Elevated liver enzyme tests among patients with rheumatoid arthritis or psoriatic arthritis treated with methotrexate and/or leflunomide (original) (raw)
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LiverToxicity in Patients with Rheumatoid arthritis on methotrexate therapy
Background: Rheumatoid arthritis (RA) is a chronic multisystem disease affecting joints, connective tissues and fibrous tissues. Methotrexate (MTX) is a folate antagonist used as a first line treatment in RA. Hepatotoxicity is a common side effect of MTX. This study was done to evaluate abnormalities of liver function with respect to cumulative dose and duration of MTX. Materials and methods: In this cross sectional analytical study 109 patients of RA aged ≥18years on methotrexate therapy were analyzed for abnormal liver profile by using Liver Function Test (LFT), Ultrasonography (USG) abdomen. The weekly dose, cumulative dose and duration of treatment were compared between patients with and without elevated liver enzymes. Results: Of 109 patients, transaminitis was observed in 22 patients (20.1%,95% CI: 13.3%-29.2%). The mean SGOT and SGPT were 44.04 ± 29.15 IU/L and 35.85 ± 23.26 IU/L respectively. The mean weekly dose, cumulative dose and duration of MTX therapy were 8.74 ±2.51 mg/wk, 2131.82 ± 1283.26 mg and 4.9 ± 2.47 years respectively. The mean weekly dose and cumulative dose of MTX was higher among the patients with transaminitis (11.19 ±2.18 mg/wk vs 8.15 ± 2.23 mg/wk and 3188.57 ± 1100.19 mg vs 1879.64 ±1196.71mg) which was statistically significant (p<0.001). Fatty liver was present in 15.6% of the study participants. Majority (87.1%) of the participants were females. Conclusion: transaminitis was the major abnormality observed, the prevalence of which was higher among patients with longer duration of treatment with MTX and with higher cumulative dose. However, there was no significant association for gender and age with transaminits. The prevalence of fatty liver was also higher among the patients receving higher dose of MTX.
Revista Brasileira de Reumatologia, 2011
Objective: Some studies have reported that adding leflunomide (LEF) to the treatment of rheumatoid arthritis (RA) in patients who do not respond to methotrexate (MTX) improved efficacy but increased the risk of liver toxicity. This study aimed at assessing the incidence of liver toxicity in patients with active RA using the LEF and MTX combination therapy in comparison with that of patients on MTX monotherapy. Methods: Between February and September 2009, 97 consecutive patients followed up at the University Hospital of the Universidade Federal de Santa Catarina, Brazil, were enrolled. RA patients on MTX alone or using the LEF and MTX combination had their medical records systematically reviewed. The alanine/aspartate aminotransferase enzymes were retrospectively analyzed since the beginning of treatment with MTX or MTX plus LEF. Hepatotoxicity was defined as an increase of at least twofold the upper limits of normal of the liver enzymes. Results: 71 RA patients were included in the study: 36.6% were using 20-25 mg/week of MTX alone and 63.4% were using 20-25 mg/week of MTX plus 20 mg/day of LEF. Of the patients on the combination therapy, 11.1% had abnormal levels of liver enzymes versus 11.5% of the patients on monotherapy (P = 1.0). Abnormal aminotransferase levels have been seen with both MTX and LEF monotherapies in patients with RA. In our study, no difference was found between the percentages of aminotransferase elevations of patients being treated with MTX alone or in combination with LEF. Conclusion: The combination of MTX and LEF in RA patients is generally safe and well tolerated.
Liver Toxicity in Rheumatoid Arthritis Patients Treated With Methotrexate
Asia Pacific Journal of Medical Toxicology, 2015
Background:Methotrexate (MTX) is one of the most commonly used disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis (RA) which can be associated with toxic effects on different organs. This study was designed to investigate the hepatotoxic effects in RA patients treated with MTX. Methods: In this cross-sectional observational study, RA patients who received standard dose regimen of methotrexate (7.5-15 mg/week) for a minimum of 3 months were included. Liver function parameters including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin as well as prothrombin time (PT) were assessed for all patients. The patients were divided into two groups according to the MTX dose received: (1) low-dose group (≤ 7.5 mg/week) and (2) high-dose group (> 7.5 mg/week). Results:One-hundred patients (64% women) with mean age of 45.8 ± 7.5 years were studied. Eighty patients (80%) received low-dose MTX and the rest received high-dose MTX. Mean...
Risk of Hepatotoxicity in Leflunomide Vs Methotrexate in Treatment of Rheumatoid Arthritis
Pakistan Journal of Medical and Health Sciences
Objective: To compare the hepatotoxicity in Leflunomide vs Methotrexate in rheumatoid arthritis patients. Study design: Cross sectional study. Place and duration of study: Study was conducted from Jun 2021 to Mar 2022 at Department of Rheumatology and immunology Sheikh Zayed Hospital Lahore. Methodology: Inclusion criteria were any patient aged between 18-70 years males and females. Patients who were diagnosed with RA according to ACR criteria 2010. Exclusion criteria were pregnancy, Known case of hepatitis B or C, patients having known hypersensitivity to DMARDS. Group A (MTX) of 150 patients received 20 mg/week of MTX and Group B (LEF) of 150 patients received 20mg/day of LEF. The collected data was analyzed on (SPSS) version 24.0. Results: 40 patients were excluded from study. Mean age of patients in Group A (MTX) was 52.73±9.34 years and in Group B (LEF) it was 51.15 + 9.79 years. 44 patients (33.8%) of group A which were given MTX developed GI symptoms while 22 patients (16.9%)...
Rheumatology, 1997
The objectives were to determine quantitative liver function prospectively in patients with rheumatoid arthritis (RA) treated with low-dose methotrexate (MTX), to search for risk factors for a loss of quantitative liver function and to assess the relationship between quantitative liver function and histological staging. A total of 117 patients with RA (ACR criteria, 85 women, mean age 59 yr) had measurements of galactose elimination capacity (GEC), aminopyrine breath test (ABT) and liver enzymes [aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase (AP), g-glutamyl transferase (GGT), bile acids, bilirubin, albumin] before treatment with weekly i.m. MTX injections and every year thereafter. In 16 patients, liver biopsies were performed. Before the introduction of MTX, mean GEC was 6.6 mg/min/kg [5th to 95th percentile (5-95 PC) 5.1-8.5; reference range 6.0-9.1] and mean ABT was 0.80%kg/mmol (5-95 PC 0.42-1.30; reference range 0.6-1.0). During treatment with MTX [mean weekly dose 11.8 mg (5-95 PC 5.4-20.2), mean observation period 3.8 yr (5-95 PC 0.4-6.9)], significant declines of GEC (−0.12 mg/min/kg per year, t = 3.30, P Q 0.002) and ABT (−0.06%kg/mmol per year, t = 4.81, P Q 0.001) were observed. Negative correlations were found between the annual change in GEC and GEC at baseline (RS = − 0.40, P Q 0.0001), and the annual change in ABT and ABT at baseline (RS = − 0.43, P Q 0.0001). No correlations were found between the annual change in GEC or ABT and weekly MTX dose, age or percentage of increased liver enzymes, and no effect of a history of alcohol consumption q30 g/week became evident. Two patients with Roenigk grade III had impaired quantitative liver function, while 14 patients with Roenigk grades I and II exhibited a high variability of GEC and ABT from normal to abnormal values. The continuous declines in GEC and ABT observed deserve attention in patients with prolonged treatment. Patients with a low GEC or ABT at baseline seem not to be at increased risk for a further loss of quantitative liver function. An impaired GEC or ABT does not necessarily concur with hepatic fibrosis on histological examination.
Effect of Methotrexate on Liver in Patient with Rheumatoid Arthritis
Saudi Journal of Pathology and Microbiology
Background: Methotrexate helps your immune system from assaulting your body's cells by calming it down. This helps to lessen the inflammation that causes rheumatoid arthritis's swollen and stiff joints, psoriasis' thickened skin, and Crohn's disease's gut damage. Because of its powerful effectiveness and safety, In the treatment of rheumatoid arthritis, methotrexate (MTX) is used as an anchor disease-modifying anti-rheumatic drug (DMARD) (RA).Although MTX aids a huge percentage of RA patients, it is not without adverse effects. When treating rheumatoid arthritis patients with the MTX, wide a variety of adverse effects, from minor to severe, can occur, leading to therapy termination. One putative harmful effect of methotrexate on the due to a local folate deficiency, there is a reduction in hepatic folate stores and toxicity. When MTX used with other medications, further research is needed to improve efficacy while reducing adverse effects. The management of MTX t...
Methotrexate and Hepatic Toxicity in??Rheumatoid Arthritis and Psoriatic Arthritis
Clinical Drug Investigation, 2006
methotrexate when used in the treatment of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in a district general hospital population, and to investigate the effect of alcohol consumption in these patients. Methods: A prospective evaluation of 550 RA patients and 69 PsA patients was undertaken, controlling for confounding factors. Systematically randomised patients were further analysed regarding alcohol consumption. A transaminase level of three times the upper limit of normal on two or more occasions was taken to indicate hepatic injury. Results: Gastrointestinal disturbance was the predominant adverse effect in RA patients (9.8%); hepatic disturbance was the most frequent in PsA patients (14.5%). Both groups had hepatic enzyme elevation; PsA patients were at significantly greater risk of elevated transaminases than RA patients (14.5% vs 7.5%, respectively, χ 2 = 4.017). Alcohol consumption did not correlate with hepatic injury (mean 5.15 vs 6.6 alcohol units/week consumed by RA and PsA patients, respectively). Conclusion: Our data show methotrexate-treated PsA patients have a higher incidence of hepatotoxicity compared with methotrexate-treated patients with RA. It is proposed that psoriatic patients may be inherently more susceptible to methotrexate hepatotoxicity than are rheumatoid patients.
Indonesian Journal of Rheumatology, 2018
Background Rheumatoid arhtirtis (RA) is a chronic autoimmune disease that mainly attacks joints. It may causes joint deformities which leads to lower quality of life of RA patients. RA is treated with metothrexate (MTX) which inhibiting disease progression. MTX is known for its hepatotoxicity side effect, which is described by an elevation of aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) beyond the upper normal limit. Factors that may enhance hepatotoxicity are gender, age, cummulative dose of MTX, and duration therapy of MTX. Prevalence of hepatotoxicity caused by MTX therapy in RA patients in Indonesia is still unknown. The objective of this research is to know the proportion of hepatotoxicity and its associations with the factors that may enhance hepatotoxicity caused by MTX therapy in RA patients in RSCM.Method Data about gender, age, cummulative dose and duration therapy of MTX are obtained from 115 RA patients' medical records.Result Proportion of...
Rheumatology, 2009
Objective. MTX hepatotoxicity is considered to occur more frequently in patients with psoriasis than in patients with RA. However, toxicity guidelines are based on reports from studies with small sample sizes and limited follow-up periods. The current study's objective was to examine the long-term risk of MTX hepatotoxicity based on a database review of patients with RA or psoriasis, and to examine whether the two populations differed. Methods. We conducted a retrospective cohort review among members of a large health maintenance organization (HMO) in Israel who were diagnosed with either RA (n ¼ 119) or psoriasis (n ¼ 690) and who had purchased at least one dose of MTX. Liver function analyses were performed serially in these patients during the follow-up. All abnormal assays were recorded in the computerized database of the HMO. Results. Both groups had hepatic enzyme elevation; the pre-disposing factors predictive of liver damage were female gender and a higher cumulative dose of MTX (hazard ratios, 1.46 and 1.07, respectively, P < 0.001). Age, concurrent diseases and type of disease had no influence on susceptibility to liver damage. No statistically significant difference was detected in any abnormal liver function test among patients with either RA or psoriasis. Conclusion. Our study did not corroborate previous findings of significant differences between psoriasis patients and RA patients concerning susceptibility to hepatotoxicity from MTX therapy. The only significant factor predicting a higher risk of hepatic damage was female gender.