Assessment of liver fibrosis by transient elastography in rheumatoid arthritis patients treated with methotrexate.
OBJECTIVE
This study was designed to assess the degree of liver fibrosis with transient elastography and noninvasive biochemical methods in rheumatoid arthritis patients treated with methotrexate.


METHODS
We reviewed the medical records of rheumatoid arthritis patients who were administered methotrexate for more than 3 years. Transient elastography was performed and serological markers of liver fibrosis were evaluated by prospectively and was compared with the result of healthy control group. A correlation of the cumulative dose of methotrexate with the elastography value (kPa) or the level of serological markers was assessed. Two subgroups of patients were compared; patients who received a cumulative dose of methotrexate of less than 4000 mg (group 1) and more than 4000 mg (group 2). A total of 177 consecutive rheumatoid arthritis patients were evaluated.


RESULTS
The mean cumulative dose of methotrexate was 3988 ± 1566 mg with doses ranging from 652.5 to 10,415 mg. The mean elastography value of all patients was 4.01 ± 0.77 kPa. The kilopascal values and levels of biochemical markers did not correlate with the cumulative dose of methotrexate, but did correlate with the AST to ALT ratio, AST to platelet ratio index, haptoglobin level. Mean kilopascal values were not statistically different for group 1 and group 2 patients. For rheumatoid arthritis patients treated with a high cumulative dose of methotrexate, significant liver fibrosis is rare and is not accurately detected in patients with liver enzyme abnormalities.


CONCLUSIONS
Taking into account the risk and benefit of a liver biopsy, transient elastography can be recommended as an additional diagnostic option.
Park
Sung-Hoon
SH
Catholic university of Daegu, School of medicine, arthritis and autoimmunity research centre, Daegu, Republic of Korea.
Choe
Jung-Yoon
JY
Kim
Seong-Kyu
SK
D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D001774:Blood Chemical Analysis; D004305:Dose-Response Relationship, Drug; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D008111:Liver Function Tests; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies
D018501:Antirheumatic Agents; D008727:Methotrexate