Hilal Ghizlane, Akasbi Nessrine, Boudouaya Hanae, Salma Ksir, Harzy Taoufik
Department of Rheumatology, CHU Hassan II, Fez, Morocco.
Department of Epidemiology, CHU Hassan II, Fez, Morocco.
Curr Rheumatol Rev. 2020;16(4):293-297. doi: 10.2174/1573397116666200319155247.
Methotrexate (MTX) is a highly effective therapy for patients with rheumatoid arthritis (RA). However, it has been associated with a range of liver related adverse events. The aim of our study was to evaluate the prevalence rate of liver fibrosis in RA patients and to assess the correlation of cumulative MTX dose with hepatic fibrosis in our context.
This is a cross-sectional study, whose goal is to describe and analyze the factors correlated with the liver fibrosis in RA patients treated with methotrexate especially the cumulative dose of MTX, along the period lying between January 2012 and March 2019. The study was carried out in the Rheumatology Department of the University Hospital Hassan II of Fez. The patients have met the assessment of the ACR 2010 criteria. The data was recorded and analyzed using SPSS v20 univariate and bivariate analysis. A value of p <0.05 has been used to identify factors associated with liver fibrosis.
A total of 319 patients with RA were recruited who were on MTX treatment. There were 276 female and 43 male patients (female: male ratio of 6.3). The average age was 53 years + /-12.4 years. The average duration of symptoms was 10.68 +/-6.9 years. RA was seropositive for the rheumatoid factor or the anti-ccp in 90.3 %. Six patients (2%) had developed liver fibrosis while on MTX therapy. In the bivariate analysis, the liver fibrosis is significantly related to the hepatic cytolysis (p<0.001) and to the combination of MTX with other DMARDs (p<0.05). However, the multiple logistic regression analysis did not find any significant association between the groups.
In our context, the prevalence rate of hepatic fibrosis in patients with rheumatoid arthritis under methotrexate is low. It is seen much more in patients treated with methotrexate in combination with other disease-modifying anti-rheumatic drugs (DMARDs). These results require confirmation in a larger number of patients.
甲氨蝶呤（MTX）是治疗类风湿关节炎（RA）患者的一种高效疗法。然而，它与一系列肝脏相关不良事件有关。我们研究的目的是评估RA患者肝纤维化的患病率，并在我们的研究背景下评估MTX累积剂量与肝纤维化的相关性。
这是一项横断面研究，其目的是描述和分析与接受甲氨蝶呤治疗的RA患者肝纤维化相关的因素，特别是MTX的累积剂量，研究时间为2012年1月至2019年3月。该研究在非斯哈桑二世大学医院的风湿病科进行。患者符合美国风湿病学会（ACR）2010标准的评估。使用SPSS v20单变量和双变量分析记录和分析数据。p<0.05的值用于确定与肝纤维化相关的因素。
共招募了319例接受MTX治疗的RA患者。其中女性276例，男性43例（女性：男性比例为6.3）。平均年龄为53岁±12.4岁。症状的平均持续时间为10.68±6.9年。90.3%的RA患者类风湿因子或抗环瓜氨酸肽抗体呈阳性。6例患者（2%）在接受MTX治疗时出现了肝纤维化。在双变量分析中，肝纤维化与肝细胞溶解显著相关（p<0.001），与MTX与其他改善病情抗风湿药（DMARDs）联合使用也显著相关（p<0.05）。然而，多因素logistic回归分析未发现两组之间有任何显著关联。
在我们的研究背景下，接受甲氨蝶呤治疗的类风湿关节炎患者肝纤维化的患病率较低。在接受甲氨蝶呤与其他改善病情抗风湿药（DMARDs）联合治疗的患者中更为常见。这些结果需要在更多患者中得到证实。
