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Methotrexate-associated hepatotoxicity: retrospective analysis of 210 patients with rheumatoid arthritis.

Publication ,  Journal Article
Shergy, WJ; Polisson, RP; Caldwell, DS; Rice, JR; Pisetsky, DS; Allen, NB
Published in: Am J Med
December 1988

PURPOSE: Beginning in the 1980s, methotrexate has been used successfully to treat rheumatoid arthritis. The magnitude and severity of short- and long-term methotrexate toxicity, however, have not been adequately investigated. Our study was performed to determine the prevalence of hepatotoxicity in patients with rheumatoid arthritis receiving long-term methotrexate therapy. PATIENTS AND METHODS: We conducted a retrospective, computer-assisted review of all Duke University Medical Center patients undergoing liver biopsy for methotrexate monitoring from January 1979 to January 1988. A total of 538 biopsies were performed in 399 patients, 259 of whom had inflammatory arthritis (210 with rheumatoid arthritis, 47 with psoriatic arthritis, and two with seronegative spondyloarthropathy). RESULTS: No evidence of cirrhosis was defined in the cohort with rheumatoid arthritis; however, six patients with rheumatoid arthritis had histologic changes of fibrotic liver disease (prevalence of 2.9 percent in the group with rheumatoid arthritis) while taking methotrexate. Five of the six patients were obese and three had glucose intolerance or overt diabetes mellitus, and one person admitted to alcohol usage. Only one patient with fibrotic liver disease had elevated liver function test results, and no person showed a declining serum albumin level at the time of biopsy. Sixty-one patients with rheumatoid arthritis underwent multiple samplings (44 with two, 13 with three, and four with four biopsies). Fourteen of these patients showed progressive hepatic disease, whereas four patients improved. CONCLUSION: Although the prevalence of methotrexate hepatotoxicity in this large cohort of patients with rheumatoid arthritis was low, a small but definite risk of hepatic fibrosis, not predictable by laboratory screening, still exists.

Duke Scholars

Published In

Am J Med

DOI

ISSN

0002-9343

Publication Date

December 1988

Volume

85

Issue

6

Start / End Page

771 / 774

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Psoriasis
  • Middle Aged
  • Methotrexate
  • Male
  • Liver Cirrhosis
  • Liver
  • Humans
  • General & Internal Medicine
 

Citation

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MLA
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Shergy, W. J., Polisson, R. P., Caldwell, D. S., Rice, J. R., Pisetsky, D. S., & Allen, N. B. (1988). Methotrexate-associated hepatotoxicity: retrospective analysis of 210 patients with rheumatoid arthritis. Am J Med, 85(6), 771–774. https://doi.org/10.1016/s0002-9343(88)80019-6
Shergy, W. J., R. P. Polisson, D. S. Caldwell, J. R. Rice, D. S. Pisetsky, and N. B. Allen. “Methotrexate-associated hepatotoxicity: retrospective analysis of 210 patients with rheumatoid arthritis.Am J Med 85, no. 6 (December 1988): 771–74. https://doi.org/10.1016/s0002-9343(88)80019-6.
Shergy WJ, Polisson RP, Caldwell DS, Rice JR, Pisetsky DS, Allen NB. Methotrexate-associated hepatotoxicity: retrospective analysis of 210 patients with rheumatoid arthritis. Am J Med. 1988 Dec;85(6):771–4.
Shergy, W. J., et al. “Methotrexate-associated hepatotoxicity: retrospective analysis of 210 patients with rheumatoid arthritis.Am J Med, vol. 85, no. 6, Dec. 1988, pp. 771–74. Pubmed, doi:10.1016/s0002-9343(88)80019-6.
Shergy WJ, Polisson RP, Caldwell DS, Rice JR, Pisetsky DS, Allen NB. Methotrexate-associated hepatotoxicity: retrospective analysis of 210 patients with rheumatoid arthritis. Am J Med. 1988 Dec;85(6):771–774.
Journal cover image

Published In

Am J Med

DOI

ISSN

0002-9343

Publication Date

December 1988

Volume

85

Issue

6

Start / End Page

771 / 774

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Psoriasis
  • Middle Aged
  • Methotrexate
  • Male
  • Liver Cirrhosis
  • Liver
  • Humans
  • General & Internal Medicine