Sir.—In the December 1975 issue of the Journal (129:1385,1975), Drs Levy and Yaffe comment: "Rheumatoid arthritis and rheumatic fever per se are not associated with either clinical or biochemical evidence of liver disease." In 1970, however, Schaller et al1 reported five patients with juvenile rheumatoid arthritis, all of whom had marked hepatomegaly and derangement of liver function studies. Two of these five patients had liver biopsy specimens taken at the onset of disease that showed periportal nonspecific inflammation and Kupffer cell hyperplasia. The patients were all under 6 years of age and had the acute febrile type of disease.
In addition, amyloidosis2 of the liver—admittedly most uncommon—may also complicate the course of juvenile rheumatoid arthritis. Kendall et al3 have reported a significant number of adult patients with rheumatoid arthritis and abnormalities of liver function as well.
In conclusion, rheumatoid arthritis may indeed be associated with