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Methotrexate Hepatotoxicity In Rheumatoid Arthritis - An Analysis Of The Physicians Policy | 45259
Journal of Clinical & Experimental Pathology
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Background: Rheumatoid Arthritis is a common chronic disease and concern about the adverse effect of methotrexate especially
hepatotoxicity could be a reason for discontinuation or reducing dose but the result of multiple policy in this situation is unclear and
the physicians need to know what would be happened after each decision.
Aim of the work: To demonstrate the result of multiple approaches to transaminitis in patients with Rheumatoid Arthritis who
Patients & Methods: The data has been collected from the previous work (since 2006) on 295 patients with Rheumatoid Arthritis
who received at least 7.5 mg methotrexate for one month in a referral rheumatology clinic. The patients who developed transaminitis
at least one time were selected for this study (N=102). At this point, physicians’ decision on discontinuing, decreasing, increasing or
fixed dose of methotrexate in approach to patients was collected and the result of the next liver enzyme was evaluated.
Results: Decreased dose or discontinuation was happened among 32 patients (31.4%) and fixed dose or rising dose in 53.9% and 8.8%
respectively. The result of next enzyme in each group was normal in 93%, 65% and 67% respectively. Among 30 patients who had
two consecutive elevated liver enzymes, 30% discontinued or decreased MTX dose. The next enzyme became normal in all of them
however it was seen in 67% of the others with fixed or rising dose.
Conclusion: Obvious improvement in liver enzymes after decreased dose or discontinuation of methotrexate could be seen that
makes this policy the best of action in approach to transaminitis of methotrexate, however trend to improvement despite of physicians’
decision were observed. If this natural course may be due to adjustment of hepatocyte activity or renal clearance, it needs to be further
Anvari B did her Medical education and Internship, from Shiraz University of medical science, in the year 1990-1997, and in 2004-2008, Internal medicine residency and Board (2008), from Tehran University of Medical science. Her previous related work experiences include: from 1997-2004, she worked as a emergency, primary care, and trustworthy physician, from 2008-2009, she worked as a Internist of Internal medicine ward of GHods Hospital, Paveh, Kermanshah, and from 2009 to present, she is working as an Assistant Professor, in Internal medicine department, at Imam Khomeini Hospital, Kermanshah.