title: Psoriasis patients with diabetes type 2 are at high risk of developing liver fibrosis during methotrexate treatment.
abstract: OBJECTIVE
  We investigated the impact of diabetes mellitus type 2, overweight, alcohol over-consumption, and chronic hepatitis B or C as risk factors, for liver fibrosis in psoriasis patients treated with methotrexate.
  
  
  METHODS
  One hundred and sixty-nine liver biopsies from 71 patients who underwent liver biopsies as part of the monitoring of methotrexate treatment for psoriasis were reviewed. Fibrosis, steatosis and inflammation were staged according to the NAFLD activity score.
  
  
  RESULTS
  Twenty-six patients had one or more of the risk factors and 25 (96%) of these (median cumulative dose methotrexate 1500 mg) developed liver fibrosis. Of those without risk factor, 26 (58%) (p=0.012) developed fibrosis (median cumulative dose methotrexate 2100 mg). Ten (38%) of the patients with risk factor(s) had severe fibrosis (stage 3-4) (mean cumulative dose methotrexate 1600 mg), while four (9%) (p=0.0012) of those without risk factors had severe fibrosis (median cumulative dose methotrexate 1900 mg).
  
  
  CONCLUSIONS
  Patients with methotrexate treated psoriasis and risk factors for liver disease, especially diabetes type 2 or overweight, are at higher risk of developing severe liver fibrosis compared to those without such risk factors, even when lower cumulative methotrexate doses are given.
authors.affiliation: Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden. peter.rosenberg@karolinska.se
authors.forename: Peter
authors.initials: P
authors.lastname: Rosenberg
authors.forename: Hanna
authors.initials: H
authors.lastname: Urwitz
authors.forename: Anders
authors.initials: A
authors.lastname: Johannesson
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Ros
authors.forename: Johan
authors.initials: J
authors.lastname: Lindholm
authors.forename: Nils
authors.initials: N
authors.lastname: Kinnman
authors.forename: Rolf
authors.initials: R
authors.lastname: Hultcrantz
mesh_terms: D000328:Adult; D000368:Aged; D000438:Alcohols / Q000378:metabolism; D003879:Dermatologic Agents / Q000494:pharmacology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005355:Fibrosis; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000494:pharmacology*; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications* / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D000438:Alcohols; D003879:Dermatologic Agents; D008727:Methotrexate