Assessment of Substantial Liver Fibrosis by Real-time Shear Wave Elastography in Methotrexate-Treated Patients With Rheumatoid Arthritis.
OBJECTIVE
A concern about methotrexate (MTX)-related liver fibrosis in patients with rheumatoid arthritis (RA) is still unresolved. This study investigated the correlation between liver stiffness and the cumulative MTX dose and the risk factors associated with substantial liver fibrosis assessed by real-time shear wave elastography (SWE), a recently introduced technique to evaluate liver stiffness in patients with RA.


METHODS
Data from 185 patients with RA were prospectively collected. Patients were divided into 3 groups according to cumulative MTX dose (group 1, total dose <1500 mg; group 2, 1500-4000 mg, and group 3, >4000 mg) and compared with healthy control participants. A Pearson correlation analysis was performed to evaluate correlations between liver stiffness and other clinical and laboratory variables. Substantial liver fibrosis was defined as liver stiffness of greater than 8.6 kPa by SWE. Associated factors were tested in a multivariate logistic analysis.


RESULTS
The mean liver stiffness value in healthy controls was significantly lower than in patients with RA treated with MTX (P< .006), but there was no significant difference among the MTX groups. Liver stiffness and the cumulative MTX dose was not correlated. Substantial liver fibrosis was detected only in 9 patients (4.9%). Multivariate analysis adjusted by age and sex revealed that only a high body mass index (odds ratio, 1.79; 95% confidence interval, 1.34-2.39; P < .001) was associated with liver stiffness of greater than 8.6 kPa.


CONCLUSIONS
Substantial liver fibrosis on SWE was observed in about 5% of MTX-treated patients with RA and was associated with only a high body mass index but not with the cumulative MTX dose, suggesting that other comorbidities might have a more important role in liver fibrosis.
Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.).
Tae Yeob
TY
Kim
Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.).
Ji Yeoun
JY
Kim
Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.). sonjh@hanyang.ac.kr.
Joo Hyun
JH
Sohn
Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.).
Hye-Soon
HS
Lee
Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.).
So-Young
SY
Bang
Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.).
Yongsoo
Y
Kim
Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.).
Min Yeong
MY
Kim
Departments of Internal Medicine (T.Y.K., J.Y.K., J.H.S., H.-S.L., S.-Y.B.) and Radiology (Y.K.), Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea; Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (M.Y.K.); and Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (W.K.J.).
Woo Kyoung
WK
Jeong
D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology*; D015984:Causality; D056486:Chemical and Drug Induced Liver Injury / Q000000981:diagnostic imaging / Q000453:epidemiology; D015897:Comorbidity; D003199:Computer Systems; D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012680:Sensitivity and Specificity
D018501:Antirheumatic Agents; D008727:Methotrexate
gastrointestinal ultrasound; liver fibrosis; liver stiffness; methotrexate; rheumatoid arthritis; shear wave elastography