Prospective analysis of liver biopsies before and after methotrexate therapy in rheumatoid patients

Brick, James E.; Moreland, Larry W.; Al–Kawas, Firas; Chang, Wenguang; Layne, Richard D.; DiBartolomeo, Anthony G.

doi:10.1016/0049-0172(89)90085-1

Cited by 58 publications

(18 citation statements)

References 35 publications

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“…One hundred three patients (14%) had mild (grade IIIA) fibrosis on biopsy, 6 (0.8%) had moderate or grade IIIB fibrosis, and 2 were identified as having cirrhosis (Table 2). After review of the pretreatment biopsy (38), it was determined that 1 of these latter 2 patients had cirrhosis at baseline.…”

Section: Resultsmentioning

confidence: 99%

Methotrexate for Rheumatoid Arthritis

Kremer

Alarcón

Lightfoot

et al. 1994

Arthritis & Rheumatism

536

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Methotrexate (MTX) has become an important drug in the treatment of rheumatoid arthritis (RA). The American College of Rheumatology convened a committee to assess the risks of development of clinically significant liver disease (CSLD) during MTX treatment, to evaluate the risk and role of surveillance liver biopsies, and to provide recommendations about monitoring patients for liver toxicity. The committee recommends obtaining liver blood tests (alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase, albumin, bilirubin), hepatitis B and C serologic studies, and other standard tests including complete blood cell count and serum creatinine tests prior to starting treatment with MTX. A pretreatment liver biopsy should be considered only for patients with a history of prior excessive alcohol consumption, persistently abnormal baseline AST values, or chronic hepatitis B or C infection. At intervals of every 4–8 weeks the AST, ALT, and albumin levels should be monitored. Routine surveillance liver biopsies are not recommended for RA patients receiving traditional doses of MTX. However, a biopsy should be performed if a patient develops persistent abnormalities on liver blood tests. These are defined as elevations (above the upper limit of laboratory normal) in the AST in 5 of 9 determinations within a given 12‐month interval (6 of 12 if tests are performed monthly) or a decrease in serum albumin below the normal range. The recommendations for monitoring and selection of patients for liver biopsy identify patients at potential risk for CSLD, and thus significantly reduce the number of patients who would be exposed to this procedure. Close monitoring is essential to reduce the risk of unrecognized serious liver disease. These recommendations should be revised as necessary to reflect new and compelling information.

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Section: Resultsmentioning

confidence: 99%

Methotrexate for Rheumatoid Arthritis

Kremer

Alarcón

Lightfoot

et al. 1994

Arthritis & Rheumatism

536

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“…Caution should be used when placing obese patients on a regimen of methotrexate since these individuals are at greater risk of developing hepatotoxicity compared to non-obese patients (Table IX). [28][29][30][31][32][33][34][35] Caution should also be exercised when using cyclosporine in obese individuals, since serum trough levels of the drug are paradoxically high in this group, increasing the risk of nephrotoxicity (Table X). 36,37 DISCUSSION Obesity and psoriasis: association studies The question of which comes first, psoriasis or obesity, is a common question.…”

Section: Evidencementioning

confidence: 99%

Obesity and psoriasis: From the Medical Board of the National Psoriasis Foundation

Bremmer

Voorhees

Hsu

et al. 2010

Journal of the American Academy of Dermatology

107

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“…Obesity may increase the likelihood of adverse effects of systemic agents such as methotrexate and cyclosporine. [21][22][23][24][25][26] Although smoking has not been studied in a large cohort of psoriasis patients in the United States, it has been characterized as a comorbidity of psoriasis in Europe. [27][28][29] Thus, we analyzed the data of the UPI cohort to gain insight into the role smoking may have in the development and presentation of psoriasis.…”

Section: Discussionmentioning

confidence: 99%