Transient Elastography for Monitoring for Hepatotoxicity in Rheumatoid Arthritis Patients on Long-term Methotrexate

Wade, Shawn M.; Yoshida, Eric M.; Carruthers, Mollie; Weinblatt, Michael E.

doi:10.1097/rhu.0000000000000885

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…Although MTX has a wide range of usage in treatments, it has negative effects especially on the liver such as inflammation, steatosis and fibrosis (1). Hepatotoxicity is a common side effect in treatment with MTX due to its metabolism in the liver (1,(3)(4)(5)(6). In addition, depending on individual sensitivity at low or high doses, MTX may cause various gastrointestinal system disorders characterized by abdominal pain, vomiting and diarrhea (1,4,7).…”

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confidence: 99%

Investigation of the effects of St. John’s wort (Hypericum perforatum) oil on the methotrexate-induced gastrointestinal mucosa injury and hepatotoxicity in mice

Seğmenoğlu

Akilli²

2021

Veterinary Journal of Mehmet Akif Ersoy University

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St. John's wort oil is a herbal product that has therapeutic features. Our aim in this study is to investigate the effects of St. John's wort oil on irritated gastrointestinal mucosa and liver. The study is based on experimental animal trials. 21 healthy swiss albino mice were randomly divided into three groups: control group, group-2, group-3. The single dose of methotrexate (20 mg/kg) was given intraperitoneally on the 1st day to the group-2 and group-3. St. John's wort oil (4 ml/kg) was given by gavages into the stomach daily for 7 days to the group-3. Following the necropsy, the gastrointestinal mucosa samples and the liver tissue samples were collected for histopathological evaluation. No pathological changes were found in the gastrointestinal mucosa and liver of control group. No pathological changes were found in the mice of group-3 in histopathological examination of the gastric mucosa. Significant hyperplasia and mononuclear cell infiltrations in lamina propria were observed in the mice of the group-2's intestinal mucosa. The group-3 mice's intestinal mucosa was similar to control group's intestinal mucosa. In liver histopathology, mononuclear cell infiltrates with locally degenerative changes in the periportal area, thrombotic changes in the vessels, bile duct hyperplasia, megalocytosis in hepatocytes in some areas, vascular congestion and sinusoidal enlargement were observed in the livers of group-2 mice. Only a mild sinusoidal enlargement was noted in group-3's liver. According to the data we obtained in our study, St. John's wort oil has protective and restorative effects especially on liver and intestinal mucosa.

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Section: Introductionmentioning

confidence: 99%

Investigation of the effects of St. John’s wort (Hypericum perforatum) oil on the methotrexate-induced gastrointestinal mucosa injury and hepatotoxicity in mice

Seğmenoğlu

Akilli²

2021

Veterinary Journal of Mehmet Akif Ersoy University

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Methotrexate

2021

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Liver cirrhosis: case reportA 59-year-old woman developed liver cirrhosis during treatment with methotrexate for rheumatoid arthritis (RA). The woman was diagnosed with RA in the 1990s. Subsequently, she started receiving oral methotrexate 15mg weekly. In 1995, due to active disease, she was enrolled in a trial with etanercept and received treatment with oral methotrexate 20mg weekly, along with etanercept and folic acid. During the reduction of methotrexate dose, she had a disease flare and synovitis in the wrists. She was a non-smoker and consumed alcohol occasionally. Her estimated body mass index (BMI) was 32 kg/m 2 . During treatment with methotrexate, her complete blood count was checked generally every 4 to 12 weeks. In 2008, her aspartate aminotransferase was increased on 1 occasion, while her alanine aminotransferase (ALT) level remained intermittently mildly elevated. She never had several elevations above the upper limit of normal for 12 months, while albumin remained consistently normal. In view of elevated BMI and long-term use of methotrexate use (for 23 years, accumulating to 22g), hepatic fibrosis was suspected. Hence, she was referred for liver assessment. The transient elastography (TE) showed liver stiffness of 17.8 kPa, which was consistent with methotrexate-induced liver cirrhosis [time to reaction onset not stated].Hence, methotrexate was permanently stopped [outcome not stated].

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Using FibroScan to Assess for the Development of Liver Fibrosis in Patients With Arthritis on Methotrexate: A Single-center Experience

et al. 2022

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Objective Methotrexate (MTX) is often the primary medication to treat various rheumatic diseases, due to its low cost and its demonstrated efficacy in controlling disease activity. However, a concern has been the potential for hepatic fibrosis associated with long term MTX usage. This study investigated the association between cumulative MTX intake and development of liver fibrosis by utilizing non-invasive transient elastography (FibroScan). Methods All patients with inflammatory arthritis treated with MTX were offered screening with FibroScan. A certified technician measured liver stiffness after patients adhered to a fast. Relevant clinical information was obtained by patient survey and medical records review. The population was divided into quartiles based on participant's cumulative dosage of MTX. Results 520 rheumatologic patients were included in this study. The prevalence of stages F3 or F4 liver fibrosis was 13.3% in the control group, and 12.7% in the entire sample. Compared with subgroup 1 (control with cumulative MTX exposure of < 500mg), MTX subgroups 2-4 were not significantly correlated with higher FS scores (p-values 0.82, 0.59, and 0.18 respectively). In multivariable linear regression analysis, statistically significant factors for liver stiffness were BMI, waist circumference, male sex, and age. Conclusion No significant correlation between the cumulative MTX dosage and liver stiffness even at high MTX doses was observed. The analyses showed significant correlations between the FibroScan score and BMI. The findings were reassuring in that current rheumatology practice appears to be safe and effective in screening for liver fibrosis in patients on long term low dose MTX therapy.

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Transient Elastography for Monitoring for Hepatotoxicity in Rheumatoid Arthritis Patients on Long-term Methotrexate

Cited by 4 publications

References 17 publications

Investigation of the effects of St. John’s wort (Hypericum perforatum) oil on the methotrexate-induced gastrointestinal mucosa injury and hepatotoxicity in mice

Investigation of the effects of St. John’s wort (Hypericum perforatum) oil on the methotrexate-induced gastrointestinal mucosa injury and hepatotoxicity in mice

Methotrexate

Using FibroScan to Assess for the Development of Liver Fibrosis in Patients With Arthritis on Methotrexate: A Single-center Experience

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