Evidence map›Paper›PMID 38159207›Full record

ArticleClinical rheumatology2024

Associated factors with liver fibrosis in rheumatoid arthritis patients treated with methotrexate.

Maroua Slouma, Wided Lahmar, Ghanem Mohamed, Omar Dhrif, Rim Dhahri, Hedia Bellali, Imen Gharsallah, Nabil Ebdelli

Abstract read
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In one paragraph

Article in Clinical rheumatology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
0.6field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. S3 Guideline for the treatment of psoriasis vulgaris, adapted from EuroGuiDerm - part 1: Treatment recommendations and monitoring.Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG · 2026
    Guideline
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  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Maroua SloumaDepartment of Rheumatology, Military Hospital, 1008, Tunis, Tunisia. maroua.slouma@gmail.com.ORCID http://orcid.org/0000-0002-6889-9687
Wided LahmarDepartment of Rheumatology, Military Hospital, 1008, Tunis, Tunisia.
Ghanem MohamedUniversity of Tunis El Manar, 1068, Tunis, Tunisia.
Omar DhrifUniversity of Tunis El Manar, 1068, Tunis, Tunisia.
Rim DhahriDepartment of Rheumatology, Military Hospital, 1008, Tunis, Tunisia.
Hedia BellaliUniversity of Tunis El Manar, 1068, Tunis, Tunisia.
Imen GharsallahDepartment of Rheumatology, Military Hospital, 1008, Tunis, Tunisia.
Nabil EbdelliUniversity of Tunis El Manar, 1068, Tunis, Tunisia.
Military Hospital of Tunis · TNHabib hospital Thameur · TN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThere are conflicting findings on the link between liver fibrosis and cumulative methotrexate dosages. We aimed to determine the frequency of liver fibrosis in rheumatoid arthritis patients treated with methotrexate and to identify its associated factors.

methodsWe conducted a cross-sectional study over 9 months (April-December 2021), including rheumatoid arthritis patients treated with methotrexate. Demographic and clinical data were collected. Liver stiffness was assessed by FibroScan. Fibrosis and significant liver fibrosis were defined as liver stiffness higher than 6 and 7.2 kPa, respectively. Liver tests, albuminemia, lipid profile, and blood glycemia were measured. Metabolic syndrome was also evaluated. Statistical analyses were performed using SPSS.

resultsWe included 21 men and 47 women. The mean age was 51.60 ± 1.82 years. The mean disease duration was 8.29 ± 6.48 years. The mean weekly intake of methotrexate was 13.76 ± 3.91 mg. The mean methotrexate duration was 4.67 ± 4.24 years. The mean cumulative dose was 3508.87 ± 3390.48 mg. Hypoalbuminemia and metabolic syndrome were found in 34% and 25% of cases. We noted increased alkaline phosphatase levels in four cases. The mean liver stiffness was 4.50 ± 1.53 kPa. Nine patients had liver fibrosis, and four had significant fibrosis. Associated factors with liver fibrosis were as follows: age ≥ 60 years (OR:22.703;

conclusionCumulating more than 3 g of methotrexate was associated with liver fibrosis in rheumatoid arthritis patients. Having a metabolic syndrome, higher age, hypoalbuminemia, and elevated alkaline phosphatase levels were also likely to be independently associated with liver fibrosis. Key points • Rheumatoid arthritis patients require monitoring hepatic fibrosis when the cumulated dose of methotrexate is above 3 g. • Metabolic syndrome is a risk factor for liver fibrosis, suggesting that its management is necessary to prevent this complication. • Hypoalbuminemia and elevated alkaline phosphatase levels (twice the upper limit) in rheumatoid arthritis patients treated with methotrexate were associated with liver fibrosis.

Indexed as

Arthritis, RheumatoidHypoalbuminemiaMetabolic SyndromeAlkaline PhosphataseCross-Sectional StudiesFemaleHumansLiverLiver CirrhosisMaleMethotrexateMiddle AgedAlkaline PhosphataseMethotrexateLiver fibrosisMetabolic syndromeMethotrexateRheumatoid arthritisTransient elastography

Identifiers

PMID38159207
OpenAlexW4390444518

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.