Summary
Baseline and sequential liver biopsies were performed in ten patients with rheumatoid arthritis (RA) treated with methotrexate (MTX) for more than 4 years. Liver biopsies were performed in all patients before the initiation of MTX therapy and were repeated after reaching a cumulative dose of 1500 mg or more. In four patients a third biopsy was performed 3 years after the first one. No significant worsening of hepatic architecture was found in any of our patients after 4 to 71/2 years of MTX therapy. No correlations between histologic findings and various clinical or pharmacological variables could be found. Our results suggested that prolonged MTX administration in RA patients did not cause severe hepatic abnormalities.
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Weinblatt ME, Coblyn JS, Fraser PA, Holdsworth DE, Falchuk KR, Trentham DE (1988) Long term prospective study of methotrexate in rheumatoid arthritis. Arthritis Rheum 31:167–175
Kremer JM, Lee JK (1988) A long term prospective study of methotrexate in rheumatoid arthritis: An update after a mean of 53 months. Arthritis Rheum 31:577–584
Tishler M, Caspi D, Rosenbach TO, Fishel B, Wigler I, Gazit E, Yaron M (1988) Methotrexate in rheumatoid arthritis: a prospective study in Israeli patients with immunogenetic correlations. Ann Rheum Dis 47:654–659
Gispen JG, Alarcon GS, Johnson JJ, Acton RT, Barger BO, Koopman WJ (1987) Toxicity to methotrexate in rheumatoid arthritis. J Rheumatol 14:74–79
Nyfors A, Poulson H (1976) Liver biopsies from psoriatics related to methotrexate therapy. 2. Findings before and after methotrexate therapy in 88 patients: a blind study. Acta Pathol Microbiol Scand 84:262–270
Lefkowitz AM, Farrow IJ (1955) The liver in rheumatoid arthritis. 15 years experience. Am J Med 75:69–73
Hoffmeister RT (1983) Methotrexate therapy in rheumatoid arthritis. 15 years experience. Am J Med 75:69–73
Kremer JM, Lee RG, Tolman KG (1989) Liver histology in rheumatoid arthritis patients receiving long term methotrexate therapy. Arthritis Rheum 32:121–127
Brick JE, Moreland LW, Al-Kawas F, Chang W, Layne RD, DiBartolomeo AG (1989) Prospective analysis of liver biopsies before and after methotrexate therapy in rheumatoid arthritis. Semin Arthritis Rheum 19:31–44
Loo AP, MacKenzie AH, Tutrill RJ, Leatherman JR (1985) Liver histology in rheumatoid arthritis before and after prolonged methotrexate therapy. Arthritis Rheum 28:S14
Roenigh HH, Auerbach R, Marbach AI, Weinstein GD (1982) Methotrexate guidelines: revised. J Am Acad Dermatol 6:145–155
Colsky J, Greenspan EM, Warren TN (1955) Hepatic fibrosis in children with acute leukemia after therapy with folic acid antagonists. Arch Pathol Lab Med 59:198–206
Roenigk HH, Bergfeld WF, St Jaques R, Owens FJ, Hawk WA (1971) Hepatotoxicity of methotrexate in the treatment of psoriasis. Arch Dermatol 103:250–261
Aponte J, Petrelli M (1988) Histopathologic findings in the liver of rheumatoid arthritis patients treated with long term bolus methotrexate. Arthritis Rheum 31:1457–1464
Mackenzie AH (1985) Hepatotoxicity of prolonged methotrexate therapy for rheumatoid arthritis. Clev Clin Q 52:129–135
Hoyumpa AM, Greene HL, Dunn GD, Schenker S (1975) Fatty liver: biochemical and clinical characteristics. Am J Dig Dis 20:1142–1170
Bridges SL, Alarcon GS, Koopman WJ (1989) Editorial: Methotrexate induced liver abnormalities in rheumatoid arthritis. J Rheumataol 16:1180–1182
Willkens RF, Leonard PA, Clegg DO, Tolman KG, Ward JR, Marks CR, Greene ML, Roth GH, Jackson CG, Cannon GW, Lee RG (1990) Liver histology in patients receiving low dose pulse methotrexate for the treatment of arthritis. Ann Rheum Dis 49:591–593
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Tishler, M., Caspi, D., Halperin, Z. et al. A prospective analysis of liver biopsies in rheumatoid arthritis patients receiving long term methotrexate therapy. Rheumatol Int 12, 39–41 (1992). https://doi.org/10.1007/BF00246875
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DOI: https://doi.org/10.1007/BF00246875