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Related Experiment Videos

Methotrexate and histologic hepatic abnormalities: a meta-analysis.

Q E Whiting-O'Keefe1, K H Fye, K D Sack

  • 1Department of Medicine, University of California, San Francisco.

The American Journal of Medicine
|June 1, 1991
PubMed
Summary
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Long-term methotrexate therapy for arthritis poses significant liver toxicity risks, increasing with cumulative dose and alcohol consumption. Regular liver biopsies are recommended for non-heavy alcohol users.

Area of Science:

  • Rheumatology
  • Hepatology
  • Pharmacology

Background:

  • Methotrexate is a common disease-modifying antirheumatic drug (DMARD) used for rheumatoid arthritis (RA) and psoriatic arthritis (PsA).
  • Long-term administration of methotrexate can be associated with potential liver toxicity, including fibrosis and cirrhosis.
  • Monitoring liver health is crucial for patients on chronic methotrexate treatment.

Purpose of the Study:

  • To evaluate the risk of liver toxicity associated with long-term, low-dose methotrexate therapy in patients with RA or PsA.
  • To identify factors influencing the progression of liver disease in these patients.

Main Methods:

  • A meta-analysis was conducted on 15 studies.
  • Included 636 patients with rheumatoid arthritis or psoriatic arthritis receiving long-term, low-dose methotrexate.

Related Experiment Videos

  • Assessed liver fibrosis through liver biopsy and histologic classification.

    • Main Results:

    • Liver disease progression occurred in 27.9% of patients, associated with cumulative methotrexate dose.
    • Advanced liver changes (grades IIIB or IV) were observed in 5.0% of patients.
    • Heavy alcohol consumption (>100 g/week) significantly increased the risk of advanced liver changes and progression.

    Conclusions:

    • Long-term methotrexate therapy carries a substantial risk of liver toxicity, influenced by cumulative dose and alcohol intake.
    • Heavy alcohol drinkers should avoid long-term methotrexate.
    • Periodic liver biopsies are recommended for patients not consuming heavy amounts of alcohol to monitor for toxicity.