Assessment of the Effect of Psoriasis and Methotrexate Treatment on Liver Stiffness by ARFI Imaging

Yıl 2023, Cilt: 15 Sayı: 2, 243 - 247, 22.06.2023

Derya Güçlü , Ebru Karagün , Elif Nisa Unlu , Mehtap Oktay , Özge Pasin

https://doi.org/10.18521/ktd.1280187

Öz

Objective: To investigate whether psoriasis and methotrexate used in its treatment cause liver fibrosis and eventually to evaluate the safety of methotrexate in treatment.
Method: 44 cases were included in the study. Methotrexate-using (group 1, n=14) and methotrexate-not-using (group 2, n=13) psoriasis patients were compared retrospectively with a healthy control group (group 3, n=17) according to mean shear wave rates obtained from sonoelastographic examinations with ARFI technique.
Results: Mean shear wave velocities were calculated as 2.57 ± 1.13 m/sec in the patients using methotrexate, 2.31 ± 1.16 m/sec in the patients who did not use methotrexate, and 1.56 ± 0.62 m/sec in the healthy control group. While the average shear wave velocity of the 3rd group was found to be significantly lower than that of the 1st and 2nd groups (p=0.032; p=0.012), no significant difference was observed between the 1st and 2nd groups (p=0.755).
Conclusion: We think that the increase in liver tissue stiffness in patients using methotrexate for psoriasis is secondary to the inflammatory process caused by psoriasis itself rather than methotrexate, and methotrexate is safe for the liver in treatment.

Anahtar Kelimeler

ARFI, Methotrexate, Psoriasis, Shear wave elastography

Psöriazis ve Metotreksat Tedavisinin Karaciğer Sertliğine Etkisinin ARFI Görüntüleme ile Değerlendirilmesi

Öz

Amaç: Psöriazisin ve tedavisinde kullanılan metotreksatın karaciğer fibrozisine neden olup
olmadığını araştırmak ve böylelikle metotreksatın tedavideki güvenilirliğini
değerlendirmektir.
Gereç ve Yöntem: Çalışmaya 44 olgu dahil edildi. Psöriasis tanılı olup metotreksat kullanan
(grup 1, n=4) ve metotreksat kullanmayan (grup 2, n=13) hastalar ile sağlıklı kontrol
grubunun (grup 3, n=17) Akustik Radyasyon Kuvveti İmpulsu (ARFI) tekniği ile yapılmış
sonoelastografik incelemelerinde shear wave hız ortalamaları retrospektif olarak
karşılaştırılmıştır.
Bulgular: Ortalama shear wave hızları metotreksat kullanan hastalarda 2,57 ± 1,13 m/sn,
metotreksat kullanmayan hasta grubunda 2,31 ± 1,16 m/sn, sağlıklı kontrol grubunda ise 1,56
± 0,62 m/sn olarak hesaplanmış olup 3. grubun shear wave hız ortalaması 1 ve 2. gruptan
anlamlı derecede düşük bulunurken (p=0,032; p=0,012), 1 ve 2. gruplar arasında anlamlı
farklılık gözlenmemiştir (p=0,755).
Sonuç: ARFI kuantifikasyon ile yapılan shear wave görüntüleme bulguları psöriasis
hastalarında metotreksat tedavisinin karaciğer fibrozu ile ilişkili olmadığını ve psöriazis
nedeniyle metotreksat kullanan hastalarda ortaya çıkan karaciğer doku sertliği artışının,
metotreksattan ziyade, psöriazisin neden olduğu inflamatuar sürece sekonder olduğunu
düşündürmüştür.

Anahtar Kelimeler

ARFI, Metotreksat, Psöriazis, Shear Wave Elastograf

Kaynakça

• 1. Korman NJ. Management of psoriasis as a systemic disease: what is the evidence? Br J Dermatol. 2020;182(4):840-8.
• 2. Chen Y, Yu CY, Deng WM. The role of pro-inflammatory cytokines in lipid metabolism of metabolic diseases. Int Rev Immunol. 2019;38(6):249-66.
• 3. Shi J, Fan J, Su Q, Yang Z. Cytokines and Abnormal Glucose and Lipid Metabolism. Front Endocrinol (Lausanne). 2019;10:703.
• 4. Bovolini A, Garcia J, Andrade MA, Duarte JA. Metabolic Syndrome Pathophysiology and Predisposing Factors. Int J Sports Med. 2021;42(3):199-214.
• 5. Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study. Br J Dermatol. 2007 Jul;157(1):68-73.
• 6. Miele L, Vallone S, Cefalo C, La Torre G, Di Stasi C, Vecchio FM, et al. Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. J Hepatol. 2009;(4):778-86.
• 7. Coates LC, Merola JF, Grieb SM, Mease PJ, Callis Duffin K. Methotrexate in Psoriasis and Psoriatic Arthritis. J Rheumatol Suppl. 2020;96:31-5.
• 8. Whiting-O'Keefe QE, Fye KH, Sack KD. Methotrexate and histologic hepatic abnormalities: a meta-analysis. Am J Med. 1991;90(6):711-6.
• 9. Aithal GP. Hepatotoxicity related to antirheumatic drugs. Nat Rev Rheumatol. 2011;(3):139-50.
• 10. Khandpur S, Yadav D, Jangid B, Kumar A, Shalimar, Devasenathipathy K, et al. Ultrasound liver elastography for the detection of liver fibrosis in patients with psoriasis and reactive arthritis on long-term methotrexate therapy: A cross-sectional study. Indian J Dermatol Venereol Leprol. 2020;86(5):508-14.
• 11. Berger D, Desai V, Janardhan S. Con: Liver Biopsy Remains the Gold Standard to Evaluate Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Clin Liver Dis (Hoboken). 2019;13(4):114-6.
• 12. Neuberger J, Patel J, Caldwell H, Davies S, Hebditch V, Hollywood C, et al. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut. 2020;69(8):1382-403.
• 13. Fu J, Wu B, Wu H, Lin F, Deng W. Accuracy of real-time shear wave elastography in staging hepatic fibrosis: a meta-analysis. BMC Med Imaging. 2020;;20(1):16.
• 14. Gallotti A, D'Onofrio M, Pozzi Mucelli R. Acoustic Radiation Force Impulse (ARFI) technique in ultrasound with Virtual Touch tissue quantification of the upper abdomen. Radiol Med. 2010;115(6):889-97.
• 15. Madhok R, Tapasvi C, Prasad U, Gupta AK, Aggarwal A. Acoustic radiation force impulse imaging of the liver: measurement of the normal mean values of the shearing wave velocity in a healthy liver. J Clin Diagn Res. 2013;7(1):39-42.
• 16. Bath RK, Brar NK, Forouhar FA, Wu GY. A review of methotrexate-associated hepatotoxicity. J Dig Dis. 2014;15(10):517-24.
• 17. Feuchtenberger M., Kraus L., Nigg A. Schulze-Koops H., Schäfer A. Methotrexate does not increase the risk of liver fibrosis in patients with rheumatoid arthritis: assessment by ultrasound elastography (ARFI-MetRA study). Rheumatol Int. 2021;Jun;41(6):1079-87.
• 18. Erre GL, Cadoni ML, Meloni P, Castagna F, Mangoni AA, Piga M, et al. Methotrexate therapy is not associated with increased liver stiffness and significant liver fibrosis in rheumatoid arthritis patients: A cross-sectional controlled study with real-time two-dimensional shear wave elastography. Eur J Intern Med. 2019;Nov;69:57-63.
• 19. Boursier J, Isselin G, Fouchard-Hubert I, Oberti F, Dib N, Lebigot J, et al. Acoustic radiation force impulse: a new ultrasonographic technology for the widespread noninvasive diagnosis of liver fibrosis. Eur J Gastroenterol Hepatol. 2010;Sep;22(9):1074-84.
• 20. Conway R, Carey JJ. Risk of liver disease in methotrexate treated patients. World J Hepatol. 2017;9(26):1092-100.
• 21. Horster S, Mandel P, Zachoval R, Clevert DA. Comparing acoustic radiation force impulse imaging to transient elastography to assess liver stiffness in healthy volunteers with and without valsalva manoeuvre. Clin Hemorheol Microcirc 2010; 46: 159-68.
• 22. Goertz RS, Sturm J, Pfeifer L, Wildner D, Wachter DL, Neurath MF, et al. ARFI cut-off values and significance of standard deviation for liver fibrosis staging in patients with chronic liver disease. Ann Hepatol. 2013;Nov-Dec;12(6):935-41.
• 23. Madanagobalane S., Anandan S. The increased prevalence of non-alcoholic fatty liver disease in psoriatic patients: a study from South India. Australas J Dermatol. 2012;53(3):190-7.
• 24. Pongpit J, Porntharukchareon S, Kaewduang P, Promson K, Stitchantrakul W, Petraksa S, et al. Liver Stiffness Measurement in Psoriasis: Do Metabolic or Disease Factors Play the Important Role? Biomed Res Int. 2016;2016:7963972.
• 25. Motosugi U, Ichikawa T, Niitsuma Y, Araki T. Acoustic radiation force impulse elastography of the liver: can fat deposition in the liver affect the measurement of liver stiffness? Jpn J Radiol. 2011;Nov;29(9):639-43.