffering from systemic lupus erythematosus (SLE), 48 with rheumatoid arthritis (RA), 12 with scleroderma, 8 with polymyositis and/or dermatomyositis, 12 with mixed connective tissue disease, 53 with chronic liver disease and 100 blood donors in order to establish the specificity of the test in SLE, its possible correlation with the degree of clinical activity and the presence or absence of neuropathy, and its possible use in the therapeutic control of the disease. The presence of anti DNA-CL was specific to SLE. It was seen at significant titres only in patients with active disease. Anti DNA-CL antibodies capable of activating complement were seen more frequently and at higher titres in cases with active nephritis. In longitudinal studies it was seen that clinical activity or inactivity were associated with parallel oscillations in anti DNA-CL titres. These data confirmed the specificity of the method and its usefulness in the diagnosis and therapeutic control of the process.