The relationship of hepatotoxic risk factors and liver histology in methotrexate therapy for juvenile rheumatoid arthritis

Objective: Tc, examine the relationship between hepatotoxic risk factors an d liver histopathology in patients with juvenile rheumatoid arthritis (JRA) treated with methotrexate (MITX). Study design: We graded the histology of 33 percutaneous liver biopsy speci mens from 25 patients with JRA treated at Children's Hospital Medical Cente r, Cincinnati, Ohio, using the Roenigk Classification Scale. Stepwise linea r and logistic regression analyses were performed to examine the relationsh ip of the Roenigk grade and presence of liver fibrosis of biopsy specimens with potential risk factors. Results: Twenty-seven biopsy specimens (82%) were classified as grade I, 4 (12%) as grade II, and 2 (6%) as grade IIIA; none demonstrated significant fibrosis. The frequency of biochemical abnormalities (P <.001) and body mas s index (P =.05) were the only risk factors found to significantly relate t o the Roenigk grade. The following factors were not significantly associate d with the Roenigk grade: age, gender, disease duration, JRA subtype and co urse, duration of MTX administration, weekly MTX dose, cumulative dose of M TX, route of MTX administration, use of folic acid supplementation, concurr ent use of other medications, and potential hepatotoxic comorbidities. Conclusions: Serial biochemical abnormalities are significantly associated with Roenigk grade and the presence of liver fibrosis. These findings concu r with studies of patients with rheumatoid arthritis, suggesting that guide lines for monitoring MTX hepatotoxicity in rheumatoid arthritis may be appl icable to patients with JRA.