Liver histology in patients receiving low dose pulse methotrexate for the treatment of rheumatoid arthritis

• Published in: Annals of the rheumatic diseases Vol. 49; no. 8; pp. 591 - 593
• Main Authors: Willkens, R F, Leonard, P A, Clegg, D O, Tolman, K G, Ward, J R, Marks, C R, Greene, M L, Roth, G J, Jackson, C G, Cannon, G W
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.08.1990; BMJ; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - pathology; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Drug Administration Schedule; Female; Humans; Liver - drug effects; Liver - pathology; Liver Cirrhosis - chemically induced; Liver Cirrhosis - pathology; Liver Function Tests; Male; Medical sciences; Methotrexate - administration & dosage; Methotrexate - adverse effects; Methotrexate - therapeutic use; Middle Aged; Pharmacology. Drug treatments; Time Factors; Antineoplastic agent; Human; Pathology; Chemotherapy; Treatment; Liver; Rheumatoid arthritis; Diseases of the osteoarticular system; Autoimmune disease; Histology; Inflammatory joint disease
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.49.8.591

The liver histology of 52 patients treated with intermittent low dose pulse methotrexate for rheumatoid arthritis was evaluated using a modification of the Roenigk grading system. Patients studied had had an average of 3.2 years of treatment or had received 1.7 g methotrexate. No patient had cirrhosis; 15 (29%) patients had evidence of mild fibrosis. Histological abnormalities were not predicted by liver function test changes, with the exception that hypoalbuminaemia occurred in 60% of those with grade IV (modified criteria) findings. The need for liver biopsy in patients with rheumatoid arthritis treated with methotrexate before two years or 1500 mg of treatment has not been established. Whether serial liver biopsies will be needed beyond this time has yet to be determined.