A pragmatic non-invasive assessment of liver fibrosis in patients with psoriasis, rheumatoid arthritis or Crohn's disease receiving methotrexate therapy

Clin Res Hepatol Gastroenterol. 2020 Jan-Jun:44S:100003. doi: 10.1016/j.clirex.2020.100003. Epub 2020 Feb 8.

Abstract

Background and aims: The reported hepatotoxicity of methotrexate underlines the need for a repeated non-invasive and reliable evaluation of liver fibrosis. We estimated, using a non-invasive strategy, the prevalence of significant liver fibrosis in patients treated by methotrexate and the predictors of significant fibrosis (fibrosis≥F2).

Methods: Fibrosis was prospectively evaluated using 9 non-invasive tests in consecutive patients with psoriasis, rheumatoid arthritis, or Crohn's disease. Significant fibrosis was assessed without liver biopsy by defining a "specific method" (result given by the majority of the tests) and a "sensitive method" (at least one test indicating a stage≥F2).

Results: One hundred and thirty-one patients (66 Psoriasis, 40 rheumatoid arthritis, and 25 Crohn's disease) were enrolled, including 83 receiving methotrexate. Seven tests were performed on average per patient, with a complete concordance in 75% of cases. Fibroscan® was interpretable in only 61% of patients. The best performances (AUROC>0.9) for predicting significant fibrosis were obtained by tests dedicated to steatohepatitis (FibroMeter NAFLD, NFS and FPI). The prevalence of fibrosis≥F2 according to the "specific" or the "sensitive" assessment of fibrosis was 10% and 28%, respectively. Methotrexate exposure did not influence the fibrosis stage. Factors independently associated with significant fibrosis according our "sensitive method" were age, male gender, and metabolic syndrome.

Conclusion: We provided a non-invasive approach for identifying liver fibrosis≥F2 by using 8 biochemical tests and Fibroscan®. In this population, the risk of significant fibrosis was related to age, male gender, and presence of metabolic syndrome, but was not influenced by methotrexate.

Keywords: Crohn's disease; Liver fibrosis; Metabolic syndrome; Methotrexate; Non-alcoholic steatohepatitis; Non-invasive fibrosis marker; Psoriasis; Rheumatoid arthritis; Transient elastography.

Publication types

  • Observational Study

MeSH terms

  • Age Factors
  • Arthritis, Rheumatoid / drug therapy*
  • Crohn Disease / drug therapy*
  • Elasticity Imaging Techniques
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Liver Cirrhosis / chemically induced*
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / epidemiology
  • Male
  • Methotrexate / adverse effects*
  • Methotrexate / therapeutic use
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Psoriasis / drug therapy*
  • Sex Factors

Substances

  • Immunosuppressive Agents
  • Methotrexate