Assessment of liver fibrosis by transient elastography in rheumatoid arthritis patients treated with methotrexate |
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| Authors: | Sung-Hoon Park Jung-Yoon Choe Seong-Kyu Kim |
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| Affiliation: | 1. Department of Rheumatology, Institute of Postgraduate Medical Education and Research, SSKM Hospital, 244, A.J.C. Bose Road, Kolkata 700 020, India;2. Department of Radiology, Institute of Postgraduate Medical Education and Research, SSKM Hospital, Kolkata, India;3. Department of Medicine, Department of Rheumatology, Institute of Postgraduate Medical Education and Research, SSKM Hospital, Kolkata, India;1. Division of Rheumatology, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela;2. Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela;3. Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA;1. Rheumatology department, Clermont-Ferrand University Hospital, place Henri-Dunant, 63000 Clermont-Ferrand, France;2. Virology laboratory, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France;3. Biostatistics unit, Clermont-Ferrand University hospital, 63000 Clermont-Ferrand, France;1. Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands;2. Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands;3. Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands;4. Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands;1. Service de rhumatologie, hôpital de Bicêtre, hôpitaux universitaires Paris Sud, Assistance publique–Hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France;2. Inserm U1184, université Paris Sud, 91400 Orsay, France;3. Labex LERMIT, 94270 Le Kremlin-Bicêtre, France;4. CEA, iBiTecS, service d’ingénierie moléculaire des protéines (SIMOPRO), Labex LERMIT, Labex VRI, 91191 Gif-sur-Yvette, France;5. Département de rhumatologie, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex, France;6. Université de Montpellier, 39, rue Université, 34295 Montpellier cedex, France;7. Laboratoire d’immunologie, hôpitaux universitaires Paris Sud, Assistance publique–Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France;8. UMR 996, 92140 Clamart, France;9. Labex LERMIT, 92140 Clamart, France;10. UMR996, faculté de pharmacie, 92290 Châtenay-Malabry, France;1. Pfizer, Collegeville, PA;2. Quintiles, Hawthorne, NY;3. Quintiles-Outcome, Rockville, MD;4. Quintiles-Outcome, Reading, UK;5. Pfizer, Walton Oaks, UK |
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| Abstract: | ObjectiveThis study was designed to assess the degree of liver fibrosis with transient elastography and noninvasive biochemical methods in rheumatoid arthritis patients treated with methotrexate.MethodsWe reviewed the medical records of rheumatoid arthritis patients who were administered methotrexate for more than 3 years. Transient elastography was performed and serological markers of liver fibrosis were evaluated by prospectively and was compared with the result of healthy control group. A correlation of the cumulative dose of methotrexate with the elastography value (kPa) or the level of serological markers was assessed. Two subgroups of patients were compared; patients who received a cumulative dose of methotrexate of less than 4000 mg (group 1) and more than 4000 mg (group 2). A total of 177 consecutive rheumatoid arthritis patients were evaluated.ResultsThe mean cumulative dose of methotrexate was 3988 ± 1566 mg with doses ranging from 652.5 to 10,415 mg. The mean elastography value of all patients was 4.01 ± 0.77 kPa. The kilopascal values and levels of biochemical markers did not correlate with the cumulative dose of methotrexate, but did correlate with the AST to ALT ratio, AST to platelet ratio index, haptoglobin level. Mean kilopascal values were not statistically different for group 1 and group 2 patients. For rheumatoid arthritis patients treated with a high cumulative dose of methotrexate, significant liver fibrosis is rare and is not accurately detected in patients with liver enzyme abnormalities.ConclusionTaking into account the risk and benefit of a liver biopsy, transient elastography can be recommended as an additional diagnostic option. |
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