The long-term effect of methotrexate therapy on the liver in patients with juvenile rheumatoid arthritis.
To determine if the long-term use of methotrexate (MTX) in juvenile rheumatoid arthritis (JRA) is associated with the development of significant liver fibrosis, and to describe the presence of risk factors for liver fibrosis in patients with JRA.
Needle biopsies of the liver were performed on a cross-section cohort of 14 patients with JRA who had received a total cumulative dose of MTX that was either>3,000 mg or>4,000 mg/1.73 m2 of body surface area.
Biopsy samples were independently graded according to the Roenigk Classification Scale by 2 pathologists.
The presence of risk factors for MTX hepatotoxicity, especially biochemical abnormalities reflective of liver injury and alcohol consumption, were assessed.
Thirteen biopsy samples (93%) were classified as grade I, and 1 (7%) as grade II ; none demonstrated significant fibrosis.
However, histologic abnormalities were found in 13 biopsy samples (93%). Only 2 patients (14%) consumed more than 1 alcoholic drink per month.
Thirteen patients (93%) had biochemical abnormalities while being treated with MTX, but only 5 patients (36%) had at least 1 determination in which the aspartate or alanine aminotransferase elevation was>3 times the upper limit of normal.
Long-term use of MTX for JRA does not appear to be associated with the development of significant liver fibrosis.
Although nearly all patients had minor histologic changes, no significant clinical consequences were apparent. (...)
Mots-clés Pascal : Arthrite chronique juvénile, Traitement, Chimiothérapie, Méthotrexate, Long terme, Toxicité, Fibrose, Foie, Homme, Epidémiologie, Incidence, Modalité traitement, Chronique, Immunodépresseur, Antifolate, Système ostéoarticulaire pathologie, Rhumatisme inflammatoire, Appareil digestif pathologie, Foie pathologie
Mots-clés Pascal anglais : Juvenile rheumatoid arthritis, Treatment, Chemotherapy, Methotrexate, Long term, Toxicity, Fibrosis, Liver, Human, Epidemiology, Incidence, Application method, Chronic, Immunosuppressive agent, Antifolate, Diseases of the osteoarticular system, Inflammatory joint disease, Digestive diseases, Hepatic disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0057237
Code Inist : 002B02U04. Création : 14/05/1998.