Liver fibrosis in inflammatory arthritis patients treated with methotrexate and hydroxychloroquine: A FIB-4 index analysis

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases Pub Date : 2024-10-23 DOI:10.1111/1756-185X.15390

Güllü Sandal Uzun, Buğu Bulat, Gizem Ayan, Levent Kılıç, Umut Kalyoncu

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Abstract

Objectives

To evaluate the risk of liver fibrosis and associated factors with the non-invasive fibrosis score-4 (FIB-4) index in patients with inflammatory arthritis using methotrexate (MTX).

Methods

Patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) who were followed up in the rheumatology outpatient clinic, who were on methotrexate only and for whom FIB-4 index was could be calculated at methotrexate initiation and follow-up were included. The FIB-4 index was calculated according to the following formula: age (years) × AST(IU/L)/(platelet count(10 (9)/L) × √ALT(IU/L)). The patients' demographics, comorbidities, other treatments, cumulative MTX dose, and reasons for MTX cessation were assessed. For the multivariate analysis, possible factors associated with intermediate-high risk FIB-4 index at last visit were determined.

Results

A total of 107 patients were enrolled in the study, of whom 82 (76.6%) had RA and 25 (23.4%) had PsA. At the initiation of MTX, 24 (22.4%) patients had intermediate-high risk FIB-4 index. Comorbidities and the rate of ≥3–4 Charlson comorbidity index were more common in patients with intermediate-high risk FIB-4 index. A total of 37 (34.5%) patients had intermediate-high risk FIB-4 index at the last visit after median 3.6 (0.3–22.06) years follow-up. The median cumulative MTX dose was 2550 mg (1050–13.991). Cumulative MTX dose [OR 1.18 (1.01–1.33), p = .03] and diabetes mellitus [OR 4.60 (1.74–12.50), p = .002] were associated factors with intermediate-high risk FIB-4 index. The concomitant use of hydroxychloroquine (HCQ) was found to be a low-risk factor for FIB-4 index [OR 0.28 (0.10–0.78) p = .015].

Conclusion

The FIB-4 index is a non-invasive method that can be used in daily rheumatology practice for the evaluation and follow-up of patients who will use methotrexate. Comorbidities and cumulative MTX dose seem to be related with the risk of liver fibrosis. Concomitant use of HCQ with MTX may reduce the risk of liver fibrosis.

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接受甲氨蝶呤和羟氯喹治疗的炎症性关节炎患者的肝纤维化：FIB-4指数分析

目的评估使用甲氨蝶呤（MTX）的炎症性关节炎患者肝纤维化的风险以及与非侵入性肝纤维化评分-4（FIB-4）指数相关的因素：方法：纳入在风湿病门诊随访的类风湿性关节炎（RA）和银屑病关节炎（PsA）患者，这些患者仅使用甲氨蝶呤，且在开始使用甲氨蝶呤和随访时可计算FIB-4指数。FIB-4 指数的计算公式如下：年龄（岁）×AST（IU/L）/（血小板计数（10（9）/L）×√ALT（IU/L））。对患者的人口统计学特征、合并症、其他治疗、MTX累积剂量以及停用MTX的原因进行了评估。在多变量分析中，确定了最后一次就诊时与中高风险 FIB-4 指数相关的可能因素：共有107名患者参与研究，其中82人（76.6%）患有RA，25人（23.4%）患有PsA。在开始使用MTX时，24名（22.4%）患者的FIB-4指数为中高风险。合并症和 Charlson 合并症指数≥3-4 的患者在 FIB-4 指数为中高风险的患者中更为常见。在中位随访3.6（0.3-22.06）年后的最后一次随访中，共有37名（34.5%）患者的FIB-4指数为中高风险。MTX累积剂量中位数为2550毫克（1050-13.991）。MTX累积剂量[OR 1.18 (1.01-1.33)，p = .03]和糖尿病[OR 4.60 (1.74-12.50)，p = .002]是中高风险FIB-4指数的相关因素。同时使用羟氯喹（HCQ）是FIB-4指数的低风险因素[OR 0.28 (0.10-0.78) p = .015]：结论：FIB-4指数是一种非侵入性方法，可用于日常风湿病学实践中对将使用甲氨蝶呤的患者进行评估和随访。合并症和MTX累积剂量似乎与肝纤维化的风险有关。在使用MTX的同时使用HCQ可降低肝纤维化的风险。

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来源期刊

International Journal of Rheumatic Diseases RHEUMATOLOGY-

CiteScore

3.70

自引率

4.00%

发文量

362

审稿时长

1 months

期刊介绍： The International Journal of Rheumatic Diseases (formerly APLAR Journal of Rheumatology) is the official journal of the Asia Pacific League of Associations for Rheumatology. The Journal accepts original articles on clinical or experimental research pertinent to the rheumatic diseases, work on connective tissue diseases and other immune and allergic disorders. The acceptance criteria for all papers are the quality and originality of the research and its significance to our readership. Except where otherwise stated, manuscripts are peer reviewed by two anonymous reviewers and the Editor.