Background/Purpose: The assessment of liver stiffness using liver elastography (Fibroscan) has facilitated early diagnosis of hepatic fibrosis in patients with chronic liver disease, but its use has not been evaluated extensively in rheumatological patients. The use of methotrexate in these patients is considered first-line disease modifying therapy for many inflammatory arthritides, and one of its potential adverse effects is hepatotoxicity which can present either as asymptomatic transaminitis, progressive liver fibrosis, or liver cirrhosis.

This is the first Australian study to examine the predictors for abnormal liver elastography in rheumatological patients, and its clinical utility in the management of methotrexate users.

Methods: A retrospective chart review of patients attending a Melbourne metropolitan rheumatology practice between 2011-2018, who has had liver elastography done as part of their liver assessment, was studied. Liver stiffness measure (LSM) of >8 kPa was used as a surrogate for liver fibrosis. Baseline diagnosis, comorbidities, laboratory results, and medication use were correlated to abnormal liver elastography using univariate and multivariate analysis.

Results: One hundred twenty nine patients were identified with rheumatological conditions that underwent LSM assessment during the 7-year period. Commonest indications for assessment were methotrexate use (47.3%), non-alcoholic steatohepatitis (27.9%), and chronic viral hepatitis (9.3%) and at-risk alcohol consumption (3.9%). Elevated LSM was associated significantly with the diagnosis of spondyloarthritis (OR 1.22 p=0.008) and with high BMI (OR 4.64 p=0.058). Biochemically, GGT was the only significant predictor of abnormal LSM. The presence or absence of methotrexate use, nor its duration, were associated with abnormal LSM. There was no difference in baseline demographic features between users and non-users of methotrexate. Median LSM were similar in methotrexate exposed patients compared to non-exposed patients (4.8kPa respectively p=0.707). The proportions of patients with LSM >8 were similar in methotrexate exposed and non-exposed group (6.6% vs 13.2% respectively, p=0.202). The discontinuation of methotrexate was associated with increased LSM (13.8% discontinued versus 2.1% that did not p=0.046) and those with increased LSM were less likely to be commenced on MTX following LSM assessment (0.0% vs 31.8% p=0.002).

Conclusion: Abnormal liver elastography in rheumatological patients was associated with high BMI and the diagnosis of seronegative spondyloarthritis. Methotrexate use was not associated with increased fibrosis but LSM did affect its use. Positive correlation with the diagnosis of spondyloarthritis with increased LSM is consistent with current theories suggesting an increase in insulin resistance and therefore an increased risk of fatty liver that may be observed in this group.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-and-predictors-of-fibrosis-in-rheumatological-patients-on-therapy-and-risk-factors-for-chronic-liver-disease/