Methotrexate (MTX) is mainly used in the treatment of diseases such as rheumatoid arthritis (RA) but, it's hepatotoxicity potential, always has been a major concern.

In this cross-sectional study patients with RA who had been on MTX treatment for more than 6 months were included. Hepatic fibrosis was determined by TE (measuring the liver stiffness). The patients were divided into 2 groups based on liver stiffness measurement and demographic, clinical and biochemical parameters compared between them. Correlation of the cumulative dose of MTX and duration of MTX treatment with the liver stiffness was assessed.

51patients were included, 44 women (86.3%), with a mean age of 52.53)±9.95) years. The cumulative dose of MTX in 17 (33.3%) patients was less than 1500 mg, 28 (54.9%) patients in the range of 1500 to 4000 mg, and in 6 (11.8%) patients it was more than 4000 mg, with a mean treatment duration of 54.14±(40.94) months. The median (IQR) value of liver stiffness was 4.70 (3.60 – 5.50) kPa. The presence of liver fibrosis was detected in 11 (21.6%) patients. There were no differences in liver stiffness depending on cumulative dose (r= 0.06 , P= 0.67) of MTX and duration of MTX treatment (r= -0.05, P= 0. 71) . The multivariate analysis demonstrated that only ALT were associated with presence of liver fibrosis (OR = 1.07; 95% CI: 1.01 to 1.13; p = 0.01).

severe hepatic fibrosis is not common in patients treated with methotrexate. Increasing the duration of methotrexate administration and the cumulative dose of the drug have no effect on hepatic fibrosis incidence. Liver stiffness was not significantly correlated with cumulative dose and duration of methotrexate treatment, but increased serum ALT levels in RA patients increased liver stiffness and chance of hepatic fibrosis.