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Background Rheumatoid Arthritis (RA) is a common autoimmune disease with a complex pathogenesis involving multiple genetic and environmental factors. The management of RA rests on several principles. Drug treatment, which comprises disease-modifying antirheumatic drugs (DMARDs), non-steroidal anti-inflammatory drugs and glucocorticoids (GCs), as well as non-pharmacological measures, such as physical, occupational and psychological therapeutic approaches, together may lead to therapeutic success. However, the mainstay of RA treatment is the application of DMARDs. Methotrexate is an antifolate and antimetabolite; it’s one of the DMARDs. Long term therapy with methotrexate has been associated with development of fatty liver and hepatic fibrosis. Liver biopsy is the standard method for diagnosing liver fibrosis, but it may be associated with significant morbidity and mortality of up to 0.33% thereby limiting its use. So the use of noninvasive markers of hepatic fibrosis such as serial platelet counts, FIB 4 score, ALT/AST ratio and recently serum PIIINP become mandatory. Objectives to evaluate the reliability of PIIINP in the screening for hepatic fibrosis induced by long term methotrexate therapy in rheumatoid arthritis patients compared with FIB 4 score and ALT/AST ratio. Patients and Methods This case study included 90 RA patients categorized into 60 RA patients on MTX therapy (group I), 30 RA patients on other medications (group II). All participants were subjected to full history taking, thorough rheumatological examination and lab investigations including complete blood count (CBC), ESR, CRP, AST, ALT, RF and measurement of serum PIINP levels, DAS and FIB-4 score were calculated. Results Patients in group I showed significant increase in serum PIIINP compared to patients in group II. There was significant negative correlation between disease duration, Platelets count and serum PIIINP levels in patients of both groups. There was significant negative correlation between folic acid intake and serum PIIINP levels of group I. There was significant positive correlation between Mean Corpuscular Volume, AST, ALT, AST/ALT ratio, FIB-4 score and serum PIIINP levels in patients of both groups. There was significant positive correlation between MTX dose and duration and levels of serum PIIINP in patients of group I. Conclusion Serum PIIINP levels could be used as non invasive marker for screening for hepatic fibrosis induced by long term MTX therapy in RA patients.

Procollagen III amino terminal propeptide (PIIINP): A non invasive marker of methotrexate induced liver fibrosis in Rheumatoid arthritis patients