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Liver fibrosis quantified by image analysis in methotrexate-treated patients with psoriasis
C Nohlgård1, C A Rubio, Y Kock
1Department of Dermatology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
Background:
Histopathologic monitoring of the liver is mandatory during methotrexate (MTX) treatment. Fibrosis is an important histologic feature of liver damage.
Objective:
Our purpose was to supply an independent measure to histopathologic grading of hepatic changes in MTX-treated patients with psoriasis.
Methods:
Forty-six liver biopsy specimens from 26 patients with psoriasis evaluated for or treated with MTX were histopathologically classified and their collagen content quantified by image analysis after staining with Sirius Red F3BA.
Results:
Fibrosis in normal liver biopsy specimens (controls) amounted to 0.9% +/- 0.1% and in patients with psoriasis varied between 9.3% +/- 1.4% and 24.0% +/- 4.9%. An effect of MTX on liver fibrosis was not discerned. No correlation was obtained between fibrosis and histologic grades, intake of alcohol, lean tissue mass, or age of the patient.
Conclusion:
Two changes occurred in the psoriatic liver; the collagen content was increased at least tenfold when compared with controls, and significant heterogeneity in collagen content was present among patients (p < 0.001).
Insights
Psoriatic liver tissue shows a tenfold increase in collagen, indicating significant fibrosis independent of methotrexate treatment. This highlights the need for careful monitoring of liver health in psoriasis patients.
Area of Science:
- Hepatology
- Dermatology
- Pathology
Background:
- Liver biopsy is essential for monitoring methotrexate (MTX) treatment.
- Liver fibrosis is a key indicator of MTX-induced liver damage.
Purpose of the Study:
- To establish an objective method for assessing liver changes in psoriasis patients undergoing MTX therapy.
- To quantify hepatic collagen content as a measure of fibrosis.
Main Methods:
- Histopathologic analysis of 46 liver biopsy specimens from 26 psoriasis patients.
- Sirius Red F3BA staining and image analysis to quantify collagen content.
- Comparison with control liver biopsy specimens.
Main Results:
- Psoriatic liver collagen content was at least tenfold higher than in controls (9.3%-24.0% vs. 0.9%).
- No correlation was found between fibrosis and MTX use, alcohol intake, body mass, or patient age.
- Significant variability in collagen content was observed among patients.
Conclusions:
- Psoriatic liver exhibits significantly elevated collagen levels, indicating substantial fibrosis.
- The observed fibrosis is not directly linked to methotrexate treatment in this cohort.
- Heterogeneity in fibrosis suggests other contributing factors in psoriatic liver disease.