StemCell Therapy

Although liver fibrosis and liver stiffness are more common in patients with rheumatoid arthritis (RA) compared with the general population, methotrexate (MTX) treatment does not appear to be a contributing factor, according to research published in the European Journal of Internal Medicine.

Using data from consecutive patients with RA, researchers sought to determine the role of MTX therapy in the development of liver stiffness and liver fibrosis. Categorically, patients who were MTX-nave and MTX-treated were assessed via real-time 2-dimensional shear wave elastography technology (2D.SWE.SSI).

The total cohort included 140 MTX-treated, 33 MTX-nave, and 100 healthy controls with a similar mean age and gender distribution across all groups. However, MTX-nave patients had a significantly shorter disease duration and higher Health Assessment Questionnaire compared with patients who were treated with MTX. In the MTX-treated group, the mean cumulative dose of MTX was 37153560 mg, with a mean time of treatment exposure of 71.366.4 months.

Liver stiffness (kPa) values were significantly lower in healthy controls compared with both patients who were MTX-nave and MTX-treated (4.320.7 vs 4.920.8 and 4.850.9, respectively). The difference in kPA values between the 2 MTX groups was not statistically significant.

Researchers, through the results of a multiple linear regression analysis, found that RA diagnosis, older age, and being a man were independently associated with higher liver stiffness values. An additional multiple linear regression analysis found that increasing age and being a man, but not treatment with and cumulative dose of MTX, were independently associated with increasing liver stiffness in patients with RA.

Based on a proposed cutoff of 7.1 kPa, only 4 out of 173 patients with RA were classified as having significant liver fibrosis (kPa values range 7.1-7.6). All 4 of these patients were in the MTX-treated RA group. However, these patients did not have liver function abnormalities or clinical signs of hepatic failure.

One study limitation is the lack of histological confirmation of hepatic fibrosis, which researchers note would have been difficult to justify from an ethical point of view. Additional limitations include the possibility of selection bias and the cross-sectional nature of the study design.

Significant liver fibrosis and liver stiffness in RA patients appear to be independent of MTX use, the researchers concluded. [The] 2D.SWE.SSI technique could be a promising tool to assess the severity of and to follow-up liver stiffness in RA patients and other chronic inflammatory conditions under MTX treatment.

Reference

Erre GL, Cadoni ML, Meloni P, et al. Methotrexate therapy is not associated with increased liver stiffness and significant liver fibrosis in rheumatoid arthritis patients: a cross-sectional controlled study with real-time two-dimensional shear wave elastography [published online August 29, 2019]. Eur J Intern Med. doi: 10.1016/j.ejim.2019.08.022

The rest is here:
Liver Fibrosis, Stiffness Rates in Rheumatoid Arthritis and Methotrexate Therapy - Rheumatology Advisor

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