Methotrexate-induced liver fibrosis in chronic inflammatory diseases: A cross-sectional study in the Tunisian population.

BACKGROUND AND STUDY AIMS: Methotrexate (MTX) is an immunosuppressive drug used to treat various chronic inflammatory diseases. While its association with liver fibrosis is concerning, several associated factors appear to play a major role. This study aimed to assess the frequency of fibrosis in MTX-treated patients and identifies its associated factors.

PATIENTS AND

METHODS

A descriptive cross-sectional study was conducted including patients with chronic inflammatory diseases who had been on MTX for at least 6 months. Liver fibrosis was assessed using transient elastography. A comparative analysis was performed between patients with and without fibrosis, defined by liver stiffness >7 kPa.

RESULTS

A total of 160 patients were included (rheumatoid arthritis (45%), psoriasis (19%), Crohn's disease (19%)), with a mean age of 53.8 years and sex-ratio F/M = 2.1. The mean duration of MTX treatment was 38 months, with an average cumulative dose of 2.340 mg. Liver fibrosis, was detected in 11.9% of patients. In a multivariate study, independent factors associated with liver fibrosis included age > 59 years (OR = 18), alcohol consumption >15.17 g/day (OR = 4.2), metabolic syndrome (OR = 9), and obesity (OR = 18).

CONCLUSION

Liver fibrosis under MTX was observed in 11.9% of patients, influenced by advanced age, alcohol consumption, metabolic syndrome, and obesity. These findings highlight the need for targeted monitoring to prevent complications.