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Volume 32, Issue 3, September 2021




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Mediterr J Rheumatol 2021;32(3):264-72
Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature
Authors Information

1. Department of Pathophysiology, “Laiko” Hospital, School of Medicine, National and Kapodistrian University of Greece, Athens, Greece

2. First Department of Internal Medicine, “Laiko” Hospital, School of Medicine, National and Kapodistrian University of Greece, Athens, Greece

3. Department of Pathology, School of Medicine, National and Kapodistrian University of Greece, Athens, Greece

T Androutsakos, S Sakellariou, CG Gialouri, GE Fragoulis

Abstract

Methotrexate is an anchor-drug for the treatment of inflammatory arthritides affecting peripheral joints, such as rheumatoid and psoriatic arthritis (PsA), but also for other immune-mediated diseases like psoriasis. Although it is generally a well-tolerated drug, adverse effects often occur. Reversible derangement of liver function test is the most common laboratory adverse event. However, in some cases, liver cirrhosis and/or fibrosis can occur. Besides, many of these diseases like PsA and psoriasis are closely linked with clinical conditions and risk factors that also contribute to liver damage/cirrhosis, such as increased body mass index, dyslipidaemia and diabetes mellitus (DM). It has been hypothesised that the aforementioned risk factors along with methotrexate usage can act synergistically, causing liver damage in these patients. Herein, we describe a PsA patient with DM who developed fatal liver cirrhosis after 10 years of treatment with MTX. We also review the literature about the liver toxicity of MTX in the context of PsA and psoriasis, describing concurring risk factors and histopathological findings. PubMed and Scopus were searched, without date limits. The keywords "methotrexate” AND “psoriatic arthritis” OR “psoriasis” AND "Liver damage" OR "liver fibrosis" OR “cirrhosis” were used. We found that although fibrosis/cirrhosis is present in about 10-25% of the patients, MTX can rarely cause liver damage itself. However, it can exert its effect when other factors, like increased alcohol consumption and obesity coexist. Prospective studies are needed, specifically examining the hepatotoxicity of MTX in individuals with immune-mediated diseases.

Cite this article as: Koutsompina M-L, Pappa M, Sakellariou S, Gialouri GG, Fragoulis GE, Androutsakos T. Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature. Mediterr J Rheumatol 2021;32(3):264-72.

Article Submitted: 30 Jun 2021; Revised Form: 18 Mar 2021; Article Accepted: 18 Apr 2021; Available Online: 7 Sep 2021

https://doi.org/10.31138/mjr.32.3.264

This work is licensed under a Creative Commons Attribution 4.0 International License (CC-BY). 

©Koutsompina M-L, Pappa M, Sakellariou S, Gialouri GG, Fragoulis GE, Androutsakos T.