The Prevalence and Risk Factors for Liver Fibrosis Among Rheumatoid Arthritis (RA) Patients on Disease-Modifying Anti-rheumatic Drugs (DMARDs)

Chou Luan Tan¹, Boon Han Ng², Noor Shahrazat Ahmad², Shahrul Aiman Soelar², Muhammad Zulhilmi Asyraf Jazlan², Mohd Ammar Dzakirin Md Mansor², Mohd Azri Mohd Suan², Kuang Kiat Kiew², Zalwani Zainuddin², Muhammad Radzi Abu Hassan² and Chong Hong Lim², ¹Hospital Sultanah Bahiyah, Kementerian Kesihatan Malaysia, Alor Setar, Kedah, Malaysia, ²Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia

Meeting: ACR Convergence 2020

Keywords: Cohort Study, Disease-Modifying Antirheumatic Drugs (Dmards), Drug toxicity, rheumatoid arthritis, Ultrasound

Session Information

Date: Sunday, November 8, 2020

Title: Epidemiology & Public Health Poster III: Inflammatory Rheumatic Disease

Session Type: Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Majority of DMARDs, including methotrexate (MTX), leflunomide (LEF) and sulfasalazine (SSZ) are
believed to be hepatotoxic, causing liver fibrosis. However, the clinical findings were inconsistent. An
ultrasound(US)-based transient elastography (TE) and shear-wave elastography (SWE) has become a
promising tool in detecting liver fibrosis and fatty liver. Our study aims to determine the risk factors of
liver fibrosis and fatty liver among RA patients on DMARDs.

Methods: Our cross-sectional cohort study recruited adult RA patients, who fulfilled ACR 1987 or EULAR-ACR 2010 classification criteria, from the rheumatology clinic at Sultanah Bahiyah Hospital, Malaysia. Liver fibrosis and fatty liver score were detected using US TE/SWE. Patient’s demographic, disease activity (DAS28 score) and relevant blood parameter were recorded. Data were analysed using Spearman correlation, One-way Anova and Kruskal-Wallis Test.

Results: A total of 43 patients were recruited; the majority were female 38 (88%). The mean age of patients was 51.6± 10.5 years. The cumulative dose of each DMARDs: MTX 1572.5mg (IQR 762.5-2490.0), SSZ 1330g (IQR 685- 2607), LEF 19621± 19719 mg and HCQ of 193.5g (IQR 66.3- 283.6). Our study showed a positive correlation between triglyceride level and SWE (r_s= 0.476, p= 0.002), negative correlation of high-density lipoprotein and SWE (r_s= -0.474, p= 0.002). Whereas there was a negative correlation between albumin level and TE (r_s= -0.312, p= 0.044). High BMI was associated with an increased fatty liver score (r_s= 0.372, p= 0.033). Interestingly, our study demonstrated a negative correlation between the cumulative dose of HCQ and the fatty liver score (r_s= -0.782, p= 0.004). There were no significant differences between monotherapy and combination therapy on the fatty liver score (F(3,37)= 0.892, p= 0.454), SWE (H(3)= 3.687, p= 0.297) and TE (H(3)= 0.693, p= 0.875).

Conclusion:

Our study demonstrated that DMARDs were generally safe with low risk of liver fibrosis. Dyslipidemia and obesity should be optimized in order to the reduce risk of liver fibrosis. Hydroxychloroquine administration may be a protective factor against fatty liver.

Disclosure: C. Tan, None; B. Ng, None; N. Ahmad, None; S. Soelar, None; M. Jazlan, None; M. Md Mansor, None; M. Mohd Suan, None; K. Kiew, None; Z. Zainuddin, None; M. Abu Hassan, None; C. Lim, None.

To cite this abstract in AMA style:

Tan C, Ng B, Ahmad N, Soelar S, Jazlan M, Md Mansor M, Mohd Suan M, Kiew K, Zainuddin Z, Abu Hassan M, Lim C. The Prevalence and Risk Factors for Liver Fibrosis Among Rheumatoid Arthritis (RA) Patients on Disease-Modifying Anti-rheumatic Drugs (DMARDs) [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/the-prevalence-and-risk-factors-for-liver-fibrosis-among-rheumatoid-arthritis-ra-patients-on-disease-modifying-anti-rheumatic-drugs-dmards/. Accessed .

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