The Role Of Fibroscan In Detecting Hepatic Fibrosis Induced By Methotrexate

Abstract

Introduction: Liver represents the main place of drug metabolisation. Drugs and toxic substances reach the level of liver after absorption at gastro-intestinal level. Drug hepatotoxicity represents an important chapter of iatrogenic pathology, because the hepatic lesions induced by drugs include extremely diverse clinical, biological and histological expressions that can take the aspect of any form of acute or chronic hepatobiliary disease. Hepatic lesions induced by drugs (LHIM) represent a histological and/or biochemical alteration caused and attributed to the consumption of a drug. Hepatic elastography (Fibroscan) represents a noninvasive method of quantification of hepatic fibrosis. Material and method: We carried out a retrospective study and longitudinally prospective study that included a set of patients under treatment with Methotrexate, amounting to 76, divided into 2 subsets: a subset consisting of patients with hepatitis to Methotrexate, subset 1, of 23 patients, a subset of patients under treatment with Methotrexate but with normal hepatic samples, subset b, of 53 patients. Results: We carried out fibroscan a t a ll t he patients treated with Methotrexate, obtaining a medium score of fibrosis of 6.23 for the subset a with hepatitis at Methotrexate and of 5.33 for the subset b with normal hepatic samples. We made a correlation between the cumulated dose of Methotrexate and the

Hepatic steatosis as measured by the computed attenuation parameter predicts fibrosis in long-term methotrexate use

“…We present further convincing data supporting the use of non-invasive markers of fibrosis and steatosis to guide the treatment of rheumatologic and dermatologic diseases. TE has been used to advise which patients on MTX have already developed fibrosis ( 12 – 14 ). However, our study shows that an increased CAP score can advise which patients are at increased risk of fibrosis.…”

“…Transient elastography (TE) is a non-invasive measure of hepatic fibrosis that has been used in patients on MTX ( 12 – 14 ). TE measures the stiffness (or elasticity) of the hepatic parenchyma using both ultrasound and low-frequency elastic waves produced by an ultrasound vibrator applied to the right upper quadrant to measure the propagation speed of a wave using a pulse-echo ultrasound ( 15 ).…”