Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, 226003, India.
Department of Medical Gastroenterology, King George's Medical University, Lucknow, 226003, India.
Clin Rheumatol. 2021 Sep;40(9):3605-3613. doi: 10.1007/s10067-021-05678-8. Epub 2021 Mar 8.
Data on the long-term use of methotrexate (MTX) causing liver fibrosis in patients with rheumatoid arthritis (RA) is sparse. Liver biopsy is the gold standard to assess fibrosis but is an invasive procedure. Transient elastography (TE) by Fibroscan is a noninvasive validated tool to detect and quantify liver fibrosis. The present study aimed to assess the prevalence of liver fibrosis by Fibroscan in patients with RA on long-term MTX therapy and its correlation with cumulative dose of MTX.
This cross-sectional study included adult patients (≥ 18 years age) of RA who had been on MTX for ≥ 3 years. The patients' records were reviewed, and the cumulative dose of MTX was calculated. Liver fibrosis was assessed by TE method, and the cutoff value of 7.1 kPa (kilopascal) was considered abnormal (liver fibrosis). Spearman's rank test was used to assess the correlation between the cumulative dose of MTX and Fibroscan score.
Seventy-five patients were enrolled of which 69 were females (92%). The mean age was 47.2 ± 11.3 years. The mean body mass index and waist circumference were 24.8 ± 3.9 kg/m and 91.6 ± 9.9 cm, respectively. The median duration and cumulative dose of MTX were 336 weeks (interquartile range,144-912 weeks) and 6300 mg (interquartile range, 2400-22,000 mg), respectively. The mean liver stiffness was 5.22 ± 2.03 kPa. Twelve patients (16%) had Fibroscan score ≥ 7.1 kPa, of which 3 patients had severe liver stiffness (9.5 to 12.5 kPa) and one patient had liver stiffness in the range of cirrhosis (> 12.5 kPa). Fibroscan scores significantly correlated with cumulative dose of MTX (r= 0.30, p = 0.008).
Long-term MTX therapy in RA was associated with increased liver stiffness on Fibroscan. Key Points • Fibroscan is a useful tool for monitoring MTX-induced liver fibrosis. • Liver fibrosis as evidenced by increased liver stiffness on Fibroscan is prevalent among patients on long-term MTX therapy for RA.
关于甲氨蝶呤（MTX）长期使用导致类风湿关节炎（RA）患者肝纤维化的数据很少。肝活检是评估纤维化的金标准，但它是一种有创的程序。瞬时弹性成像（TE）通过 Fibroscan 是一种非侵入性的验证工具，可用于检测和量化肝纤维化。本研究旨在通过 Fibroscan 评估长期接受 MTX 治疗的 RA 患者的肝纤维化患病率及其与 MTX 累积剂量的相关性。
这是一项横断面研究，纳入了接受 MTX 治疗≥3 年的成年 RA 患者（≥18 岁）。回顾患者记录，并计算 MTX 的累积剂量。通过 TE 方法评估肝纤维化，将 7.1 kPa（千帕）的临界值视为异常（肝纤维化）。采用 Spearman 秩检验评估 MTX 累积剂量与 Fibroscan 评分之间的相关性。
共纳入 75 例患者，其中 69 例为女性（92%）。平均年龄为 47.2±11.3 岁。平均体重指数和腰围分别为 24.8±3.9 kg/m 和 91.6±9.9 cm。MTX 的中位持续时间和累积剂量分别为 336 周（四分位距 144-912 周）和 6300 mg（四分位距 2400-22,000 mg）。平均肝硬度为 5.22±2.03 kPa。12 例（16%）患者的 Fibroscan 评分≥7.1 kPa，其中 3 例患者肝硬度严重（9.5 至 12.5 kPa），1 例患者肝硬度处于肝硬化范围（>12.5 kPa）。Fibroscan 评分与 MTX 累积剂量显著相关（r=0.30，p=0.008）。
RA 患者长期接受 MTX 治疗与 Fibroscan 上肝硬度增加有关。关键点 • Fibroscan 是监测 MTX 诱导的肝纤维化的有用工具。• 接受长期 MTX 治疗的 RA 患者中，肝纤维化表现为 Fibroscan 上肝硬度增加。
