Liver biopsies upsilon liver scans in methotrexate-treated patients with psoriasis

Abstract

The possibility of hepatotoxic reactions in 24 patients receiving long-term methotrexate therapy for psoriasis was evaluated by both liver biopsies and technetium TC 99 m sulfur-colloid liver scans. The two diagnostic methods were compared in a retrospective analysis. Six of 17 patients with clinically normal liver biopsy interpretations were found to have abnormal liver scans, while three of five patients with histologically proved fibrosis had completely normal liver scans. We conclude that hepatotoxic reactions from long-term methotrexate use in psoriasis cannot be reliably evaluated by the technetium Tc 99m sulfur colloid liver scan.

Low dose pulse methotrexate in rheumatoid arthritis: an 8-year experience with hepatotoxicity

“…Preliminary reports, including our own study of the liver histology of 52 patients who had received at least two years of methotrexate, suggest that patients with RA may be at somewhat lower risk for developing hepatotoxicity than patients with psoriasis (3,4,17,18); however, long-term follow-up is not available. Noninvasive measures for evaluating hepatic function in patients with RA including standard liver chemistries, galactose tolerance tests, liver scans and fasting bile salt measurements have been found to be too insensitive and nonspecific to be of value in detecting hepatic fibrosis (19)(20)(21). Nonetheless, it is still recommended that standard liver chemistries be routinely obtained.…”

Diagnostic accuracy of noninvasive markers of liver fibrosis in patients with psoriasis taking methotrexate: a systematic review and meta-analysis

“…Liver histology was classified using a variety of systems (see Supporting Information Table S10). The Roenigk system, developed by the Psoriasis Task Force to evaluate liver biopsies in patients with psoriasis taking methotrexate, is recommended by the AAD and was used in six studies . The remainder used other recognized scores or their own methods.…”

“…Three studies evaluated radionuclide scanning ( n = 136), demonstrating pooled and predictive sensitivities of 60% and 62%, and specificities of 77% and 73%.…”

“…Table summarizes the studies. From 622 studies, 18 fulfilled the inclusion criteria . Data from Risteli et al .…”

“…Studies were excluded largely because of incorrect study design or insufficient data to perform statistical analysis (for excluded studies, see Supporting Information Table S8). Seven studies were prospective and 11 retrospective . All studies except one were performed in Europe or the U.S.A. between 1982 and 2012.…”