title: Autoimmune hepatitis after long-term methotrexate therapy for rheumatoid arthritis.
abstract: Methotrexate (MTX) therapy may be effective in patients with rheumatoid arthritis (RA) or psoriasis due to its anti-inflammatory and immunosuppressive properties. Potential liver toxicity of MTX exists, but the incidence of MTX-specific lesions in liver biopsy of patients with RA and elevated serum transaminase levels is rare; however, severe hepatic damage may occurs unexpectedly in these patients. We describe the first documented case of an adult patient with RA who developed an acute flare of severe hepatitis after long-term therapy with MTX. Autoantibodies positivity, elevated serum IgG levels and compatible liver biopsy findings prompted us to diagnose autoimmune hepatitis, most probably triggered by a breakdown of immune tolerance induced by MTX. A complete remission was achieved in this patient with corticosteroids therapy.
authors: Service of Digestive Diseases and Ciberehd (Planta 3), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Diego de León 62, 28006 Madrid, Spain. rmoreno.hlpr@salud.madrid.org
authors: Ricardo
authors: R
authors: Moreno-Otero
authors: Luisa
authors: L
authors: García-Buey
authors: Asunción
authors: A
authors: García-Sanchez
authors: María
authors: M
authors: Trapero-Marugán
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001323:Autoantibodies / Q000276:immunology; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use; D019693:Hepatitis, Autoimmune / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies; D005938:Glucocorticoids; D007074:Immunoglobulin G; D008727:Methotrexate