Abstract
Methotrexate (MTX) is recommended as a first-line treatment for rheumatoid arthritis (RA). There are no strict guidelines regarding monitoring for liver damage in RA patients. This study aimed to evaluate noninvasive diagnostic procedures in assessing liver fibrosis in RA patients. Ninety-six RA patients were recruited for this study. The procollagen III N-terminal peptide (PIIINP) serum level was measured in all patients. The Enhanced Liver Fibrosis score (ELF-1) was calculated for 82 patients. Transient elastography (TE) was performed in 91 patients, those examined were divided into two groups: a study and control group, comprising patients with and without risk factors for liver fibrosis, respectively. The TE result correlated only with the body mass index—BMI (p < 0.05); there was no correlation with the cumulative MTX dose (p = 0.33). The TE result was significantly higher in those with risk factors for liver fibrosis than in those without risk factors (TE result > = 7.1 kPa 28/42 vs 13/41, HR = 2.103, Mann–Whitney U test, approximately 0.02). There was a positive correlation between the PIIINP level and body weight (p = 0.028), cumulative MTX dose (p = 0.007), RA activity (p = 0.028) and diabetes mellitus (DM) (p = 0.001). There was a positive correlation between the ELF-1 score and age (p < 0.001), cumulative MTX dose (p = 0.007) and RA activity (p < 0.001). The PIIINP level and ELF-1 score are not organ specific, and readings may vary depending on RA activity. TE is organ specific and can be performed by a skilled ultrasonographer might be useful to assess actual liver condition.
Highlights
Methotrexate (MTX) is an essential disease-modifying antirheumatic drug (DMARD) used in rheumatoid arthritis (RA) therapy due to its efficacy, relatively good tolerance and low price-to-efficacy ratio [1, 2]
There was no correlation of the Transient elastography (TE) result with any other parameter assessed in our study: procollagen III N-terminal peptide (PIIINP) serum level (p = 0.5); Enhanced Liver Fibrosis (ELF) score (p = 0.56); cumulative MTX dose (p = 0.33)
No other common risk factors for liver fibrosis correlated with the TE result: diabetes mellitus (DM) (Mann–Whitney U test, p = 0.86); concomitant therapy with hepatotoxic drugs (Chi-squared test, p = 0.42)
Summary
Methotrexate (MTX) is an essential disease-modifying antirheumatic drug (DMARD) used in rheumatoid arthritis (RA) therapy due to its efficacy, relatively good tolerance and low price-to-efficacy ratio [1, 2]. The most common side effects are gastrointestinal ailments and hepatotoxicity (usually manifesting as elevated aminotransferase activity). The long-term administration of MTX may cause liver fibrosis; In the European League against Rheumatism (EULAR) recommendations for the management of RA from 2019, there is no information about monitoring for the side effects of therapy or how to manage them. The authors of those recommendations assumed that the clinicians prescribing the drugs would be aware of any potential toxicity [1]. Precise guidelines for monitoring patients undergoing methotrexate therapy comprise recommendations from the Joint American Academy of Dermatology and European Academy of Dermatology and Venerology for the treatment of psoriasis vulgaris [5, 6]
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