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.


Liver Injury in Patients with Rheumatic Diseases and Inflammatory Syndrome: A Case-Control Prospective Analysis Using Biomarkers (FibroTest, ActiTest and SteatoTest).

Gaujoux-Viala2,  Cécile, Benhamou2,  Mathilde, Munteanu1,  Mona, Ngo1,  Yen, Messous1,  Djamila, Imbert-Bismut1,  Françoise, Ratziu1,  Vlad

Paris 6–Pierre et Marie Curie University; Hepatology, Pitié-Salpêtrière Hospital, Paris, France
Paris 6– Pierre et Marie Curie University; Rheumatology, Pitié-Salpêtrière Hospital, Paris, France
DILI-GHPS Study Group

Background:

Several drugs used in chronic rheumatic diseases (RHU) can induce liver damage. Few studies on consecutive cohorts are available because of the limitations of liver biopsy.

The aim was 1) to use validated biomarkers to evaluate the presence of fibrosis (Fibrotest), necroinflammatory activity (Actitest), and steatosis (Steatotest) and associated risk factors among RHU subjects hospitalized in a rheumatology department 2) to evaluate the impact of inflammatory syndrom estimated by C-reactive protein (CRP) on FibroTest parameters.

Methods:

211 prospective RHU were compared to 211 healthy controls without known liver disease (CTR), matched for age, gender, self-declared alcohol intake (SDA) and body mass index. Standard thresholds were: Fibrotest<0.27 for no/minimal fibrosis (METAVIR F0) and Fibrotest>0.48 for advanced fibrosis (AF, METAVIR>F2); Actitest<0.29 for no/minimal activity (METAVIR A0); Steatotest<0.38 for no steatosis.

Results:

Among RHU (36.4% male, age 48 years, median [range] CRP 4g/L[4–72]), 96 had rheumatoid arthritis (RA), 57 ankylosing spondylitis (AS), 14 psoriatic arthritis (PsA) and 50 other diagnoses; 36.5% were treated with methotrexate (MTX), 22.7% with corticosteroids, 22.8% with non-steroid anti-inflammatory, 8.1% with infliximab (IFX), 29.4% with paracetamol. Median [range] number of treatments per subject was 3[0–11]. The mean (SE) SDA in PsA compared with others was 12g/d (7.7) vs. 5g/d (0.7) (p=0.02).

The prevalence of presumed lesions in RHU versus CTR in overall population and according to etiology was presented in the table.

 RHUCTRp
Fibrosis %10.97.20.17
        - RA7.35.2NS
        - AS8.85.3NS
        - PsA21.47.1NS
AF2.40.10.025
Activity %10.44.30.015
  OR=2.61 [1.17–5.82] 
        - RA11.53.10.026
  OR=4.012 [1.082–14.88] 
        - AS8.81.80.09
        - PsA21.414.3NS
Steatosis%38.530.20.048
  OR=1.44 [0.95–2.17] 
        - RA41.233.7NS
        - AS30.234NS
        - PsA64.328.60.058

Steatosis was more prevalent in patients treated with MTX or IFX than in CTR (40.3% vs 29.9%, p<0.0001; 52.9%vs17.6%, p=0.031 respectively). The prevalence of other lesions was not different according to treatment regimen.

CRP was not correlated [Spearman correlation coefficient (SCC)] with alpha2-macroglobulin (SCC= 0.01, p=0.89) and was correlated only with haptoglobin (SCC= 0.71, p<0.0001) without impact on FibroTest results (SCC=-0.07, p=0.36).

Conclusions:

Compared with CTR, RHU had a higher prevalence of necroinflammatory activity and steatosis presumed with biomarkers. The subjects with RA had greater presumed activity, and subjects with PsA more frequent steatosis. The presumed steatosis was associated with treatments with MTX and IFX. Haptoglobin and not alpha2macroglobulin was correlated with inflammatory syndrom without impact on final FibroTest results.

To cite this abstract, please use the following information:
Gaujoux-Viala, Cécile, Benhamou, Mathilde, Munteanu, Mona, Ngo, Yen, Messous, Djamila, Imbert-Bismut, Françoise, et al; Liver Injury in Patients with Rheumatic Diseases and Inflammatory Syndrome: A Case-Control Prospective Analysis Using Biomarkers (FibroTest, ActiTest and SteatoTest). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1762
DOI: 10.1002/art.29527

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