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Assessment of liver fibrosis markers in people with rheumatoid arthritis on methotrexate
Author(s) -
OlssonWhite Debbie A.,
Olynyk John K.,
Ayonrinde Oyekoya T.,
Paramalingam Shereen,
Keen Helen I.
Publication year - 2022
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.15125
Subject(s) - medicine , gastroenterology , transient elastography , rheumatoid arthritis , fibrosis , cirrhosis , liver fibrosis , liver biopsy , methotrexate , rheumatology , hepatic fibrosis , biopsy
Background Up to 3% of methotrexate (MTX)‐treated rheumatoid arthritis (RA) patients might develop liver fibrosis or cirrhosis, requiring effective screening algorithms. Aims To assess the utility of non‐invasive liver fibrosis assessment in RA patients on MTX. Methods Fifty‐six patients were recruited from rheumatology outpatient clinics in a public tertiary centre from July 2017 to October 2018. Clinical data was collected. Screening for hepatic fibrosis was performed using transient elastography (TE), aminoaspartate transaminase to platelet ratio index (APRI), Hepascore and Fibrosis‐4 index (FIB‐4). Those with suspected significant liver fibrosis based on these screening tests were assessed by a hepatologist. Results Twenty‐seven patients were suspected to have liver fibrosis on screening, including 10/56 (18%) by TE, 20/56 (36%) by Hepascore, 2/56 by APRI (4%) and 1/56 by FIB‐4 (2%). Of these 27 patients, 11 were reviewed by a hepatologist and one diagnosed with significant liver fibrosis. TE, but not APRI, Hepascore or FIB‐4, was found to have 100% sensitivity and 84% specificity ( P = 0.029) for hepatologist‐diagnosed liver fibrosis. Conclusion Liver fibrosis develops in a minority of MTX‐treated RA patients. The present study suggests that TE is a more sensitive screening test than APRI, FIB‐4 or Hepascore in the identification of people with RA at risk of hepatic fibrosis.