title: Significance of liver biopsy for the evaluation of methotrexate-induced liver damage in patients with rheumatoid arthritis.
abstract: It is well recognized that long-term administration of methotrexate (MTX) in patients with rheumatoid arthritis (RA) can induce liver fibrosis via a steatohepatitis-like inflammatory process. Several non-invasive tests have been investigated as alternatives to liver biopsy, which is, however, still recognized as a final diagnostic modality to detect the MTX-induced liver damage. To clarify whether there is a significant discrepancy between clinical estimations and pathologic findings of this hepatic condition, we performed a following comparative study. Four RA patients (4 women, age 67-80 yr) with MTX-induced liver damage were reviewed. The severity of hepatic damage estimated clinically was compared with histopathologic findings. Consequently, the liver biopsies showed the relatively earlier stages of and milder degrees of hepatic damages than the clinical estimations. The histopathologic findings were more reliable and useful than any other clinical examinations, to plan and modify the treatment strategies, especially in cases of liver damages with multiple etiologies besides MTX. These findings suggest that liver biopsy is an unavoidable examination to assess precisely MTX-induced liver damage. Non-invasive tests may be useful to monitor the hepatic condition of RA patients receiving MTX but do not constitute an acceptable alternative to liver biopsy.
authors.affiliation: Department of Gastroenterology, Takatsuki General Hospital 1-3-13, Kosobecho, Takatsuki 569-1192, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Osuga
authors.affiliation: Department of Pathology, Takatsuki General Hospital 1-3-13, Kosobecho, Takatsuki 569-1192, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ikura
authors.affiliation: Department of Gastroenterology, Takatsuki General Hospital 1-3-13, Kosobecho, Takatsuki 569-1192, Japan.
authors.forename: Chikara
authors.initials: C
authors.lastname: Kadota
authors.affiliation: Department of Gastroenterology, Takatsuki General Hospital 1-3-13, Kosobecho, Takatsuki 569-1192, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hirano
authors.affiliation: Department of Pathology, Takatsuki General Hospital 1-3-13, Kosobecho, Takatsuki 569-1192, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Iwai
authors.affiliation: Department of Gastroenterology, Takatsuki General Hospital 1-3-13, Kosobecho, Takatsuki 569-1192, Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Hayakumo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000473:pathology*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: Methotrexate; biopsy; liver fibrosis; rheumatoid arthritis; steatohepatitis