原创力文档rare incidence of methotrexate-specific lesions in liver biopsy of patients with arthritis and elevated liver enzymes罕见的肝活检methotrexate-specific病变的发生率关节炎患者和肝酶升高.pdfVIP
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rare incidence of methotrexate-specific lesions in liver biopsy of patients with arthritis and elevated liver enzymes罕见的肝活检methotrexate-specific病变的发生率关节炎患者和肝酶升高
Quintin et al. Arthritis Research Therapy 2010, 12:R143
/content/12/4/R143
RESEARCH ARTICLE Open Access
Rare incidence of methotrexate-specific lesions in
liver biopsy of patients with arthritis and elevated
liver enzymes
1 2 1 1*
Emilie Quintin , Jean-Yves Scoazec , Hubert Marotte , Pierre Miossec
Abstract
Introduction: The present study objective was to evaluate the incidence of methotrexate (MTX)-specific liver
lesions from the analysis of a liver biopsy of inflammatory arthritis patients with elevated liver enzymes.
Methods: A case-control study was performed with 1,571 arthritis patients on long-term low-dose MTX therapy.
Results of liver biopsy were analyzed in 41 patients with elevated liver enzymes. The expression of autoimmune
markers was also assessed. This population was compared with 41 disease control subjects obtained from the
same database, also on MTX but without elevated liver enzymes, matched for age, sex and rheumatic disease.
Results: Compared with the disease controls, patients with liver biopsy showed lower disease duration and lower
MTX exposure, weekly and cumulative doses, reflecting shorter treatment duration due to liver abnormalities. Liver
biopsies showed 17 autoimmune hepatitis-like (AIH-like) lesions, 13 nonalcoholic steatohepatitis-like lesions, seven
limited liver lesions, and two primary biliary cirrhoses. However, MTX-specific lesions with dystrophic nuclei in
hepatocytes were seen in only two cases. Liver biopsy lesions were associated with autoimmune markers (P =
0.007); notably, AIH-like lesions were associated with rheumatoid arthritis and with the presence of the HLA-DR
shared epitope.
Conclusions: MTX-specific liver lesions are rarely observed in arthritis patients under long-term MTX therapy a
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