Published online May 27, 2023. doi: 10.4254/wjh.v15.i5.699
Peer-review started: December 16, 2022
First decision: December 31, 2022
Revised: January 7, 2023
Accepted: April 10, 2023
Article in press: April 10, 2023
Published online: May 27, 2023
Methotrexate (MTX) is the usual first-line treatment for rheumatoid arthritis (RA). Long-term use of MTX has been associated with liver steatosis (LS) and liver fibrosis (LF).
To determine if LS in patients treated with MTX for RA is associated with MTX cumulative dose (MTX-CD), metabolic syndrome (MtS), body mass index (BMI), the male sex, or LF.
A single-center, prospective study of patients receiving MTX for RA was per
Fifty-nine patients were included. Forty-three were female (72.88%), and the mean age was 61.52 years (standard deviation: 11.73). When we compared MTX-CD ≤ 4000 mg (26 patients; 14 with LS and 12 without) with > 4000 mg (33 patients; 12 with LS and 21 without), no statistical differences were found (P = 0.179). We compared CAP scores stratified by MtS, BMI, sex, and LF. There were no significant differences in CAP scores based on the presence of MtS [CAP/MtS: 50 no MtS (84.75%); 9 MtS (15.25%); P = 0.138], the male sex (CAP/sex: 8 male/18 female LS; 8 male/25 female no LS; P = 0.576), or LF [CAP/fibrosis: 53 no LF (89.83%); 6 LF (10.17%); P = 0.239]. LS determined by CAP was significantly associated with BMI > 25 (CAP/BMI: 22 BMI ≤ 25 (37.29%); 37 BMI > 25 (62.71%); P = 0.002].
LS in patients with RA treated with MTX was not associated with MTX-CD, LF, the male sex, or MtS. However, BMI was significantly related to LS in these patients.
Core Tip: Methotrexate (MTX) is the cornerstone of treatment for rheumatoid arthritis and has been associated with the development of liver fibrosis (LF) and liver steatosis (LS). The objective of this work was to study if LS in patients with rheumatoid arthritis treated with MTX and determine the association with body mass index, MTX cumulative dose, sex, LF, and metabolic syndrome. We concluded that LS in patients with rheumatoid arthritis on MTX treatment was not related to MTX-cumulative dose, LF, the male sex, or metabolic syndrome. In our study, body mass index was significantly associated with LS in these patients.