Background/Purpose: We aimed to determine whether methotrexate (MTX) treatment in patients with rheumatoid arthritis (RA) leads to the development of nonalcoholic fatty liver (NAFL).

Methods: Data were derived from records of all patients with RA who underwent abdominal ultrasonography at Jeonbuk National University Hospital. Patients with ultrasound-proven NAFL were identified, and those without NAFL were matched by age and sex using the propensity score matching method at 1:3 ratio. We also analyzed the Health Insurance Review and Assessment Service-National Patient Samples, a nationwide cohort database, to determine the association between MTX use and NAFL in a large number of patients (n = 24,653).

Results: In the hospital cohort, 92 patients with NAFL did not show significant differences in the cumulative MTX dose when compared with the no-NAFL group (n = 276) (1,908.5 ± 1,757.5 vs. 1,948.6 ± 2,118.8 mg, p = 0.911). The prevalence of NAFL was not significantly different across strata of cumulative MTX dose. Multiple logistic analyses identified hypertriglyceridemia (OR, 4.88 [95% CI, 1.13–20.93]) and higher body mass index (OR, 1.22 [95% CI, 1.05–1.41]) as being associated with an increased risk of NAFL. In the nationwide cohort, the MTX exposure rate between the NAFL and no-NAFL groups was not significantly different.

Conclusion: Collectively, no significant association between NAFL development and administration of MTX was detected in this study. Our results suggest that it is more efficient to adjust for individualized risk factors for NAFL prevention rather than discontinuation of MTX in patients with RA.

Figure 1. Flow chart of the study design MTX, Methotrexate; NAFL, Non-alcoholic fatty liver; RA, Rheumatoid arthritis

Table 1. Risk factors influencing the development of NAFL among RA patients (n=368) BMI, Body mass index; HbA1c, hemoglobin A1c; HDL, High-density lipoprotein cholesterol; LDL, Low-density lipoprotein cholesterol; MTX, Methotrexate; NAFL, Non-alcoholic fatty liver 95% C.I., 95% Confidence Interval

Figure 2. Prescription rate of MTX in RA patients with or without NAFL based on HIRA-NPS data Prescription rate of MTX in RA patients with or without the diagnosis code of NAFL was analyzed and compared using HIRA-NPS data for 6 years, from 2012 to 2017. HIRA-NPS, Health Insurance Review and Assessment Service-National Patient Samples; MTX, Methotrexate; NAFL, Non-alcoholic fatty liver; RA, Rheumatoid arthritis

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/methotrexate-use-does-not-increase-the-prevalence-of-hepatic-steatosis-a-real-world-retrospective-nested-case-control-study/