Introduction Liver biopsy is recommended for the assessment of Methotrexate (MTX) related liver disease. Transient Elastography (TE) to measure Liver Stiffness (LSM) has been used to assess the degree of hepatic fibrosis. We investigated the use of TE to assess MTX treated patients.
Method Between October 2008 and July 2014 patients with suspected MTX-related liver damage referred to Glasgow Royal Infirmary underwent TE using the Fibroscan®. A quality scan was defined as a scan with a >60% success rate and an IQR <30% (Quality 30). Readily available parameters were derived from computer records including standard liver blood tests, pro-collagen-3 N-terminal peptide (P3NP) when measured, the AST to Platelet Ratio Index (APRI), the Fib-4 score and abdominal ultrasound features of liver disease.
Results 147 scans were performed on 118 patients. Most patients had chronic psoriasis (70; 59%) or arthritis (43, 36%). The median age was 55 (range 19–87) and median follow up was 838 days (range 79–2080).
Seven scans were unsuccessful: in 5 obesity was cited as a factor. Quality 30 scans were obtained 99 (71%) of cases.
Rank Correlations (p values; 95% CI for significant correlations):
In the Psoriatic group there was a correlation with P3NP (p = 0.029; 0.0295, 0.463).
LSM >7.9 was found in 52 scans (37%); 33 were Quality 30. Advice to discontinue MTX was given in 35 of these cases, with further assessment and/or monitoring advised in the remainder.
Serial scans have been performed in 21 patients continuing MTX. The median interval between the serial scans was 510 days (331–1205). The median change in LSM between scans was 0.3 (-8.4 – 8.1) but the LSM rose in 15 cases: with a median rise of 1.6 (range 0.1 – 8.1).
In 89 cases an abdominal ultrasound result was available: 55 cases (62%) had fatty change present. During follow-up there were 10 deaths: there were no recorded liver-related deaths.
Conclusion LSM is feasible in patients treated with MTX related. It correlates with other markers of fibrosis such as APRI and P3NP in some patient groups. LSM should be considered as part of the assessment of MTX hepatoxicity in order to advise on treatment changes and selection for liver biopsy.
Disclosure of interest None Declared.