The British Journal of Rheumatology, Vol 36, 338-344, Copyright © 1997 by British Society for Rheumatology
C Beyeler, J Reichen, SR Thomann, BH Lauterburg and NJ Gerber
The objectives were to determine quantitative liver function prospectively
in patients with rheumatoid arthritis (RA) treated with low-dose
methotrexate (MTX), to search for risk factors for a loss of quantitative
liver function and to assess the relationship between quantitative liver
function and histological staging. A total of 117 patients with RA (ACR
criteria, 85 women, mean age 59 yr) had measurements of galactose
elimination capacity (GEC), aminopyrine breath test (ABT) and liver enzymes
[aspartate amino transferase (AST), alanine amino transferase (ALT),
alkaline phosphatase (AP), 7-glutamyl transferase (GGT), bile acids,
bilirubin, albumin] before treatment with weekly i.m. MTX injections and
every year thereafter. In 16 patients, liver biopsies were performed.
Before the introduction of MTX, mean GEC was 6.6 mg/min/kg [5th to 95th
percentile (5-95 PC) 5.1- 8.5; reference range 6.0-9.1] and mean ABT was
0.80% kg/mmol (5-95 PC 0.42-1.30: reference range 0.6-1.0). During
treatment with MTX [mean weekly dose 11.8 mg (5-95 PC 5.4-20.2), mean
observation period 3.8 yr (5-95 PC 0.4-6.9)], significant declines of GEC
(-0.12 mg/min/kg per year. t = 3.30, P < 0.002) and ABT (-0.06% kg/mmol
per year, t = 4.81, P < 0.001) were observed. Negative correlations were
found between the annual change in GEC and GEC at baseline (Rs = -0.40, P
< 0.0001), and the annual change in ABT and ABT at baseline (Rs = -0.43,
P < 0.0001). No correlations were found between the annual change in GEC
or ABT and weekly MTX dose, age or percentage of increased liver enzymes,
and no effect of a history of alcohol consumption > 30 g/week became
evident. Two patients with Roenigk grade III had impaired quantitative
liver function, while 14 patients with Roenigk grades I and II exhibited a
high variability of GEC and ABT from normal to abnormal values. The
continuous declines in GEC and ABT observed deserve attention in patients
with prolonged treatment. Patients with a low GEC or ABT at baseline seem
not to be at increased risk for a further loss of quantitative liver
function. An impaired GEC or ABT does not necessarily concur with hepatic
fibrosis on histological examination.
ORIGINAL PAPERS
Quantitative liver function in patients with rheumatoid arthritis treated with low-dose methotrexate: a longitudinal study
Department of Rheumatology, University of Berne, Switzerland.
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