RESEARCH - MTX and hepatic toxicity in RA and PsA

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Clin Drug Investig. 2006;26(2):55-62.

Methotrexate and hepatic toxicity in rheumatoid arthritis and

psoriatic arthritis.

Tilling L, Townsend S, J.

Department of Rheumatology, Royal Berkshire and Battle Hospitals NHS

Trust, Reading, UK.

BACKGROUND: We set out in this study to demonstrate the adverse effect

profile of methotrexate when used in the treatment of rheumatoid

arthritis (RA) and psoriatic arthritis (PsA) in a district general

hospital population, and to investigate the effect of alcohol

consumption in these patients.

METHODS: A prospective evaluation of 550 RA patients and 69 PsA

patients was undertaken, controlling for confounding factors.

Systematically randomised patients were further analysed regarding

alcohol consumption. A transaminase level of three times the upper

limit of normal on two or more occasions was taken to indicate hepatic

injury.

RESULTS: Gastrointestinal disturbance was the predominant adverse

effect in RA patients (9.8%); hepatic disturbance was the most

frequent in PsA patients (14.5%). Both groups had hepatic enzyme

elevation; PsA patients were at significantly greater risk of elevated

transaminases than RA patients (14.5% vs 7.5%, respectively, chi2 =

4.017). Alcohol consumption did not correlate with hepatic injury

(mean 5.15 vs 6.6 alcohol units/week consumed by RA and PsA patients,

respectively).

CONCLUSION: Our data show methotrexate-treated PsA patients have a

higher incidence of hepatotoxicity compared with methotrexate-treated

patients with RA. It is proposed that psoriatic patients may be

inherently more susceptible to methotrexate hepatotoxicity than are

rheumatoid patients.

PMID: 17163236

http://www.ncbi.nlm.nih.gov/pubmed/17163236

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