Reliability of the Roenigk Classification of Liver Damage After Methotrexate Treatment for Psoriasis

Abstract

To determine the interobserver reliability of the Roenigk score as a classification system of liver damage and its possible consequences for clinical practice.

Histological patterns in drug-induced liver disease

“…Liver biopsy is necessary in patients who develop deranged liver function following methotrexate therapy. A grading scheme has been proposed to assess toxicity (Roenigk classification50 – 52; table 4). …”

Hepatoprotective effect of tumour necrosis factor α blockade in psoriatic arthritis: a cross-sectional study

“…Institutional guidelines for monitoring of MTX-associated hepatotoxicity are effective in most countries and include periodic determination of aminotransferase serum levels or liver biopsy 1. However, the role of liver biopsy has been questioned,2 3 and it has been proposed that the detection of abnormal serum levels of the N-terminal peptide of type III procollagen might identify patients at risk, thereby reducing the number of biopsies in patients who are psoriatic by 45% 4. Recently, transient elastography (FibroScan; Echosens, Paris, France)was accepted as an alternative method to quantify liver tissue stiffness 5.…”

Drug Induced Liver Disease

“…Liver biopsy is reasonable in case when continued use or re-challenge with a suspected drug is clinically necessary. For patients receiving methotrexate there are guidelines for biopsy [21,22]. Other situations where liver biopsy could be recommended are: exacerbation of liver function in spite of stopping drug exposure, unexpected decreases of ALT within 30-60 days in hepatocellular or ALP within 180 days in cholestatic DILDs despite termination of use of the suspected drug [13].…”