Liver biopsy in methotrexate-treated psoriatics-a re-evalution

Area of Science:

• Hepatology
• Dermatology
• Pharmacology

Background:

• Methotrexate is a common treatment for psoriasis.
• Long-term methotrexate use is associated with potential liver toxicity.
• Monitoring liver health in psoriatic patients undergoing methotrexate therapy is essential.

Purpose of the Study:

• To evaluate the effects of methotrexate on liver biopsies in psoriatic patients.
• To identify risk factors associated with methotrexate-induced liver damage.
• To determine the necessity of liver biopsies for monitoring psoriatic patients on methotrexate.

Main Methods:

• Performed 286 liver biopsies in 139 psoriatic patients.
• Conducted pre- and post-methotrexate biopsies in 56 patients.
• Analyzed biopsy data for signs of fatty infiltration, fibrosis, and cirrhosis.
• Correlated liver damage with methotrexate dosage, alcohol consumption, and potassium arsenite use.

Main Results:

• A statistically significant increase in fatty infiltration was observed post-methotrexate treatment.
• Alcohol consumption was significantly associated with liver fibrosis.
• Potassium arsenite use showed a potential association with liver fibrosis.
• Three cases of liver cirrhosis appeared in patients with pre-existing fibrosis, despite intermittent methotrexate dosage.

Conclusions:

• Long-term methotrexate therapy in psoriatic patients can cause liver damage, including fatty infiltration and fibrosis.
• Early detection of liver damage is possible through liver biopsies, even with minor laboratory abnormalities.
• Regular liver biopsies are necessary for monitoring psoriatic patients on long-term methotrexate treatment.
• Disease severity may be a complicating factor in methotrexate-induced liver damage.