Methotrexate (MTX) was frequently the first-line treatment for rheumatic diseases (RDs) due to its inexpensive cost and proven effectiveness in decreasing disease activity. For a study, researchers sought to explore the connection between cumulative MTX intake and the development of liver fibrosis using noninvasive transient elastography (FibroScan). All MTX-treated patients with inflammatory arthritis were provided FibroScan screening. A qualified technician assessed the liver stiffness of fasting patients. Relevant clinical information was acquired by a survey of patients and a review of their medical records. The population was classified into quartiles based on the cumulative MTX dosage of the subjects. This study included 520 individuals diagnosed with RD. The prevalence of liver fibrosis stages F3 or F4 was 13.3% in the control group and 12.7% in the whole sample. MTX subgroups 2 to 4 were not significantly connected with higher FibroScan scores (P=0.82, 0.59, and 0.18, respectively) compared to subgroup 1 (controls with a cumulative MTX exposure of ≤499 mg). In multivariable linear regression analysis, BMI, waist circumference, male gender, and age were statistically significant predictors for liver stiffness. No association between cumulative MTX dosage and liver stiffness was seen even at high MTX doses. Analyses revealed strong relationships between the FibroScan score and body mass index (BMI). According to the outcomes, current rheumatology practice was safe and effective for screening for liver fibrosis in patients on long-term, low-dose MTX therapy.