Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Magnetic Resonance Elastography for the Evaluation of Liver Fibrosis in Patients with Rheumatoid Arthritis Receiving Methotrexate.

Hoganson1,  Deana D., Chen2,  Jun, Ehman2,  Richard L., Talwalkar2,  Jayant A., Michet1,  Clement J., Yin1,  Meng, Matteson1,  Eric L.

Mayo Clinic, Rochester, MN
Mayo Clinic

Background:

Hepatic magnetic resonance elastography (MRE) allows for noninvasive assessment of liver fibrosis. The purpose of this study was to evaluate the usefulness of MRE in detecting and quantifying liver fibrosis in patients with rheumatoid arthritis (RA) who have received methotrexate (MTX).

Methods:

Patients receiving MTX for > 5 years or with an abnormal serum AST value in the two years preceding the study onset were evaluated with MRE. Logistic regression and linear regression models with and without adjustment were used to assess the association between mean liver stiffness value as determined by MRE and variables of interest. Prior analyses have shown that a diagnostic cut-off value of 2.9 kilopascals (kPa) can predict all stages of liver fibrosis when compared to normal liver with a sensitivity and specificity of 98% and 99%, respectively. Study participants with an abnormal liver stiffness were subsequently offered evaluation in the hepatology clinic and the decision for a liver biopsy was made based on clinical judgment.

Results:

Sixty-five RA patients were enrolled. Mean liver stiffness value by MRE was abnormal in 7 patients, suggestive of hepatic injury. As a result of findings from the MRE, biopsies were performed in 5 patients and all correlated with elevated liver stiffness values (Table). The biopsies revealed chronic inflammation in all subjects; 4 individuals had evidence of fibrosis. There was a significant association between elevated mean liver stiffness and abnormal AST values ever and in the preceding 2 years prior to the scan (p=0.035 and p=0.031, respectively). Elevated mean liver stiffness values were associated with body mass index (BMI) (OR= 1.18 per 1 kg/m2; 95% CI: 1.03, 1.36; p=0.017), and this remained significant following adjustment for MTX dose, MTX treatment duration, diabetes mellitus, hyperlipidemia, and impaired fasting blood glucose. Neither the total MTX dose nor the duration of MTX treatment was associated with mean liver stiffness value (p=0.51 and P=0.20, respectively). Eleven patients reported using alcohol more than once a month. Alcohol use was not associated with abnormal mean liver stiffness values (p=0.96).

Conclusions:

MRE provides a reliable, non-invasive assessment of liver fibrosis in patients with RA receiving MTX. Patients with RA receiving MTX who have an elevated BMI may be at increased risk for chronic hepatic injury, regardless of MTX cumulative dose or duration of treatment.

Table. Abnormal Hepatic Magnetic Resonance Elastography (MRE) Scans in Patients receiving Methotrexate for Treatment of Rheumatoid Arthritis.

PatientAge (years)SexBMI (kg/m2)Total MTX dose (mg)Frequency abnormal AST 2 years prior to MREMean liver stiffness value (kPa)Liver biopsy findings
171F31.1142354/93.36Mildly active (grade 1 of 3) steatohepatitis with focal pericellular fibrosis and mild portal fibrosis (stage 1 of 4)
265F37.929501/133.46Mild reactive hepatitis with mild portal fibrosis (stage 1 of 4)
357F42.1118800/153.23Mildly active steatohepatitis without fibrosis.
446F44.968755/72.92Moderately active steatohepatitis, grade 2 (of 3) with portal, periportal, and pericellular fibrosis, stage 2 (of 4).
565F27.463401/83.26Not pursued; repeat MRE showed results within a normal range
666M37.336800/103.13Mild fatty change with mild portal fibrosis.
762F31.892957/173.15Discontinued MTX; no biopsy performed
Abbreviations: AST-aspartate aminotransferase; BMI-body mass index; MTX-methotrexate; kPa-kilopascal

To cite this abstract, please use the following information:
Hoganson, Deana D., Chen, Jun, Ehman, Richard L., Talwalkar, Jayant A., Michet, Clement J., Yin, Meng, et al; Magnetic Resonance Elastography for the Evaluation of Liver Fibrosis in Patients with Rheumatoid Arthritis Receiving Methotrexate. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :129
DOI: 10.1002/art.27898

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