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) remains the cornerstone of treatment for rheumatoid arthritis (RA), both in monotherapy and in association with other treatments. The most concerning adverse effect of this treatment, in the long term, is liver fibrosis (LF). Liver steatosis (LS) has been associated with RA and with MTX.
MTX, as a risk factor for secondary LS, has been studied recently. RA has been independently associated with moderate to severe LS. Sex, higher body mass index (BMI), and MTX cumulative dose (MTX-CD) are predisposing factors. However, the studies have shown conflicting results, and the impact of MTX on LS is still unclear.
The objective of our work was to study if LS in RA patients treated with MTX was related to BMI, MTX-CD, metabolic syndrome (MtS), sex, or LF.
We performed a prospective study of RA patients treated with MTX. The principal objective of this work was to study the presence of LF by transient elastography and aspartate aminotransferase to platelet ratio index as well as the detection of LS by ultrasonography and computer attenuation parameter (CAP).
Fifty-nine patients were included in the study. When comparing MTX-CD ≤ 4000 mg with > 4000 mg, we found no statistical differences in LS between low and high MTX-CD. We compared CAP scores with MtS, BMI, sex, and LF. There were no significant differences based on the presence or absence of MtS, the male sex, or LF. LS determined by CAP was significantly associated with BMI > 25.
We concluded that, in our series, LS in RA patients treated with MTX is not related to sex, MTX-CD, MtS, or LF. BMI > 25 is significatively associated with LS in our study. Other factors, apart from MTX-CD or time in treatment, are more important for the development of LS in these patients.
The routine incorporation of FS for the study of LF and LS in RA patients with MTX treatment is critical and will aid in understanding the real impact of MTX on LS. More studies (larger and multicentric) are recommended to validate these results.