Validation of the fibrosis-4 (FIB-4) index in the diagnosis of liver disease of rheumatoid arthritis patients treated with methotrexate.

Abstract

Objectives: To validate the usefulness of a hepatic fibrosis scoring system fibrosis-4 (FIB-4) index to diagnose liver diseases in rheumatoid arthritis (RA) patients treated with methotrexate (MTX).Methods: The FIB-4 index (age(years) × AST(U/L)/platelet (PLT) (109/L) × √ALT(U/L)), proposed as a predictor for liver fibrosis in HIV/HCV coinfection, was evaluated in this study. RA patients on MTX treatment were screened by FIB-4 index values to detect fibrotic change in the liver. Liver biopsy specimens were examined histologically in patients with high values.Results: Thirteen of 14 patients showed histology closely resembling non-alcoholic steatohepatitis. In three of them, two biopsies were performed: 1st, during MTX treatment; and 2nd, after discontinuation of MTX. All of them showed improvement in histology along with decreased FIB-4 values. Age, AST/√ALT, and 1/PLT, as well as creatinine levels and cumulative MTX doses were significantly higher in the high FIB-4 group compared with the low FIB-4 group. In the high FIB-4 group, 1/PLT and AST/√ALT were significantly correlated with FIB-4 values, but age was not.Conclusions: The FIB-4 index is simple to calculate and a valuable marker to diagnose liver disease in RA patients treated with long-term MTX administration.

• Authors: Masayuki Miyata, Masahito Kuroda, Masamitsu Unakami, Kazuhiro Tasaki, Kiyoshi Migita, Hiromasa Ohira
• Journal: Modern rheumatology (Mod Rheumatol) Vol. 29 Issue 6 Pg. 936-942 (Nov 2019) ISSN: 1439-7609 [Electronic] England
• PMID: 30379089 (Publication Type: Journal Article, Validation Study)

Chemical References

• Biomarkers
• Methotrexate

Topics

• Adult
• Arthritis, Rheumatoid (drug therapy)
• Biomarkers (blood)
• Chemical and Drug Induced Liver Injury (blood, etiology, pathology)
• Female
• Humans
• Liver Cirrhosis (blood, etiology, pathology)
• Male
• Methotrexate (therapeutic use, toxicity)
• Middle Aged
• Severity of Illness Index