HISTOLOGIC LIVER ABNORMALITIES IN AN AUTOPSY SERIES OF PATIENTS WITH RHEUMATOID-ARTHRITIS

A retrospective review was performed on 188 autopsied cases of rheumat oid arthritis at our institutions during 1958-1985, prior to the wides pread use of methotrexate. Hepatic histology was reported in 182 cases . All available microscopic liver slides from cases in which the autop sy report described portal tract inflammation, fibrosis, cirrhosis, tu mour, amyloid, vasculitis, or infections involving the liver were exam ined and graded by a hepatic pathologist blinded to the original diagn osis, along with a representative sample of cases with reports describ ing fatty change or no hepatic pathologic abnormalities. Ninety normal and abnormal cases were reviewed from the 182 for which hepatic histo logy was available. Fifteen cases of diffuse fibrosis were identified upon blinded review. Two cases were graded as severe fibrosis (grades 3 or 4 on a scale of 0-4) without an identifiable pathologic cause, in both of which the liver disease was suspected premortem (alcohol abus e and viral hepatitis). Although the incidence of fibrosis in this ser ies is slightly higher than that previously described, serious fibroti c liver disease was rare. These results support the current practice o f limiting pre-treatment liver biopsies prior to methotrexate therapy to patients with suspected liver disease.