Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature

Methotrexate is an anchor-drug for the treatment of inflammatory arthritides affecting peripheral joints, such as rheumatoid and psoriatic arthritis (PsA), but also for other immune-mediated diseases like psoriasis. Although it is generally a well-tolerated drug, adverse effects often occur. Reversi...

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Autores principales:	Maria-Loukia Koutsompina, Maria Pappa, Stratigoula Sakellariou, Chrysoula G. Gialouri, George E. Fragoulis, Theodoros Androutsakos
Formato:	article
Lenguaje:	EN
Publicado:	PCO Convin S.A. 2021
Materias:	methotrexate liver dysfunction psoriatic arthritis psoriasis Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/6fecdd8762bc43b1a2df2262de4bff40
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spelling	oai:doaj.org-article:6fecdd8762bc43b1a2df2262de4bff402021-11-08T08:28:47ZMethotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature2529-198X10.31138/mjr.32.3.264https://doaj.org/article/6fecdd8762bc43b1a2df2262de4bff402021-01-01T00:00:00Zhttp://www.mjrheum.org/assets/files/792/file322_1364.pdfhttps://doaj.org/toc/2529-198XMethotrexate is an anchor-drug for the treatment of inflammatory arthritides affecting peripheral joints, such as rheumatoid and psoriatic arthritis (PsA), but also for other immune-mediated diseases like psoriasis. Although it is generally a well-tolerated drug, adverse effects often occur. Reversible derangement of liver function test is the most common laboratory adverse event. However, in some cases, liver cirrhosis and/or fibrosis can occur. Besides, many of these diseases like PsA and psoriasis are closely linked with clinical conditions and risk factors that also contribute to liver damage/cirrhosis, such as increased body mass index, dyslipidaemia and diabetes mellitus (DM). It has been hypothesised that the aforementioned risk factors along with methotrexate usage can act synergistically, causing liver damage in these patients. Herein, we describe a PsA patient with DM who developed fatal liver cirrhosis after 10 years of treatment with MTX. We also review the literature about the liver toxicity of MTX in the context of PsA and psoriasis, describing concurring risk factors and histopathological findings. PubMed and Scopus were searched, without date limits. The keywords “methotrexate” AND “psoriatic arthritis” OR “psoriasis” AND “Liver damage” OR “liver fibrosis” OR “cirrhosis” were used. We found that although fibrosis/cirrhosis is present in about 10–25% of the patients, MTX can rarely cause liver damage itself. However, it can exert its effect when other factors, like increased alcohol consumption and obesity coexist. Prospective studies are needed, specifically examining the hepatotoxicity of MTX in individuals with immune-mediated diseases.Maria-Loukia KoutsompinaMaria PappaStratigoula SakellariouChrysoula G. GialouriGeorge E. FragoulisTheodoros AndroutsakosPCO Convin S.A.articlemethotrexateliver dysfunctionpsoriatic arthritispsoriasisDiseases of the musculoskeletal systemRC925-935ENMediterranean Journal of Rheumatology, Vol 32, Iss 3, Pp 264-272 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	methotrexate liver dysfunction psoriatic arthritis psoriasis Diseases of the musculoskeletal system RC925-935
spellingShingle	methotrexate liver dysfunction psoriatic arthritis psoriasis Diseases of the musculoskeletal system RC925-935 Maria-Loukia Koutsompina Maria Pappa Stratigoula Sakellariou Chrysoula G. Gialouri George E. Fragoulis Theodoros Androutsakos Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature
description	Methotrexate is an anchor-drug for the treatment of inflammatory arthritides affecting peripheral joints, such as rheumatoid and psoriatic arthritis (PsA), but also for other immune-mediated diseases like psoriasis. Although it is generally a well-tolerated drug, adverse effects often occur. Reversible derangement of liver function test is the most common laboratory adverse event. However, in some cases, liver cirrhosis and/or fibrosis can occur. Besides, many of these diseases like PsA and psoriasis are closely linked with clinical conditions and risk factors that also contribute to liver damage/cirrhosis, such as increased body mass index, dyslipidaemia and diabetes mellitus (DM). It has been hypothesised that the aforementioned risk factors along with methotrexate usage can act synergistically, causing liver damage in these patients. Herein, we describe a PsA patient with DM who developed fatal liver cirrhosis after 10 years of treatment with MTX. We also review the literature about the liver toxicity of MTX in the context of PsA and psoriasis, describing concurring risk factors and histopathological findings. PubMed and Scopus were searched, without date limits. The keywords “methotrexate” AND “psoriatic arthritis” OR “psoriasis” AND “Liver damage” OR “liver fibrosis” OR “cirrhosis” were used. We found that although fibrosis/cirrhosis is present in about 10–25% of the patients, MTX can rarely cause liver damage itself. However, it can exert its effect when other factors, like increased alcohol consumption and obesity coexist. Prospective studies are needed, specifically examining the hepatotoxicity of MTX in individuals with immune-mediated diseases.
format	article
author	Maria-Loukia Koutsompina Maria Pappa Stratigoula Sakellariou Chrysoula G. Gialouri George E. Fragoulis Theodoros Androutsakos
author_facet	Maria-Loukia Koutsompina Maria Pappa Stratigoula Sakellariou Chrysoula G. Gialouri George E. Fragoulis Theodoros Androutsakos
author_sort	Maria-Loukia Koutsompina
title	Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature
title_short	Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature
title_full	Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature
title_fullStr	Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature
title_full_unstemmed	Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature
title_sort	methotrexate-related liver cirrhosis in psoriatic arthritis: a case report and review of the literature
publisher	PCO Convin S.A.
publishDate	2021
url	https://doaj.org/article/6fecdd8762bc43b1a2df2262de4bff40
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Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature

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