Histologic liver abnormalities in an autopsy series of patients with rheumatoid arthritis

A retrospective review was performed on 188 autopsied cases of rheumatoidarthritis at our institutions during 1958-1985, prior to the widespread useof methotrexate. Hepatic histology was reported in 182 cases. All availablemicroscopic liver slides from cases in which the autopsy report describedportal tract inflammation, fibrosis, cirrhosis, tumour, amyloid,vasculitis, or infections involving the liver were examined and graded by ahepatic pathologist blinded to the original diagnosis, along with arepresentative sample of cases with reports describing fatty change or nohepatic pathologic abnormalities. Ninety normal and abnormal cases werereviewed from the 182 for which hepatic histology was available. Fifteencases of diffuse fibrosis were identified upon blinded review. Two caseswere graded as severe fibrosis (grades 3 or 4 on a scale of 0-4) without anidentifiable pathologic cause, in both of which the liver disease wassuspected premortem (alcohol abuse and viral hepatitis). Although theincidence of fibrosis in this series is slightly higher than thatpreviously described, serious fibrotic liver disease was rare. Theseresults support the current practice of limiting pre-treatment liverbiopsies prior to methotrexate therapy to patients with suspected liverdisease.