Classic signs of liver disease include jaundice, or yellowing of the skin, and a swollen abdomen. However, doctors also associate certain joint and muscle issues with liver disease.

A common cause of joint pain in people with liver disease is arthritis, which is inflammation of the joints. Arthritis can cause joint swelling, stiffness, and pain.

In late stage liver disease, a person may develop cirrhosis. This is where scar tissue replaces healthy tissue, preventing the liver from functioning correctly. The incidence of septic arthritis, which occurs due to an infection, is up to two times greater in those with cirrhosis.

This article looks at joint and muscle pain with liver disease and its causes.

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Yes, joint and muscle pain can be signs of liver disease. However, they are not always direct symptoms of it.

“Liver disease” is an umbrella term for various conditions that affect the liver. Some examples include:

Each type of liver disease affects a person in different ways, and may contribute to joint pain for different reasons. Joint pain may be a:

  • direct symptom of the illness
  • side effect of treatment
  • sign of a coexisting condition
  • complication of liver disease

Doctors associate various musculoskeletal issues with chronic liver disease. These include:

  • muscle wasting
  • septic arthritis
  • prosthetic joint infection
  • osteoporosis, a loss of bone density
  • changes in bone mineral metabolism
  • death of bone tissue

Cirrhosis is also a risk factor for complications following joint replacement surgery. It results in longer hospital stays, higher costs, and increased mortality rates.

There are several reasons why joint pain can develop in people with liver disease.

Viral hepatitis

Hepatitis is liver inflammation. Viruses such as the hepatitis C virus (HCV) can cause it. Viruses can also affect other parts of the body, such as the joints and muscles.

Around 2 in 3 people with HCV have rheumatological disorders, such as pain in the joints and muscles. These complications arise as the immune system fights the virus.

With HCV, the virus multiplies continually. This means the immune system must work overtime to fight the infection, causing widespread inflammation. This can lead to inflamed and painful joints and muscles.

Some medications that treat HCV, such as peginterferon, can also cause joint pain as a side effect.


NAFLD occurs when fat accumulates in liver cells. However, this does not happen because of alcohol misuse.

In nonalcoholic fatty liver (NAFL), the fat deposits are fairly harmless. However, NAFL can progress to nonalcoholic steatohepatitis, which is liver inflammation. Doctors consider it a progressive form of NAFLD, as it can lead to cirrhosis and liver cancer.

Around 1 in 3 adults in the United States have NAFLD. The condition has strong links with inflammatory arthritis, and in particular, psoriatic arthritis (PsA).


In hemochromatosis, iron builds up in the body to harmful levels. Without treatment, the iron can damage the liver, heart, other organs, and joints.

A person with hemochromatosis may feel weak and have joint pain, particularly in their knees and hands. They may also have pain in their abdomen over their liver and darkening skin. In severe cases, a person can develop cirrhosis.

Sometimes, it is not liver disease itself that causes joint or muscle pain. Instead, the pain may be the result of another condition. This condition may be the cause of liver inflammation or occur alongside it.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune condition that primarily affects the joints. It occurs when the immune system mistakenly attacks joint linings, causing inflammation. This leads to swelling, joint pain, and stiffness.

RA can develop in people with hepatitis C and NAFLD.

Psoriasis and PsA

Psoriasis is a skin condition that causes scaly, itchy patches. Up to 3 in 10 people with psoriasis also have PsA. This is a type of inflammatory arthritis that can cause joint pain and stiffness, as well as other symptoms.

People with these inflammatory conditions have an increased risk of NAFLD and liver damage. Doctors link the conditions with obesity, diabetes, and metabolic syndrome, which are all risk factors for NAFLD.


Lupus is a chronic autoimmune condition that can affect various parts of the body, including the joints, skin, and organs. It occurs when the immune system attacks healthy tissue by mistake. This results in inflammation and pain in the joints and muscles, as well as other parts of the body.

Up to 23% of people with lupus develop hepatitis and have abnormal liver enzymes.


Gout is a type of arthritis that causes sudden, severe episodes of joint pain and swelling. It occurs when there is too much uric acid in the blood. The uric acid forms crystals in the joints, causing pain and inflammation.

Some studies show that people with high uric acid levels have more than twice the risk of elevated liver enzymes. People with elevated uric acid levels are also more likely to develop liver dysfunction.

Joint and muscle pain can have many different causes. If the pain is severe, persistent, or accompanied by other symptoms, a person should contact a doctor for a diagnosis.

It is especially important to talk with a doctor if a person suspects they may have undiagnosed liver disease or an infection such as HCV.

A doctor can provide advice and recommendations for managing or treating the condition. Treatment options will vary depending on the underlying cause.

Joint and muscle pain are common symptoms or complications of liver disease. The pain can be caused by the immune system fighting an infection, such as viral hepatitis.

Joint pain may also be a side effect of medications, or the result of conditions with links to liver disease, such as RA.

If a person is unsure why they have muscle pain or wants help managing this symptom, they should talk with a doctor.