Determinants of serious liver disease among patients receiving low-dose methotrexate for rheumatoid arthritis
Article first published online: 9 DEC 2005
Copyright © 1993 American College of Rheumatology
Arthritis & Rheumatism
Volume 36, Issue 3, pages 329–335, March 1993
How to Cite
Walker, A. M., Funch, D., Dreyer, N. A., Tolman, K. G., Kremer, J. M., Alarcón, G. S., Lee, R. G. and Weinblatt, M. E. (1993), Determinants of serious liver disease among patients receiving low-dose methotrexate for rheumatoid arthritis. Arthritis & Rheumatism, 36: 329–335. doi: 10.1002/art.1780360307
- Issue published online: 9 DEC 2005
- Article first published online: 9 DEC 2005
- Manuscript Accepted: 5 NOV 1992
- Manuscript Received: 13 APR 1992
- Lederle Laboratories, Pearl River, NY
Objective. To assess the risk of serious liver disease in patients with rheumatoid arthritis (RA) taking methotrexate (MTX).
Methods. We surveyed members of the American College of Rheumatology to determine previous use of MTX in the treatment of rheumatoid arthritis and to identify cases of cirrhosis and liver failure. Cases were confirmed by review of pathology specimens, findings from diagnostic testing, and clinical presentations. A case—control study was then conducted to ascertain prognostic factors. Case and control medical records were reviewed for information on MTX therapy as well as other possible determinants of serious liver disease.
Results. Twenty-four cases of cirrhosis and liver failure were identified, giving a 5-year cumulative incidence of ˜ 1/1,000 treated patients. Six of the 24 patients had died: 4 died of the initial liver disease, 1 of hepatic complications of another illness, and 1 of unrelated causes. Two patients continue to have active liver disease. Late age at first use of MTX and duration of therapy with MTX were independent predictors of serious liver disease.
Conclusion. Serious liver disease is an uncommon, age- and dose-related complication of low-dose MTX therapy for RA.