To test the usefulness and cost savings resulting from application of the new American College of Rheumatology (ACR) guidelines for assessing the risk for the development of clinically significant liver disease in rheumatoid arthritis (RA) patients treated with methotrexate (MTX).
One-hundred twelve MTX-treated RA patients were prospectively followed up for MTX hepatotoxicity and underwent liver biopsies according to modified guidelines of the Psoriatic Task Force (PTF).
All biopsies were graded according to the Roenigk classification.
The new ACR recommendations were then retrospectively applied to test their usefulness and cost-effectiveness in this cohort.
Based on the PTF guidelines, 66 patients underwent liver biopsies ; a total of 110 liver biopsies were performed.
Five patients were found to have Roenigk grade IIIB or IV histologic abnormalities.
The new ACR guidelines on MTX monitoring and biopsy surveillance appear to be clinically useful and result in considerable cost savings.
However, 1 IDDM patient with significant liver histologic abnormalities would have been missed.
We suggest that IDDM be added to the ACR guidelines as a risk factor for MTX hepatotoxicity.
Mots-clés Pascal : Polyarthrite rhumatoïde, Homme, Traitement, Chimiothérapie, Toxicité, Foie, Evaluation, Recommandation, Biopsie, Surveillance, Méthotrexate, Economie santé, Analyse avantage coût, Antirhumatismal, Chronique, Système ostéoarticulaire pathologie, Rhumatisme inflammatoire, Immunopathologie, Maladie autoimmune, Foie pathologie, Appareil digestif pathologie
Mots-clés Pascal anglais : Rheumatoid arthritis, Human, Treatment, Chemotherapy, Toxicity, Liver, Evaluation, Recommendation, Biopsy, Surveillance, Health economy, Cost benefit analysis, Antirheumatic agent, Chronic, Diseases of the osteoarticular system, Inflammatory joint disease, Immunopathology, Autoimmune disease, Hepatic disease, Digestive diseases
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0482309
Code Inist : 002B02U04. Création : 01/03/1996.