Introduction: Methotrexate (MTX) is a highly effective therapy for patients with rheumatoid
arthritis (RA). However, it has been associated with a range of liver related adverse events.
The aim of our study was to evaluate the prevalence rate of liver fibrosis in RA patients and to assess
the correlation of cumulative MTX dose with hepatic fibrosis in our context.
Materials and Methods: This is a cross-sectional study, whose goal is to describe and analyze the
factors correlated with the liver fibrosis in RA patients treated with methotrexate especially the cumulative
dose of MTX, along the period lying between January 2012 and March 2019. The study
was carried out in the Rheumatology Department of the University Hospital Hassan II of Fez. The
patients have met the assessment of the ACR 2010 criteria. The data was recorded and analyzed using
SPSS v20 univariate and bivariate analysis. A value of p <0.05 has been used to identify factors
associated with liver fibrosis.
Results: A total of 319 patients with RA were recruited who were on MTX treatment. There were
276 female and 43 male patients (female: male ratio of 6.3). The average age was 53 years + /-12.4
years. The average duration of symptoms was 10.68 +/-6.9 years. RA was seropositive for the
rheumatoid factor or the anti-ccp in 90.3 %. Six patients (2%) had developed liver fibrosis while on
In the bivariate analysis, the liver fibrosis is significantly related to the hepatic cytolysis (p<0.001)
and to the combination of MTX with other DMARDs (p<0.05). However, the multiple logistic regression
analysis did not find any significant association between the groups.
Conclusion: In our context, the prevalence rate of hepatic fibrosis in patients with rheumatoid arthritis
under methotrexate is low. It is seen much more in patients treated with methotrexate in
combination with other disease-modifying anti-rheumatic drugs (DMARDs). These results require
confirmation in a larger number of patients.