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Methotrexate (MTX) can provide remission and is recommended as first-line systemic therapy for psoriasis (1). However, despite reasonable efficacy, its use is restricted by concerns regarding the risk of developing liver fibrosis (2). Liver biopsy, which is considered the gold standard for assessment of fibrosis, is invasive and has become less accepted for monitoring liver injury during long-term treatment with MTX (3, 4). Several scoring systems based on laboratory parameters have therefore been created to identify liver fibrosis (5-7). Serial monitoring of the amino terminal of type III procollagen peptide (PIIINP) is proposed as an alternative for liver biopsy (8, 9). Several studies have shown that transient elastography (TE) may be useful for monitoring patients treated with MTX (10, 11). We have identified several cases of advanced liver fibrosis confirmed with liver biopsies despite normal levels of PIIINP. The aim of this case-control study in a cohort of patients with psoriasis treated with MTX was to compare TE measurements with serological markers for liver fibrosis.

Transient Elastography May Improve Detection of Liver Fibrosis in Psoriasis Patients Treated with Methotrexate