A 12-month prospective study was undertaken to determine prevalence and causes of clinical and subclinical liver disease in 260 SLE patients and 100 controls, and to look for concordance between‘unexplained’enzyme elevations and SLE activity. Hepatic status was assessed clini cally and by tests of liver function with additional tests where indicated. In 76 per cent of patients there were no clinical or laboratory abnormalities. Liver enzyme elevations occurred in 23 per cent. In 15 per cent there were identifiable causes, and in 8 per cent the elevations were‘unexplained’, compared with none in the controls. Four patients had persistent‘unexplained’mild transaminase elevations. Liver tissue available from 14 patients revealed no serious lesions. Data on 156 patients with more than four assessments were analysed. In 12 of 15 patients with‘unexplained’transaminase elevations, changes in SGPT levels were concordant with SLE activity. This study suggests that subclinical liver disease is a manif
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