Abstracts of the 2023 Annual Meeting of the ALEH
More infoMethotrexate (MTX) is the first-line treatment for rheumatoid arthritis (RA). Long-term usage of MTX may lead to liver injury, including the development of progressive liver fibrosis. Nevertheless, the prevalence of this adverse event and its associated risk factors remains unclear in RA patients. This study aimed to investigate the risk of long-term MTX therapy on liver fibrosis in patients with RA.
Materials and MethodsA cross-sectional study was conducted among patients with RA recruited from a rheumatology outpatient clinic. Liver fibrosis was assessed using transient elastography. Only patients who had received MTX were included in the study. Patients with a history of alcohol consumption or with known liver diseases were excluded.
ResultsA total of 128 patients (91.4% women) with a mean age of 60 ± 12 years were enrolled. The duration of MTX therapy ranged from 3 to 306 months (median 106, interquartile range [IQR] 106). MTX was currently being used by 52% of the patients, with a median cumulative dose of 8022 mg (IQR 9363).
Comorbidities among the participants included diabetes mellitus (21.1%), arterial hypertension (63.3%), dyslipidemia (77.2%), metabolic syndrome (60.3%), and a history of tobacco use (31.3%). The median liver stiffness was 4.9kPa (IQR 2.2). Liver stiffness 8.0kPa was observed in 12.5% of the patients and was found to be associated with a history of tobacco use (p=0.004) and larger waist circumference (p=0.001). Liver stiffness showed a positive correlation with waist circumference (Rho = 0.220, p=0.014), while MTX cumulative dose showed a positive correlation with alanine aminotransferase levels (Rho = 0.250, p=0.005).
Conclusions12.5% of the patients with RA exposed to long-term MTX therapy exhibited liver stiffness 8kPa. Tobacco use and larger waist circumference were identified as risk factors for liver fibrosis, while MTX cumulative dose was not associated with progressive liver fibrosis.
