Prevalence of liver fibrosis in patients with inflammatory arthritis on methotrexate therapy using transient elastography based assessment and its correlation with methotrexate duration and cumulative doses

Aim and Objective: The study aimed to assess the prevalence of liver fibrosis using Transient Elastography (TE) in patients with inflammatory arthritis on methotrexate (MTX) therapy. It also explored the correlation between liver fibrosis and both the cumulative dose and duration of MTX use. Material and Methods: This observational cross-sectional study was conducted at the Hind Institute of Medical Sciences, Barabanki and included 210 patients with inflammatory arthritis who had been on MTX therapy for atleast 6 months. Patient s with confounding factors for LF (liver fibrosis), such as obesity, alcohol use, or other hepatotoxic drugs, were excluded. Liver stiffness was assessed using Fibroscan, with the following classification: No fibrosis (<7.1kPa), significant fibrosis (7.1-9.5kPa), moderate fibrosis (9.5-12.5kPa) and cirrhosis (>12.5 kPa). Statistical analysis included multivariate regression, Spearman's rank correlation, Chi-square tests, and t-tests. Results: Liver fibrosis (?7.1 kPa) was detected in 54 patients (25.2%), with 50 (23%) having significant fibrosis and 4 (2%) having moderate fibrosis. No cases of cirrhosis were identified. Patients with fibrosis had significantly higher cumulative MTX doses (r=0.244, p=0.00003) and longer MTX duration (r=0.285, p<0.001). Multivariate analysis revealed that both MTX cumulative dose (p=0.006) as well as duration (p<0.001) had been independent predictors of liver stiffness. Conclusion: The present Study found a 25.2% prevalence of liver fibrosis in inflammatory arthritis patients on MTX, with fibrosis severity positively correlating with MTX dose and duration.