Rheumatoid arthritis: study nixes link between MTX and liver stiffness, fibrosis

  • Erre GL & al.
  • Eur J Intern Med
  • 29.08.2019

  • von Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Methotrexate (MTX) therapy is associated with neither liver stiffness nor liver fibrosis in patients with rheumatoid arthritis (RA).

Why this matters

  • This is the first study to use noninvasive real-time 2-dimensional shear-wave elastography.
  • Findings suggest that MTX should remain the first-line treatment for RA.

Study design

  • Cross-sectional case series of 140 consecutive RA patients being treated with MTX vs 2 control groups: MTX-naive RA patients (n=33), and age- and sex-matched healthy blood donors (HD group, n=100).
  • Liver fibrosis was defined by values ≥7.1 Kilopascals (kPa) using real-time 2-dimensional shear-wave elastography.
  • Funding: Fondazione Banco di Sardegna.

Key results

  • Liver stiffness, albeit within the normal range, was higher in RA patients than in the HD group, but irrespective of MTX therapy.
    • HD: 4.32±0.7 kPa (mean±standard deviation).
    • MTX-naive RA: 4.92±0.8 kPa.
    • MTX-treated RA: 4.85±0.9 kPa (P<.0005 for trend>
  • Liver stiffness was not associated with cumulative MTX dose.
    • MTX
    • MTX 1-3 g: 4.90±1.1 kPa.
    • MTX >3 g: 4.80±0.9 kPa (P=.610).
  • Liver fibrosis was diagnosed in 4 patients in the MTX-treated RA group vs 0 in both control groups (P=.145).
    • The highest kPa value was 7.6, but no abnormalities on liver function tests or clinical signs of hepatic failure were observed.

Limitations

  • Cross-sectional, single-center design.
  • Possible selection bias.