Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
FibroScan (FS) is a non-invasive investigation that allows assessment of possible liver fibrosis by measuring liver stiffness. There are studies which confirm that MTX-related liver fibrosis (LF) may not be associated with abnormal liver function tests (LFTs). The aim of this study was to investigate the incidence of possible LF detected by FS in RA patients taking MTX, who had never had abnormal LFTs since commencing MTX.
This was a pilot, single-centre, prospective, cross-sectional cohort study. Patients were recruited from the rheumatology department at Wrexham Maelor Hospital, North Wales, UK, between September 2012 and July 2016. We included only patients with RA (seropositive and seronegative), who had never had abnormal LFTs since commencement of MTX, and who had been on MTX for 2 years or more. The hepatology team performed the FS in all patients. The FS score of an average of 10 readings was expressed in kilopascals (KPa). A FS result was considered abnormal if ≥ 8KPa. Patients with abnormal FS results were then assessed by the hepatology team for further clinical evaluation to establish the liver condition. Linear regression test was used to examine the relation between raised FS values and dose and duration of MTX use.
A total of 104 patients were recruited in this study. FS readings were invalid in 4 patients, and those patients were later excluded from the analysis. There were 65% females and 35% males in this cohort, reflecting the predominance of females in RA. The mean patient age was 65.1 years (SD 9.7). The mean MTX dose was 17.2mg (SD 5.2) weekly. The median duration of MTX treatment was 5.4 years (range 2-16 years) and this gave a total of 347 MTX- years. There were 41 patients on at least one other DMARD (SSZ, LEF, HCQ), and 17 patients on a biologic drug. The median FS score in this study was 4.7 KPa (range 0-14.5). Fifteen patients had abnormal FS readings with a median score of 9.1 (range 8.1-14.5). The incidence of an abnormal FS result was 15% in this cohort. The rate of abnormal FS score was 0.043/100 patient-years. We found no correlation between raised FS score and the dose or duration of MTX use – correlation coefficient F was 2.8 (p value 0.09) and 0.57 (p value 0.45) respectively. All patients with abnormal FS scores were clinically obese (BMI>30), and were diagnosed by the hepatologist as having fatty liver disease. None of these had MTX-induced liver fibrosis. Only 1 patient had non-alcoholic steatohepatitis with liver fibrosis confirmed on liver biopsy. This patient was advised to stop MTX, and all other patients were advised to lose weight and to continue taking MTX.
We demonstrated in this study that subclinical MTX-induced LF in RA patients taking long-term MTX with normal LFTs is extremely low. The use of FS as part of routine monitoring for liver fibrosis in clinical practice is not necessary in patients with normal LFTs.
To cite this abstract in AMA style:Alachkar M, Mathialahan T, Walsh S, Lim V. The Use of Fibroscan in Detecting Early Liver Fibrosis in RA Patients on Long Term MTX with Normal Liver Enzymes [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-use-of-fibroscan-in-detecting-early-liver-fibrosis-in-ra-patients-on-long-term-mtx-with-normal-liver-enzymes/. Accessed October 20, 2020.
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