PATIENTS PREFERENCE REGARDING THE OPTION OF PERFORMING UNSELECTIVE LIVER-BIOPSY FOLLOWING METHOTREXATE TREATMENT IN RHEUMATOID-ARTHRITIS

Objective. This study was aimed at the evaluation of patient preferenc es concerning long-term methotrexate (MTX) therapy and whether or not to perform unselective liver biopsy to detect serious liver disease du e to MTX therapy in rheumatoid arthritis (RA). Methods. Seventeen lite rate patients with RA consecutively selected from a rheumatic disease unit and 17 rheumatologists (asked to consider themselves as RA patien ts) were assessed by a trained interviewer. The Bedside Decision Board instrument was used to assess the patient preference. Scenarios descr ibed the options in terms of follow-up for RA patients treated with MT X. The benefits and risks of liver biopsy, defined according to the pu blished literature, were presented to RA patients and rheumatologists in an unbiased fashion. Results. Twelve patients (71%) preferred not t o be subjected to the liver biopsy within 1 month, even though they ha d already taken MTX for 3 years, and consequently ran the risk of deve lopment of cirrhosis in the long term. Conversely, 12 rheumatologists (71%) preferred to undergo an unselective liver biopsy. Conclusion. Gi ven patients' preferences, liver biopsy following long term MTX treatm ent should not be performed unselectively. It can be postulated that r heumatologists did not perceive liver biopsy as an intimidating proced ure or were influenced by the until recently recommended guidelines fo r following up patients treated with MTX.