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Serum type III procollagen aminopeptide for assessing liver damage in methotrexate‐treated psoriatic patients
Author(s) -
BOFFA M.J.,
SMITH A.,
CHALMERS R.J.G.,
MITCHELL D.M.,
ROWAN B.,
WARNES T.W.,
SHOMAF M.,
HABOUBI N.Y.
Publication year - 1996
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1046/j.1365-2133.1996.d01-1036.x
Subject(s) - medicine , histology , gastroenterology , fibrosis , steatosis , biopsy , methotrexate , cirrhosis , liver biopsy , psoriasis , pathology , dermatology
Summary This study was designed to establish whether measurement of a serological marker of fibrosis might reduce the need for liver biopsy in psoriatic patients receiving methotrexate (MTX). Levels of type III procollagen aminopeptide (PIIINP‐O and PIITNP‐B) and laminin PI (LamP1‐B) were measured in 147 serum samples taken at the time of liver biopsy in 87 patients receiving long‐term MTX treatment for severe psoriasis. Biopsies were classified as: (1) normal. (2) steatosis. (3) inflammation, (4) fibrosis, or (5) cirrhosis. Groups 3–5 were considered to show clinically relevant abnormality. Compared with controls. PIIINP‐O was significantly raised in the group of MTX‐treated psoriatics (P<0.001). Within this group, levels were significantly higher in patients with inflammation, fibrosis or cirrhosis compared with those with normal histology or steatosis alone (P<0.0001). In contrast. PIIINP‐B and LamP1‐B did not distinguish between controls and MTX‐treated patients or between histological groups. Forty‐two patients had two or more biopsies with simultaneous PIIINP‐O measurement. PIIINP‐O levels at the time of the first biopsy were normal in six of the seven patients whose histology was initially normal and subsequently became abnormal. A single measurement of PIIINP‐O thus did not predict which patients might develop abnormal histology following further MTX. In a group of 17 patients, PIIINP‐O was measured 3‐monthly for up to 6 years during MTX treatment. PPIINP‐O was elevated at some time during follow‐up in all three patients who developed abnormal histology but was consistently normal in eight of the 11 patients whose histology remained or became normal. Our findings indicate that PIIINP‐O is of value in detecting liver damage and, particularly if measured serially, may reduce the need for liver biopsy in MTX‐treated patients. Although the test does not detect all patients with fibrosis, it would appear that the risk of missing significant liver damage in patients with persistently normal PIIINP‐O is low.