Methotrexate (MTX) is frequently used as the first-line therapy for numerous rheumatic diseases (RDs) due to its inexpensive cost and established efficacy in decreasing disease activity. However, the risk of hepatic fibrosis linked with long-term MTX use has been raised. Using non-invasive transient elastography, researchers for a study explored the relationship between cumulative MTX consumption and the development of liver fibrosis (FibroScan).

All MTX-treated inflammatory arthritis patients were provided FibroScan screening. Following a fast, a qualified technician assessed liver stiffness. A patient survey and a review of medical records yielded pertinent clinical information. The individuals’ cumulative MTX dose was used to split the population into quartiles.

In the study, 520 individuals with RD were enrolled. Stages F3 or F4 hepatic fibrosis were seen in 13.3% of the control group and 12.7% of the whole sample. MTX subgroups 2–4 were not significantly connected with higher FibroScan scores (P=0.82, 0.59, and 0.18, respectively) when compared to subgroup 1 (control with total MTX exposure of ≤499 mg). In multivariable linear regression analysis, BMI, waist size, male sex, and age were statistically significant variables for liver stiffness.

Even at high MTX dosages, there was no significant association between cumulative MTX dosage and liver stiffness. The relationships between the FibroScan score and BMI were significant in the studies. These findings are comforting because current rheumatology practice appears safe and successful in screening for liver fibrosis in patients receiving long-term low-dose MTX treatment.

Reference: jrheum.org/content/49/6/558