Hepatic fibrosis in rheumatoid arthritis patients treated with methotrexate: application of a new semi-quantitative scoring system

Objective. Evaluation of hepatic lesions in patients treated with methotrex ate (MTX) generally used the Roenigk histological score. However, the sensi tivity of the method for hepatic fibrosis assessment has been discussed. Th e semi-quantitative histological scoring system (SSS) offers a sensitive an d specific evaluation of liver fibrosis. Both scores have been evaluated in liver biopsies of patients with rheumatoid arthritis. Methods. Seventy-four liver biopsies were obtained in 57 rheumatoid arthrit is patients before initiation of MTX (group 1, 38 cases), in cases of a per sistently high level of transaminases during 1 yr of treatment (group 2, 10 cases) and after a MTX total dose of 2 g (group 3, 26 cases). Eleven biops ies of groups 1 and 3 originated from the same patient in 11 cases. Specime ns were examined blindly by two anatomopathologists. The three groups were compared with an ANOVA. Sequential biopsies performed in 11 patients were c ompared with the Wilcoxon paired test. Results. The Roenigk score and the SSS were significantly correlated (P < 0 .0001). Only a mild fibrosis was found in 33.8% (25/74) of the biopsies wit h the Roenigk score. Liver fibrosis, graded as mild (48.6%), moderate (41.8 %) or severe (4'%), was demonstrated in 94.6% (70/74) of the biopsies with the SSS. The Roenigk score and the SSS of the three patient groups were not statistically significantly different. The scores did not progress in the 11 patients who had serial biopsies. Conclusion. SSS is much more sensitive than the Roenigk score for the evalu ation of hepatic fibrosis. However, SSS did not show progression of hepatic fibrosis in patients with rheumatoid arthritis treated with MTX.