Validation of the fibrosis-4 (FIB-4) index in the diagnosis of liver disease of rheumatoid arthritis patients treated with methotrexate

• Published in: Modern rheumatology Vol. 29; no. 6; pp. 936 - 942
• Main Authors: Miyata, Masayuki, Kuroda, Masahito, Unakami, Masamitsu, Tasaki, Kazuhiro, Migita, Kiyoshi, Ohira, Hiromasa
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 02.11.2019
• Subjects: Adult; Arthritis, Rheumatoid - drug therapy; Biomarkers - blood; Chemical and Drug Induced Liver Injury - blood; Chemical and Drug Induced Liver Injury - etiology; Chemical and Drug Induced Liver Injury - pathology; Female; Fibrosis-4 index; folate; Humans; Liver Cirrhosis - blood; Liver Cirrhosis - etiology; Liver Cirrhosis - pathology; Male; methotrexate; Methotrexate - therapeutic use; Methotrexate - toxicity; Middle Aged; non-alcoholic steatohepatitis; rheumatoid arthritis; Severity of Illness Index; methotrexate; folate; Fibrosis-4 index; rheumatoid arthritis; non-alcoholic steatohepatitis
• ISSN: 1439-7595; 1439-7609
• DOI: 10.1080/14397595.2018.1542962

Objectives: To validate the usefulness of a hepatic fibrosis scoring system fibrosis-4 (FIB-4) index to diagnose liver diseases in rheumatoid arthritis (RA) patients treated with methotrexate (MTX). Methods: The FIB-4 index (age(years) × AST(U/L)/platelet (PLT) (10 9 /L) × √ALT(U/L)), proposed as a predictor for liver fibrosis in HIV/HCV coinfection, was evaluated in this study. RA patients on MTX treatment were screened by FIB-4 index values to detect fibrotic change in the liver. Liver biopsy specimens were examined histologically in patients with high values. Results: Thirteen of 14 patients showed histology closely resembling non-alcoholic steatohepatitis. In three of them, two biopsies were performed: 1st, during MTX treatment; and 2nd, after discontinuation of MTX. All of them showed improvement in histology along with decreased FIB-4 values. Age, AST/√ALT, and 1/PLT, as well as creatinine levels and cumulative MTX doses were significantly higher in the high FIB-4 group compared with the low FIB-4 group. In the high FIB-4 group, 1/PLT and AST/√ALT were significantly correlated with FIB-4 values, but age was not. Conclusions: The FIB-4 index is simple to calculate and a valuable marker to diagnose liver disease in RA patients treated with long-term MTX administration.