RESEARCH - Liver fibrosis in patients with psoriasis and psoriatic arthritis on long-term, high cumulative dose MTX

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Rheumatology Advance Access originally published online on March 9, 2009

Rheumatology 2009 48(5):569-572; doi:10.1093/rheumatology/kep023

Liver fibrosis in patients with psoriasis and psoriatic arthritis on

long-term, high cumulative dose methotrexate therapy

1, D. Fraser2, Alison Layton3, Mark Goodfield4,

Hans Gruss5 and Gough1

1Department of Rheumatology, Harrogate District Hospital, Harrogate,

2Department of Rheumatology, Leeds General Infirmary, Leeds,

3Department of Dermatology, Harrogate District Hospital, Harrogate,

4Department of Dermatology, Leeds General Infirmary, Leeds and

5Norgine Limited International, Middlesex, UK.

Abstract

Objectives. Dermatologists and rheumatologists have differed in their

use of serial liver biopsy and liver function tests (LFT) to monitor

the risk of hepatic fibrosis in long-term MTX therapy. It is judged

safe to monitor LFT only in RA. Whilst there are few studies in PsA to

justify this approach, it is widely used in rheumatology practice. The

study aimed to assess prevalence of hepatic fibrosis in both psoriasis

and PsA patients on long-term MTX therapy.

Methods. A prospective study of 54 patients with psoriatic disease had

a liver biopsy according to dermatology guidelines on long-term MTX

treatment with full assessment of risk factors. Previously, monitoring

these patients was in accordance with ACR guidelines with 3-monthly

LFT.

Results. MTX treatment duration was a mean of 6.9 years, with a mean

cumulative dose of 4396 mg. There were no cases of advanced fibrosis

or of cirrhosis and mild early fibrosis in 11 (22%) patients. The

presence of early mild changes was related to the number of risk

factors that the patient had for hepatic fibrosis [also the risk

factors for non-alcoholic steatohepatitis (NASH)]. Pro-collagen 3

N-terminal peptide (PIIINP) was unhelpful in PsA and frequently

elevated despite normal liver biopsy.

Conclusions. Despite other risk factors for NASH, monitoring for

hepatic fibrosis using serial liver function and ACR guidelines tests

alone as in RA appears safe in psoriasis and PsA. Liver biopsy ought

to be considered to assess the liver if LFT are persistently elevated.

PIIINP is misleading in active PsA.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/5/569?etoc

Not an MD