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Methotrexate use in rheumatoid arthritis is associated with few clinically significant liver function test
Y Yazici1, D Erkan, M J Harrison
1Hospital for Special Surgery, Weill Medical College of Cornell University, USA. yaziciy@yahoo.com
Clinical and Experimental Rheumatology
|August 13, 2005
Summary
Methotrexate (MTX) use in rheumatoid arthritis (RA) is linked to very few significant liver issues. Current monitoring guidelines for MTX may be revised to less frequent testing, particularly for patients without liver disease risk factors.
Area of Science:
- Hepatology
- Rheumatology
- Pharmacology
Background:
- Methotrexate (MTX) is a common disease-modifying antirheumatic drug (DMARD) for rheumatoid arthritis (RA).
- Liver function test (LFT) abnormalities are a known potential side effect of MTX therapy.
- Current guidelines recommend regular LFT monitoring for patients on MTX.
Purpose of the Study:
- To assess the frequency of LFT abnormalities in RA patients treated with MTX.
- To evaluate the clinical significance of MTX-associated LFT elevations.
- To inform potential revisions of MTX monitoring guidelines.
Main Methods:
- Retrospective chart review of 182 RA patients with current or past MTX use.
- Analysis of demographic data, RA history, medication history, and complications.
- Review of LFT results (AST, ALT), CBC, albumin, creatinine, and liver biopsy reports.
Main Results:
- Out of 2791 LFTs in 182 patients, 94 were abnormal (16.5% of tests).
- 30 patients (16.5%) experienced at least one LFT abnormality.
- Most abnormalities (73.3%) resolved with continued MTX treatment without intervention.
Conclusions:
- MTX is associated with a low frequency of clinically significant hepatic side effects in RA patients.
- Current LFT monitoring frequency for MTX may be excessive, especially for low-risk patients.
- Consideration for revising MTX monitoring guidelines towards less frequent testing is warranted.
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