Abstract Background/Aims Methotrexate is widely used in the management of inflammatory disease and requires routine blood monitoring to identify adverse effects such as hepatotoxicity or bone marrow suppression. In recent years there has been consideration of the role of routine transient elastography as a non-invasive method to assess liver fibrosis in patients receiving methotrexate. Methods A study with prospective and retrospective arms was conducted to assess the risk of liver disease in patients with inflammatory arthritis on methotrexate. Patients were grouped into new starters, those on methotrexate for a five-year duration, and those receiving treatment for ten or more years. Sixty patients were initially identified in each of the five- and ten-year exposure groups. The new starters had no evidence of pre-existing liver disease. After exclusions, liver elastography was performed on 44 patients in the five-year group and 42 patients in the ten-year group. Controlled Attenuation Parameter (CAP) scores and liver stiffness measurements were recorded. Confounding factors and patients’ comorbidities, including diabetes mellitus and hypertension were recorded. Body mass indices (BMIs) were calculated using GP records of height and weight. Results There were 76.7% of patients with rheumatoid arthritis, 19.5 % with psoriatic arthritis and 3.6% with miscellaneous diagnoses. The transient elastography results were compared by calculating the mean for both CAP scores and stiffness in the five-year and ten-year groups. The mean CAP scores were 241± 60.4 standard deviation (SD) and 244.7± 56.9 SD, respectively, both within the normal range. For the stiffness results the five-year group had a mean of 5.2 ± 1.87 SD and the ten-year group 5.57 ± 1.82 SD. In both groups, six patients were identified with mild liver fibrosis and were advised to follow lifestyle interventions to reduce the risk of further liver injury. The liver stiffness values showed a trend towards higher values in the ten-year group (median 5.35 kPa) compared with the five-year group (median 4.95 kPa). The results were plotted on a histogram; CAP scores were approximately normally distributed, while liver stiffness demonstrated right-skewed distributions. There was a positive correlation between BMI and transient elastography scores, suggesting that high BMI is associated with higher CAP scores. Conclusion In this cohort of patients on long-term methotrexate therapy, no significant differences in liver steatosis or stiffness were observed between the two groups. The findings support the hepatic safety of methotrexate with routine blood test monitoring over a ten-year period. The presence of elevated stiffness values in some individuals highlights the need for ongoing liver monitoring, particularly those with other comorbidities. Further analysis with a larger patient cohort and additional statistical analysis to account for age, BMI and alcohol intake would provide more robust data. Disclosure A. Dyson: None. S. Gor: None. M. Jamal: None.
Dyson et al. (2026) studied this question.