P285 The utility of FibroScan in the monitoring of methotrexate therapy in inflammatory arthritis patients

Abstract

Abstract Background/Aims Methotrexate (MTX) is a drug used to treat inflammatory arthropathies. A significant side effect of MTX is liver fibrosis. There are numerous ways to screen for liver fibrosis, liver biopsy being the gold-standard, but its invasive nature and accompanying adverse effects limits its utility as a screening tool. Guidelines advise the use of liver function tests, yet liver enzymes and synthetic liver function may be normal even in advanced disease. This leaves the question of the best screening tool for liver fibrosis unanswered. This data collection seeks to explore the utility of FibroScan in the screening of liver fibrosis in rheumatoid arthritis and psoriatic arthritis patients taking long-term methotrexate. Methods A hospital-based survey was conducted where electronic records of rheumatoid and psoriatic arthritis patients, who were referred for FibroScan due to being on long-term methotrexate therapy, were reviewed. Long-term MTX therapy was defined as MTX use of greater than ten years. The following data were collected: demographics, BMI, MTX duration, results of FibroScan, and impact on management. The primary outcome was to determine whether FibroScan altered the patients’ management as this has not been tested in the literature previously. ‘Change of management' was defined as reduction of MTX dose or cessation of MTX therapy. Three secondary outcomes were assessed. Firstly, relationship of BMI (body mass index) with FibroScan result. FibroScan result consisted of median elastography and controlled attenuation parameter (CAP). Secondly, relationship of BMI with impact on management. Finally, relationship of MTX therapy duration with impact on management. Results A total of 16 patients were identified. With regards to primary outcome, 29.4% of patients had their management changed secondary to FibroScan. In terms of secondary outcomes, positive correlations were found between BMI and median elastography and CAP. Mean BMI was greater in patients who had their management changed. Patients whose MTX was stopped had a greater mean MTX therapy duration. Conclusion These data show the utility of FibroScan to screen for liver fibrosis in patients on long-term MTX therapy. It recommends that practitioners consider FibroScan in patients who have been taking MTX for longer than 10 years, especially if they have associated risk factors such as high BMI. Disclosure M.H. Amin: None. E. Justice: None.