Abstract

PREVALENCE OF LIVER FIBROSIS DETECTED BY TRANSIENT ELASTOGRAPHY IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH METHOTREXATE

Kitti Chuenyong*, Thanakrit Proyklang, MD, Kittiwan Sumethkul, MD and Piyathida Hansomburana, MD

Abstract

Background: Methotrexate is the main drug used to treat rheumatoid arthritis (RA), but it can cause liver fibrosis. In the past, liver biopsy was required to assess the degree of fibrosis, but nowadays a noninvasive test known as transient elastography is available and has been shown to be equally effective. We aimed to determine the prevalence and risk factors of liver fibrosis in rheumatoid arthritis patients treated with methotrexate using TE. Methods: This study was conducted to evaluate liver stiffness using TE in RA patients without pre-existing liver diseases who had taken a cumulative dose of methotrexate of more than 1,500 mg over a period of more than 3 years. Patients with TE of more than 7.1 kPa and more than 9.5 kPa were classified as having significant and advanced fibrosis respectively. Results: A Total of 100 patients were included. The average duration of methotrexate exposure was 8.2±4.2 years and the average cumulative dose was 4,227.5±1,925.1 mg. Both significant fibrosis (11%) and advanced fibrosis (5%) were found in our study. Only BMI and CAP were found to be risk factors. Conclusions: Future prospective research may need to exclude NAFLD in order to assess the effects of MTX alone.

Keywords: Methotrexate, Liver fibrosis, Transient elastography, Fibroscan.