The reverse of the coin: Methotrexate and liver fibrosis in a group of psoriatic arthritis patients

Abstract

Objectives. We aimed to assess the presence of liver fibrosis using transient elastography in a group of PsA patients, compared to controls, and its possible relationship with MTX treatment. Methods. We performed a prospective study on 41 patients diagnosed with PsA admitted to the Rheumatology Department of the Emergency County Hospital Craiova and a control group, of 20 sex and age-matched subjects. Patients data included demographic, clinical and laboratory parameters and were collected from every patient in accordance to the study protocol. Liver stiffness was evaluated using transient elastograhy, by an experienced investigator, using Fibroscan system (Echosens, Paris, France). Results. After assessing liver fibrosis (LF) by transient elastography, we obtained statistically significant values compared to controls (6.04+1.65 kPa vs 4.16 +0.93 kPa, p = 0.002); liver fibrosis was found in 11 patients (26.81%), 9 of them undergoing MTX treatment. Analyzing the impact of MTX treatment, we found statistically significant values between the two groups (6.04+1.65 kPa for MTX treated group vs 5.35+1.30kPa, p = 0.03 for non-MTX patients). Analyzing the differences between patients with/without liver fibrosis, we reckoned the following data: no differences for sex, age, alcohol consumption, hypertension, diabetes or hepatic function; significant differences were observed for BMI, dyslipidemia and fatty liver. Conclusions. Hepatic involvement, especially liver fibrosis might be underestimated in PsA patients, and it is necessary to be properly and periodically evaluated in order to prevent further complications and maintain the efficient and safe dose of MTX, the first line therapeutic agent chosen for these patients. Non invasive hepatic imaging methods, such as transient elastography should certainly be considered for screening, along with a proper monitoring of comorbidities.

Keywords

• psoriatic arthritis
• liver fibrosis
• methotrexate
• transient elastography