Liver fibrosis quantified by image analysis in methotrexate-treated patients with psoriasis

Nohlgård, C.; Rubio, Carlos A.; Kock, Y.; Hammar, H

doi:10.1016/0190-9622(93)70006-f

Cited by 25 publications

(20 citation statements)

References 14 publications

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“…The American Association of Reumatology has provided guidelines for monitoring patients receiving Methotrexate therapy as there is a known relation between this treatment and hepatotoxicity [78].…”

Section: Drug Induced Liver Injury (Dili) Examplesmentioning

confidence: 99%

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Rethinking the Role of Liver Biopsy in the Era of Personalized Medicine

Taltavull¹

2012

Liver Biopsy - Indications, Procedures, Results

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Section: Drug Induced Liver Injury (Dili) Examplesmentioning

confidence: 99%

“…Now patients with psoriasis are also treated with this drug, albeit at a lower dose. Many potentially hepatotoxic medications, used in such cases are worth investigating [78].…”

Section: Drug Induced Liver Injury (Dili) Examplesmentioning

confidence: 99%

Rethinking the Role of Liver Biopsy in the Era of Personalized Medicine

Taltavull¹

2012

Liver Biopsy - Indications, Procedures, Results

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“…4 Recently, we reported preliminary results on the characteristics of bile ducts stained with anticytokeratin 7 (CK7), 5 using a monoclonal antibody that reacts with the 54 kDa cytokeratin intermediate filament protein of a large number of epithelial cell types, including many ductal and glandular epithelial cells. In the liver, hepatocytes are unreactive, whereas the epithelial cells of the bile ducts are strongly positive.…”

mentioning

confidence: 99%

“…In the liver, hepatocytes are unreactive, whereas the epithelial cells of the bile ducts are strongly positive. 5 The aim of our study was to investigate the structural characteristics and distribution of CK7 stained bile ducts in a relatively large number of liver biopsies from patients with primary biliary cirrhosis or chronic hepatitis.…”

mentioning

confidence: 99%

Qualitative and quantitative differences between bile ducts in chronic hepatitis and in primary biliary cirrhosis

Rubio

2000

J Clin Pathol

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Aim-Lymphocytic infiltration in the portal triads usually conceals the detection-in haematoxylin and eosin (H&E) stained sections-of bile ducts in two liver diseases: chronic hepatitis and primary biliary cirrhosis. The aim was to assess the number and the characteristics of the bile ducts in those diseases with the aid of an antibody to cytokeratin 7 (CK7) Methods-Consecutive sections from 99 liver biopsies were stained with H&E and anti-CK7. Results-In H&E sections the total number of central bile ducts in the triads was 52 in primary biliary cirrhosis (n = 37), 69 in chronic hepatitis (n = 43), and 30 in miscellaneous cases (n = 19). Using anti-CK7, the number of central bile ducts was 276 in primary biliary cirrhosis, 348 in chronic hepatitis, and 96 in miscellaneous cases. Central bile ducts with lumen were found in 93.0% of chronic hepatitis cases and in 89.5% of the miscellaneous cases, but in only 13.5% of the primary biliary cirrhosis cases. Peripheral bile ducts in groups of > 4/triad were found in all cases of chronic hepatitis (100%) and in 75.7% primary biliary cirrhosis cases, but only in 10.5% of the miscellaneous cases. In 21.6% of primary biliary cirrhosis cases, no bile ducts (central and/or peripheral) were present. Conclusions-Anti-CK7 detects bile ducts in the triads that are concealed by chronic inflammatory cells. Central and peripheral bile ducts in groups of > 4 were significantly more common in primary biliary cirrhosis and chronic hepatitis than in other liver diseases. The lack of lumen in central bile ducts, as well as the absence of central and/or peripheral bile ducts in CK7 stained liver sections, seem to be valuable additional parameters in the diVerential diagnosis between primary biliary cirrhosis and chronic hepatitis. (J Clin Pathol 2000;53:765-769)

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“…Liver fibrosis and cirrhosis have been reported in patients with psoriasis [1,2,3] or rheumatoid arthritis [4] treated with methotrexate; damage to the canals of Hering [5] and increased liver collagen content [6, 7] have been implicated as aetiological mechanisms. The duration of methotrexate therapy [8], non-alcoholic steatohepatitis [4, 9, 10], excess alcohol ingestion [11], patient age and weekly oral dosage schedule [12] as well as cumulative methotrexate dose [11] have been associated with the development of liver fibrosis in these patients.…”

Section: Introductionmentioning

confidence: 99%

Tempting Liver Fibrosis? Long-Term Psoriatic Methotrexate Therapy and Heterozygous α<sub>1</sub>-Antitrypsin Deficiency

Mathew

Igbokwe²,

Morley³

et al. 2006

Dermatology

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Background: Dermatologists, or pathologists, occasionally need to decide whether or not to continue methotrexate therapy in a patient with an identifiable risk factor for liver fibrosis, in this instance heterozygous α₁-antitrypsin deficiency. Case Presentation: We relate our experience with an elderly male patient, diagnosed as having α₁-antitrypsin deficiency on a liver biopsy, genotypically confirmed as PiMZ. He had been receiving methotrexate for psoriasis for 17 years with a cumulative dose of 7,200 mg. He was monitored by biochemical profiling and interval (10) liver biopsies. Non-specific changes were seen on liver histology although grade 1 liver fibrosis was seen in his last 2 biopsies. Conclusion: We suggest that methotrexate therapy is relatively safe in patients with heterozygous α₁-antitrypsin deficiency, with no other risk factor. We however advise that the risk of fibrosis should be monitored and that the patient receives appropriate counselling.

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Liver fibrosis quantified by image analysis in methotrexate-treated patients with psoriasis

Cited by 25 publications

References 14 publications

Rethinking the Role of Liver Biopsy in the Era of Personalized Medicine

Rethinking the Role of Liver Biopsy in the Era of Personalized Medicine

Qualitative and quantitative differences between bile ducts in chronic hepatitis and in primary biliary cirrhosis

Tempting Liver Fibrosis? Long-Term Psoriatic Methotrexate Therapy and Heterozygous α<sub>1</sub>-Antitrypsin Deficiency

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