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ORIGINAL ARTICLE
Year : 2018  |  Volume : 13  |  Issue : 4  |  Page : 246-251

Assessment of hepatic fibrosis in patients with rheumatoid arthritis on long-term methotrexate therapy using transient elastography


1 Department of Rheumatology, Command Hospital (Eastern Command), Kolkata, West Bengal, India
2 Department of Rheumatology, Army Hospital Research and Referral, Delhi, India
3 Department of Gastroenterology, Army Hospital Research and Referral, Delhi, India

Correspondence Address:
Dr. Vivek Vasdev
Department of Rheumatology, Army Hospital Research and Referral, Delhi -110 010
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injr.injr_92_18

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Background: Methotrexate (MTX) is has been associated with hepatotoxicity including hepatic fibrosis; however, the incidence of severe hepatic fibrosis or cirrhosis with MTX use has remained a controversial issue. The gold standard test for detecting liver fibrosis has been a liver biopsy, which is an invasive procedure with potentially serious complications. The transient elastography (TE) is a noninvasive method of assessing hepatic fibrosis. The primary objective of this study was to assess the prevalence of hepatic fibrosis associated with long-term MTX therapy in patients with RA and the secondary objective was to assess the correlation of cumulative MTX dose with hepatic fibrosis as assessed by TE using Fibroscan. Methods: In this cross-sectional study patients with RA who had been on MTX treatment for >5 years were included. Hepatic fibrosis was determined by measuring the hepatic stiffness by TE method (by FibroScan) in kilopascal (kPa) in study patients. The hepatic stiffness of the patient group was compared with that of healthy controls. Results: A total of 160 patients and 63 healthy controls were included in the study. The mean age of the patients was 51±10.9 years and there were 139 female and 21 male patients.The median duration of MTX use was 317.5 weeks (range 260, 1302 years). Median MTX cumulative dose was 4225 mg (range 2340, 18,200 mg). Mean hepatic stiffness was 4.8 kPa (SD 1.35) in the patient group and 4.7 kPa (SD 1.07) in the control group (P = 0.550). Cumulative dose or duration of MTX treatment did not correlate with hepatic fibrosis. Conclusions: Severe hepatic fibrosis or cirrhosis as detected by the TE using Fibroscan was uncommon with high cumulative dose of MTX when administered in the low-dose weekly schedule. The cumulative dose of MTX did not correlate with hepatic fibrosis as assessed by FibroScan.


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