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Category: Volume 06 Issue 10 October 2018
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Title: Utility of Transient elastography of liver in patients with Rheumatoid arthritis on methotrexate

Authors: Dr Santh Ledge G, Dr Poppy Rejoice

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i10.14

Abstract

Background: Methotrexate is an anchor drug in the treatment of Rheumatoid arthritis. But it can cause liver toxicity on long term treatment. Liver enzymes are conventionally monitored to detect the liver toxicity. Transient elastography (TE) is a novel tool to detect the fibrosis of the liver.

Aim:  To find out the utility of Transient elastography of liver in patients with Rheumatoid arthritis on methotrexate

Materials and Methods: 50 patients with Rheumatoid arthritis (RA) on methotrexate for more than 2 years were subjected to Transient elastography evaluation. The resistance or stiffness offered by the liver was measured in kilopascals. According to the stiffness of the liver, the amount of fibrosis was graded from F0 to F4 using colour codes. Stiffness of < 6 kilopascals (kpa) is graded under F0; 6-7.2 kpa = grade F1; 7.3 -8.1 KPA = grade F2; 8.2 – 8.8 kpa = grade F2-F3; 8.9 – 10.5 kpa = grade F3; 10.6 – 11.8 kpa = grade F3-F4; > 11.8 kpa = grade F4. Serum Alanine transaminase (ALT) was measured in all patients.

Results: 50 patients with RA on methotrexate for more than 2 years were enrolled. The duration of treatment with methotrexate ranged from 2- 6.5 years. The stiffness of liver ranged from 2.7 to 8.6kpa. Grade 0 fibrosis (F0) = 40 patients; Grade 1 fibrosis (F1) = 7 patients; Grade 2 fibrosis (F2) = 2 patients; Grade 2-3 fibrosis (F2-F3) = 1; No patients were in grade 3 fibrosis or more.10 patients had elevated ALT above upper limit of normal (40 U/L).  No patients had elevated serum ALT of more than two times of normal. Nine patients with normal ALT had evidence for fibrosis in TE. One patient in F2 grade and one patient in F2-F3 grade had normal ALT.  

Conclusion: Transient elastography of liver is more useful than liver enzymes in monitoring the liver toxicity in RA patients on long term methotrexate.  

Keywords: methotrexate, liver toxicity, alanine transaminase, Transient elastography.

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Corresponding Author

Dr Poppy Rejoice

Assistant Professor, Dept of Medical Gastroenterology, Kanyakumari Govt. Medical College, Asaripallam, India