title: Methotrexate-associated nonalcoholic fatty liver disease with transaminitis in rheumatoid arthritis.
abstract: BACKGROUND
  The aim of this study was to determine the risk factors of MTX-associated nonalcoholic fatty liver disease (NAFLD) with transaminitis in a cohort of rheumatoid arthritis (RA) patients from Singapore.
  
  
  METHODS
  Patients who developed ultrasound proven NAFLD with transaminitis while on MTX therapy were identified. The demographic and clinical characteristics of the above patients (cases) were compiled and compared with age- and gender-matched controls who were RA patients on long standing MTX therapy without any episode of transaminitis.
  
  
  RESULTS
  Among the 978 patients who had received MTX, the prevalence of MTX-associated NAFLD was 4.7% (46 patients). Compared to the controls, the cases had significantly higher mean cumulative dose of MTX (4.03 ± 2.25 g versus 10.04 ± 9.94 g, P ≤ 0.05), weekly dose of MTX (11.3 ± 4.8 mg versus 13.1 ± 4.4 mg weekly, P = 0.033), and fasting blood glucose (P = 0.029). Following multivariate regression analysis, only cumulative dose of MTX remained significant (P = 0.015). Among the cases, the cumulative dose of MTX was found to have a significant positive correlation with the alanine transaminase (ALT) level (P < 0.05, standardised beta coefficient 0.512).
  
  
  CONCLUSIONS
  The cumulative dose of MTX was the only independent predictor of MTX-associated NAFLD with transaminitis.
authors: Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433 ; Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
authors: Rajalingham
authors: 0000-0001-7028-334X
authors: R
authors: Sakthiswary
authors: Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433.
authors: Grace Yin Lai
authors: GY
authors: Chan
authors: Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433.
authors: Ee Tzun
authors: ET
authors: Koh
authors: Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433.
authors: Khai Pang
authors: 0000-0003-4060-5525
authors: KP
authors: Leong
authors: Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433.
authors: Bernard Yu Hor
authors: BY
authors: Thong
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012846:Singapore
chemical_list: D000410:Alanine Transaminase; D008727:Methotrexate