Hepatic failure in a patient with rheumatoid arthritis treated with methotrexate: A case report.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
27 Jan 2023
27 Jan 2023
Historique:
entrez:
27
1
2023
pubmed:
28
1
2023
medline:
31
1
2023
Statut:
ppublish
Résumé
Chronic liver damage from methotrexate (MTX) is not uncommon, and fatal outcome is rare. We experienced a case of hepatic failure leading to death. We considered the cause of death through this case and proposed a method to prevent the progression of this liver injury. We report the case of a patient with rheumatoid arthritis treated with MTX for 15 years. A liver biopsy revealed histological changes similar to those of advanced nonalcoholic steatohepatitis (NASH), most likely induced by MTX. MTX was discontinued after 4 years. Two years after the discontinuation, the patient died of irreversible hepatic failure. Her obesity, complicated by type 2 diabetes mellitus, might have aggravated MTX-induced NASH-like liver injury. Early diagnosis and immediate MTX discontinuation following NASH diagnosis and strict type 2 diabetes mellitus control might have prevented the irreversible progression of liver injury.
Identifiants
pubmed: 36705384
doi: 10.1097/MD.0000000000032711
pii: 00005792-202301270-00040
pmc: PMC9875947
doi:
Substances chimiques
Methotrexate
YL5FZ2Y5U1
Antirheumatic Agents
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e32711Informations de copyright
Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317–25.
Miyata M, Kuroda M, Unakami M, et al. Validation of the fibrosis-4 (FIB-4) index in the diagnosis of liver disease of rheumatoid arthritis patients treated with methotrexate. Mod Rheumatol. 2019;29:936–42.
Matteoni CA, Younossi ZM, Gramlich T, et al. Non-alcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116:1413–9.
Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for non-alcoholic fatty liver disease. Hepatology. 2005;41:1313–21.
Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54:2665–73.
Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569–81.
Kalb RE, Strober B, Weinstein G, et al. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol. 2009;60:824–37.
Takahashi C, Kaneko Y, Okano Y, et al. Association of erythrocyte methotrexate-polyglutamate levels with the efficacy and hepatotoxicity of methotrexate in patients with rheumatoid arthritis: a 76-week prospective study. RMD Open. 2017;3:e000363.
Whiting-O’Keefe QE, Fye KH, Sack KD. Methotrexate and histologic hepatic abnormalities: a meta-analysis. Am J Med. 1991;90:711–6.
Dahl MG, Gregory MM, Scheuer PJ. Liver damage due to methotrexate in patients with psoriasis. Br Med J. 1971;1:625–30.
Coates LC, Soriano ER, Corp N, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol. 2022;18:465–79.
Osuga T, Ikura Y, Kadota C, et al. Significance of liver biopsy for the evaluation of methotrexate-induced liver damage in patients with rheumatoid arthritis. Int J Clin Exp Pathol. 2015;8:1961–6.
Evidence-based practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. 2nd ed. Nankodo, Tokyo27–29 (in Japanese); 2020.