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