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Abstract Number: 0786

Diagnostic Utility of FibroScan in Screening for Liver Injury in Patients with Inflammatory Arthritis on Treatment with Methotrexate (MTX)

Saman Darabian1, john Wade2, Stefanie Wade3, Jason Kur2 and Maziar Badii2, 1University of British Columbia, North Vancouver, BC, Canada, 2University of British Columbia, Vancouver, BC, Canada, 3Beth Israel Deaconess Medical Center, Boston, MA

Meeting: ACR Convergence 2021

Keywords: FibroScan, inflammatory arthritis, methotrexate

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Session Information

Date: Sunday, November 7, 2021

Title: RA – Diagnosis, Manifestations, & Outcomes Poster II: Miscellaneous Aspects of RA (0786–0812)

Session Type: Poster Session B

Session Time: 8:30AM-10:30AM

Background/Purpose: Methotrexate (MTX) is often the primary medication to treat various rheumatic diseases, including rheumatoid arthritis, psoriasic arthritis and many other inflammatory diseases. MTX is significantly less expensive than other alternatives and has been shown in randomized controlled trials to be effective in controlling disease activity, enhancing patient quality of life, and potentially decreasing mortality among patients with inflammatory disorders. Despite its advantages, however, a major concern has been the potential for hepatic fibrosis associated with long term MTX usage.
The present study investigates the association between cumulative MTX intake and development of liver fibrosis among patients with rheumatic diseases. We utilized non-invasive transient elastography (FibroScan) to assess for liver fibrosis among patients in a large academic outpatient rheumatology clinic.

Methods: All patients with inflammatory arthritis treated with MTX were offered screening with FibroScan. All patients who volunteered to participate were included. A certified FibroScan technician measured the liver stiffness after patients adhered to a minimal 90-minute fast. Health and medication information were collected from the patient. FibroScan measurements were recorded as both numerical values represented by the machine in kilopascal (kPa), as well as an ordinal classification from F0 (normal liver stiffness) to F4 (cirrhosis).

Results: Five hundred and twenty rheumatologic patients were included in the primary analysis. FibroScan scores ranged between 1.5 kPa and 37.1 kPa, with an average of 6.13 kPa ± 3.76 kPa. Univariate and multivariate linear and logistic regression models were used for analysis in this study. In multivariable linear regression analysis, statistically significant factors were BMI (regression coefficients: 0.060, p=0.001), waist circumference (0.041, p=0.015), male sex (0.109, p=0.004), and age (0.026, p=0.054). The population was then divided into quartiles based on the participant’s cumulative dosage of MTX. The prevalence of F3/F4 liver fibrosis (i.e. FS ≥ 8.7 kPa) was 13.3% in the control group (MTX cumulative dosage < 500mg), 9.1% in subgroup 4 (MTX >6000mg) and 12.7% in the entire sample. Compared with subgroup 1 (control), MTX subgroups 2-4 were not significantly correlated with higher FS scores (p-values 0.82, 0.59, and 0.18 respectively).

Conclusion: FibroScan scores compatible with liver fibrosis were seen in all MTX subgroups; however, no significant correlation between the cumulative MTX dosage and liver stiffness was observed, even at high MTX doses. The analysis showed significant correlations between the FibroScan score and BMI, waist circumference, male sex, and age. Further studies are needed to assess agreement between liver function tests and FibroScan scores and to better identify threshold FibroScan scores warranting methotrexate discontinuation, particularly in patients with additional risk factors such as high BMI and waist circumference.

Average liver stiffness score per cumulative MTX dosage group. No significance difference between groups of different cumulative MTX dosage has been observed.

Scatterplot of the FibroScan score vs the cumulative MTX dosage among all participants. The plot shows that there is no significant correlation between the cumulative MTX dosage and the FibroScan score. The dotted line is the best linear fit to the data and the fact that it is almost horizontal indicates that the two variables (the cumulative MTX dosage and the FibroScan score) are almost independent from each other. Minimum cumulative MTX dosage = 0mg, maximum cumulative MTX dosage 27200mg, minimum FibroScan score = 1.5 kPa, maximum FibroScan score = 37.1 kPa.

This table shows number (N) and percentage of participants with corresponding FibroScan scores in four cumulative MTX dosage subgroups and in the total study population. Also demonstrated are prevalence’s of participants with stages F2+ and F3+ liver stiffness according to FibroScan measurements.


Disclosures: S. Darabian, None; j. Wade, None; S. Wade, None; J. Kur, None; M. Badii, None.

To cite this abstract in AMA style:

Darabian S, Wade j, Wade S, Kur J, Badii M. Diagnostic Utility of FibroScan in Screening for Liver Injury in Patients with Inflammatory Arthritis on Treatment with Methotrexate (MTX) [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/diagnostic-utility-of-fibroscan-in-screening-for-liver-injury-in-patients-with-inflammatory-arthritis-on-treatment-with-methotrexate-mtx/. Accessed .
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