Estimation of the Prevalence of Liver Fibrosis in Patients Receiving Chronic Methotrexate Therapy with MR Elastography

Jun Chen¹, Deana Hoganson², Meng Yin¹, Kevin Glaser¹, Jayant Talwalkar³, Eric Matteson², Richard Ehman¹

Methotrexate (MTX) has become the most frequently prescribed disease modifying antirheumatic agent (DMARD) for rheumatoid arthritis (RA), due to its efficacy, low cost and tolerability. An ongoing primary concern of MTX treatment is its potential hepatotoxicity. Guidelines published in 1994 by the American College of Rheumatology (ACR) suggest that serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and albumin be monitored every 4-8 weeks for assessing hepatotoxicity in RA patients receiving MTX. If a patient develops 5 of 9 abnormal AST values within a 12 month time frame or if serum albumin decreases below the normal range, a liver biopsy is recommended. Because of the apparently low rate of clinically significance, MTX related hepatotoxicity, the usefulness and cost-effectiveness of such frequent monitoring, particularly in the absence of risk factors for liver disease have been brought into question. The unavailability of accurate non-invasive hepatic fibrosis detection methods other than biopsy has frustrated clinicians in addressing these important questions. Since its advent 15 years ago [8], Magnetic Resonance Elastography (MRE) has developed into a clinical useful diagnostic technology. This abstract reports interim results from a currently ongoing project using MRE to assess hepatic fibrosis in RA patients who are on MTX treatment seen at our institution.