Does methotrexate use increase the risk of liver fibrosis in patients with rheumatoid arthritis?

This study evaluated whether methotrexate use increased the presence of liver fibrosis (scarring) in patients with rheumatoid arthritis (RA). The data showed that there was no increase in the rate of liver fibrosis in patients with RA that received methotrexate.

RA is an inflammatory disease that affects the joints. Disease-modifying anti-rheumatic drug (DMARD) therapy has considerably improved the prognosis for patients with RA. Methotrexate is the drug of choice for initiating DMARD therapy. Methotrexate is recognized for its effectiveness, anti-inflammatory properties, and ability to reduce radiological progression in patients with RA.

Since DMARD therapy is given during the patient’s lifetime, long-term safety considerations are important. A potential side effect of the long-term use of methotrexate is an increased risk of liver fibrosis (deposition of scar tissue). Liver fibrosis can result in liver cirrhosis (chronic liver disease).

Acoustic radiation force impulse (ARFI) imaging offers a non-invasive alternative to liver biopsies to assess liver stiffness in patients. The ability to assess liver stiffness with a non-invasive approach in patients with RA is desirable because of a reduced risk of complications. The impact of long-term methotrexate use on liver stiffness measured with ARFI in patients with RA is still unknown.

The study included 119 patients with RA. 65 patients had received methotrexate therapy for at least 1 year. 54 patients had not yet started methotrexate therapy. 3602 mg was the average dose of methotrexate given to patients. The average duration of treatment was 4.39 years. All patients were assessed for liver fibrosis using ARFI imaging.

The results showed comparable ARFI scores between patients that received methotrexate therapy compared to those who were not given therapy prior to the start of the study.

The authors concluded that there was no increase in the occurrence of liver fibrosis in patients with RA that received methotrexate therapy.

The study involved German patients and results may not apply to all ethnicities. Additional larger studies with other designs are needed.