S. Darabian, Faculty of Arts, University of British Columbia.
J.P. Wade, MD, J. Kur, MD, M. Badii, MD, Division of Rheumatology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada.
J Rheumatol. 2022 Jun;49(6):558-565. doi: 10.3899/jrheum.211281. Epub 2022 Mar 15.
Methotrexate (MTX) is often the primary medication to treat various rheumatic diseases (RDs) because of its low cost and its demonstrated efficacy in controlling disease activity. However, a concern has been the potential for hepatic fibrosis associated with long-term MTX usage. This study investigated the association between cumulative MTX intake and development of liver fibrosis by utilizing noninvasive transient elastography (FibroScan).
All patients with inflammatory arthritis treated with MTX were offered screening with FibroScan. A certified technician measured liver stiffness after patients adhered to a fast. Relevant clinical information was obtained by patient survey and medical records review. The population was divided into quartiles based on participants' cumulative dosage of MTX.
Five hundred twenty patients with RD were included in this study. The prevalence of stages F3 or F4 liver fibrosis was 13.3% in the control group and 12.7% in the entire sample. Compared with subgroup 1 (control with cumulative MTX exposure of ≤ 499 mg), MTX subgroups 2 to 4 were not significantly correlated with higher FibroScan scores ( = 0.82, 0.59, and 0.18, respectively). In multivariable linear regression analysis, statistically significant factors for liver stiffness were BMI, waist circumference, male sex, and age.
No significant correlation between the cumulative MTX dosage and liver stiffness, even at high MTX doses, was observed. The analyses showed significant correlations between the FibroScan score and BMI. These findings were reassuring in that current rheumatology practice appears to be safe and effective in screening for liver fibrosis in patients on long-term low-dose MTX therapy.
甲氨蝶呤（MTX）由于其成本低且在控制疾病活动方面具有显著疗效，因此常用于治疗各种风湿性疾病（RDs）。然而，长期使用 MTX 可能会导致肝纤维化，这一问题引起了人们的关注。本研究通过使用瞬时弹性成像（FibroScan）技术，探讨了 MTX 累积摄入量与肝纤维化发展之间的关系。
所有接受 MTX 治疗的炎性关节炎患者均接受 FibroScan 筛查。经患者禁食后，由认证技术员测量肝脏硬度。通过患者问卷调查和病历回顾获取相关临床信息。根据参与者的 MTX 累积剂量，将人群分为四组。
本研究共纳入 520 例 RD 患者。对照组和全样本组的 F3 或 F4 期肝纤维化患病率分别为 13.3%和 12.7%。与亚组 1（累积 MTX 暴露量≤499mg 的对照组）相比，MTX 亚组 2 至 4 与更高的 FibroScan 评分无显著相关性（分别为=0.82、0.59 和 0.18）。在多变量线性回归分析中，与肝硬度相关的统计学显著因素为 BMI、腰围、男性和年龄。
即使在高 MTX 剂量下，也未观察到 MTX 累积剂量与肝硬度之间存在显著相关性。分析表明，FibroScan 评分与 BMI 之间存在显著相关性。这些发现令人放心，因为目前的风湿病学实践在长期低剂量 MTX 治疗患者中筛查肝纤维化似乎是安全有效的。
