| Title: |
Rheumatoid Arthritis: Treatment [151-201]: 151. Should we be Looking More Carefully for Methotrexate Induced Liver Disease? |
| Authors: |
Lloyd, Mark; Makadsi, Raad; Ala, Aftab; Connor, Patrick; Gwynne, Catherine; Rhys Dillon, Brian; Lawson, Tom; Emery, Paul; Mease, Philip J.; Rubbert-Roth, Andrea; Curtis, Jeffrey R.; Müller-Ladner, Ulf; Gaylis, Norman; Armstrong, Gillian K.; Reynard, Mark; Tyrrell, Helen; Joshi, Nilay; Loke, Yoon; MacGregor, Alex; Malaiya, Ritu; Rachapalli, Satish M.; Parton, Ted; King, Lloyd; Parker, Gerry; Nesbitt, Andrew; Schiff, Michael; Sheikzadeh, Ali; Formosa, Dan; Domanska, Barbara; Morgan, Darrell; van Vollenhoven, Ronald; Cifaldi, Mary; Roy, Sanjoy; Chen, Naijun; Gotlieb, Larry; Malaise, Michel; Langtree, Matthew; Lam, Manda; Malipeddi, Aruna; Hassan, Waji; El Miedany, Yasser; El Gaafary, Maha; Palmer, Deborah; Dutta, Shouma; Breslin, Anne; Ahmad, Yasmeen; Morcos, Peter N.; Zhang, Xiaoping; Grange, Susan; Schmitt, Christophe; Malipeddi, Aruna S.; Neame, Rebecca; Isaacs, John D.; Olech, Ewa; Tak, Paul P.; Deodhar, Atul; Keystone, Edward; Yocum, David; Hessey, Eva; Read, Simon; Blunn, Karina J.; Williams, Richard B.; McDowell, Jackie A.; Rees, David H.; Young, Adam; Marks, Jonathan L.; Westlake, Sarah L.; Baird, Janis; Kiely, Patrick D.; Östör, Andrew J.; Quinn, Mark A.; Taylor, Peter C.; Edwards, Christopher J.; Vagadia, Vipul; Bracewell, Claire; McKay, Neil; Collini, Anna; Kidd, Elizabeth; Wright, David; Watson, Kathryn; Williams, Emma; Mossadegh, Somayyeh; Ledingham, Joanna; Combe, Bernard; Schwartzman, Sergio; Massarotti, Elena; Keystone, Edward C.; Luijtens, Kristel; van der Heijde, Desiree; Mariette, Xavier; Kivitz, Alan; Stohl, William; Jones, Richard; Jahreis, Angelika; Armstrong, Gillian; Shaw, Tim; Westhovens, Rene; Strand, Vibeke; Purcaru, Oana; Khanna, Dinesh; Smolen, Josef; Kavanaugh, Arthur; Fleischmann, Roy M.; Dougados, Maxime; Baldassare, Andrew R.; Linnik, Matthew; McInnes, Iain B.; Burmester, Gerd; Keiserman, Mauro; Codding, Christine; Songcharoen, Suthin; Berman, Alberto; Nayiager, Sauithree; Saldate, Cristina; Aranda, Richard; Becker, Jean-Claude; Zhao, Cathy; Le Bars, Manuela; Burmester, Gerd R.; Kary, Sonja; Unnebrink, Kristina; Guérette, Benoît; Oezer, Uemit; Kupper, Hartmut; Patra, Kaushik; Lavie, Frederic; Gasparyan, Armen Y.; Sandoo, Aamer; Stavropoulos-Kalinoglou, Antonios; Kitas, George D.; Dubash, Sayam R.; Linton, Stuart; Genovese, Mark C.; Matteson, Eric L.; Hsia, Elizabeth C.; Xu, Stephen; Doyle, Mittie K.; Rahman, Mahboob U.; on behalf of the GO-BEFORE GO-FORWARD and GO-AFTER Investigators; Curtis, Jeffery; Fleischmann, Roy; Mease, Philip; Coteur, Geoffroy; van Vollenhoven, Raymond; Goel, Niti; Desai, Chintu; Choy, Ernest; Van Vollenhoven, Ronald; Furie, Richard; Blesch, Anne; Wang, Candace D.; Hughes, Lyndsay D.; Done, D. John; Treharne, Gareth; van Vollenhoven, Ronald F; Bingham, Clifton O.; Furst, Daniel E.; Macey, Katherine; Sweetster, Marianne T.; Lehane, Patricia B.; Farmer, Pamela; Long, Simon G.; Kremer, Joel M.; Russell, Anthony S.; Abud-Mendoza, Carlos; Szechinski, Jacek; Wu, George; van der Heijde, Désirée; Sinisi, Sandra; Strand, V.; Landewe, Robert; Ansari, Zainab; Alavi, Azita; Fitzgerald, Oliver; Collins, Emily S.; Fraser, Owen; Tarelli, Edward; Ng, Vincent C.; Breshnihan, Barry; Veale, Douglas J.; Axford, John S.; Aletaha, D.; Alasti, F.; Smolen, J. S.; Schiff, Michael H.; Rovensky, Josef; Taylor, Monet; John, Ani K.; Balbir-Gurman, Alexandra; John Done, D.; Treharne, Gareth J.; Ezard, Carsten; Willott, Ruth; Butt, Sayqa; Gadsby, Kate; Deighton, Chris; Tsuru, Tomoni; Terao, Kimio; Suzaki, Midori; Nakashima, Hitoshi; Akiyama, Azusa; Nishimoto, Norihiro; Wordsworth, Paul; Kay, Jonathon; Hsia, Elizabeth; Zhou, Yiying; on behalf of the and GO-AFTER Investigators; Siri, Daniel; Krasnow, Joel; Alecock, Emma; Alten, Rieke; Kawata, Yuichi; Aoki, Chieko; Mima, Toru; van Vollenhoven, Ronald F.; Nishimoto, Norihio; Yamanaka, Hisashi; Woodworth, Thasia; Taylor, Andrew; Pope, Janet E.; Rubbert, Andrea; Buchanan, Jacqueline; Klareskog, Lars; Murphy, Frederick T.; Wu, Zhong; Parasuraman, Shreekant; on behalf of the and GO-FORWARD Investigators; Kay, Jonathan; Shreekant, Parasuraman; Gomez-Reino, J. J.; Davies, C.; Alecock, E.; Rubbert-Roth, A.; Emery, P. |
| Publisher Information: |
Oxford University Press |
| Publication Year: |
2010 |
| Collection: |
HighWire Press (Stanford University) |
| Subject Terms: |
POSTER VIEWING II (THURSDAY 22 APRIL 2010; 08:30-10:00) |
| Description: |
Background: UK guidelines and a `Rheumatology' editorial suggest that liver function tests (LFTs) alone remain a satisfactory method for methotrexate (MTX) monitoring in rheumatoid arthritis (RA). Recent literature also suggests no difference in hepatotoxity between MTX treated RA and psoriatic arthritis (PsA) patients. We describe 3 cases of liver fibrosis / cirrhosis missed by conventional monitoring. Methods: Case 1: 71 yr old female, RA 35 yrs. Presented 2005. Previous breast cancer. Alcohol < 1 unit/week. Rx MTX for 20 years, up to 25mg weekly. Leflunomide (Lef) 10 mg od added 3 mths previously. LFTs normal, P3NP 6.6. 2005-6 RA well controlled, normal LFTs. Repeat P3NP 2006 11.7. Liver ultrasound (US): normal echogenicity and hepatic and portal vein flow. Attempts to stop Lef were unsuccessful and led to use of rescue depomedrone. Developed diabetes. Sept 2007 LFTs normal, albumin 35. Feb 2008: admitted with ascites, ALT 41, albumin 31, bilirubin 24. CT liver normal, US suggested fatty change with normal portal flow. Biopsy showed established cirrhosis on a background of steatohepatitis. MTX and Lef stopped. June 2008: fatal pneumonia. Case 2: 69 yr old male. RA 2007; previous type II diabetes Rx insulin. On simvastatin. Alcohol < 1 unit/week. eGFR 60. LFTs normal. Rx MTX 12.5 mg/week + folic acid. July 2008 ALT 83: MTX ↓ 10 mg, Oct 2008 ALT 89: MTX ↓7.5 mg. Nov 2008 ALT 69. Dec 2008 - Aug 2009 ALT 70, 91, 67, 65, 52 (ie < x2 normal). Aug 2009 ALT 38, alb 27. Sept 2008 ALT 85, albumin 22, INR 1.7.US: shrunken liver. Full liver screen negative. Developed spontaneous bacterial peritonitis. Died Sept 2009. Results: Case 3: 63 yr old female, presented 1999. PsA diagnosed 1993, Rx MTX 7.5mg weekly. Alcohol < 1 unit/week. 1996 ‘routine’ liver biopsy performed (i.e. after 3 yrs MTX), result missing. 1997 US liver normal. Jan 1999: AST 69. Previous liver biopsy retrieved: steatosis + perivascular fibrosis. MTX stopped. LFTs normalized and remain normal. Conclusions: The risk of liver damage in some MTX ... |
| Document Type: |
text |
| File Description: |
text/html |
| Language: |
English |
| Relation: |
http://rheumatology.oxfordjournals.org/cgi/content/short/49/suppl_1/i89; http://dx.doi.org/10.1093/rheumatology/keq725 |
| DOI: |
10.1093/rheumatology/keq725 |
| Availability: |
http://rheumatology.oxfordjournals.org/cgi/content/short/49/suppl_1/i89; https://doi.org/10.1093/rheumatology/keq725 |
| Rights: |
Copyright (C) 2010, British Society for Rheumatology |
| Accession Number: |
edsbas.AC8A8EE0 |
| Database: |
BASE |