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[Hypertransaminemia and methotrexate: not always a toxic effect?]
C Montilla Morales1, F J López Longo, M Moreno Zazo
1Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid.
Revista Clinica Espanola
|February 4, 1999
Summary
Regular liver enzyme monitoring is crucial for detecting methotrexate-induced liver toxicity in rheumatic disease patients. Transient transaminase elevations occurred in 9.2% of patients, with viral infections also noted.
Area of Science:
- Rheumatology
- Hepatology
- Pharmacology
Background:
- Methotrexate is a common disease-modifying antirheumatic drug (DMARD) used for rheumatoid arthritis and other rheumatic conditions.
- Liver toxicity is a potential adverse effect of methotrexate therapy, necessitating monitoring.
- Serial liver enzyme measurements are recommended to detect early signs of hepatotoxicity.
Observation:
- A retrospective review of 141 adult patients treated with methotrexate between 1988 and 1991 was conducted.
- The primary diagnoses included rheumatoid arthritis (120 patients) and psoriatic arthritis (12 patients).
- Periodic liver function tests were performed every 2-3 months.
Findings:
- Transient elevations in transaminase levels, indicative of potential liver injury, were observed in 13 patients (9.2%) during methotrexate therapy.
- Two patients concurrently developed viral infections (cytomegalovirus and Epstein-Barr virus) while on methotrexate.
- Both patients experiencing viral infections showed a favorable outcome after methotrexate discontinuation.
Implications:
- Serial liver enzyme monitoring is essential for the safe use of methotrexate in patients with rheumatic diseases.
- Methotrexate-induced liver enzyme elevations may be transient and manageable.
- Clinicians should consider viral infections as a potential cause or contributor to liver enzyme abnormalities during methotrexate treatment.