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Related Experiment Videos

[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
PubMed
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.

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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.

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  • 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.