ArticleRheumatology advances in practice2020
Incidence, predictive factors and severity of methotrexate-related liver injury in rheumatoid arthritis: a longitudinal cohort study.
Article in Rheumatology advances in practice, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Blood-test monitoring strategies for patients established on immune-suppressing drugs: a mixed-methods study.Health technology assessment (Winchester, England) · 2026Pooled it
- Pooled it
- Discontinuation vs. continuation of concomitant methotrexate in patients with rheumatoid arthritis on certolizumab pegol: results from a randomised, controlled trial.Arthritis research & therapy · 2025Trial
- DAS28-ESR may underestimate disease activity in rheumatoid arthritis patients with nonalcoholic fatty liver disease: a retrospective cohort study.Arthritis research & therapy · 2026Article
- A Shared EGR1-IL-32-Macrophage Polarisation Signature in Rheumatoid Arthritis and Metabolic Dysfunction-Associated Steatotic Liver Disease.Journal of inflammation research · 2026Article
- Methotrexate induced hepatotoxicity in metabolic dysfunction-associated steatotic liver disease.JPGN reports · 2024Article
- Article
- Development of prediction model for alanine transaminase elevations during the first 6 months of conventional synthetic DMARD treatment.Scientific reports · 2023Article
- Quality standards for the management of non-alcoholic fatty liver disease (NAFLD): consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology NAFLD Special Interest Group.The lancet. Gastroenterology & hepatology · 2022Review
- Psoriatic Arthritis: The Influence of Co-morbidities on Drug Choice.Rheumatology and therapy · 2022Review
- Initial methotrexate dosage is not associated with an increased risk of liver toxicity in patients with rheumatoid arthritis.Clinical rheumatology · 2021Article
- Risk of venous thromboembolism associated with Janus kinase inhibitors for rheumatoid arthritis: case presentation and literature review.Clinical rheumatology · 2021Review
- Patients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review.Frontiers in medicine · 2021Article
- Review
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe aims were to determine the incidence rate, predictive factors and severity of liver injury that develops during MTX treatment for RA and to evaluate the role of pretreatment hepatic fat deposition.
methodsWe used an ongoing real-life registry containing RA patients who had started MTX between August 2007 and April 2018 at participating institutions. The liver-to-spleen attenuation ratio on CT scans at enrolment was used to evaluate pretreatment fat deposition quantitatively. Patients were followed until persistent transaminitis developed or until the end of the study. Liver biopsy was performed for patients who presented with persistent transaminitis.
resultsWe followed 289 new MTX users without pretreatment elevations of transaminases (mean follow-up time, 58.3 months). Hepatic fat deposition was detected in half of the patients at enrolment. During follow-up, persistent transaminitis occurred at a crude incidence rate of 3.13 per 100 person-years, and the cumulative incidence at 5 years was estimated to be 13%. A multivariate Fine-Gray regression analysis showed that the most important predictive factors were pre-existing moderate to severe fat deposition (adjusted hazard ratio, 7.69; 95% CI: 3.10, 19.10) and obesity (adjusted hazard ratio, 2.68; 95% CI: 1.37, 5.25). Non-alcoholic steatohepatitis (NASH) was the most predominant pattern in liver biopsy samples. Hepatic fibrosis was found in 90% of samples, but most cases were not advanced.
conclusionAggravation of underlying fatty liver to NASH with fibrosis seems to be an important mechanism of liver injury that occurs in MTX-treated RA patients.
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