Yahya Atayan, Yasir Furkan Cagın, Mehmet Ali Erdogan, Yılmaz Bilgic, Remzi Bestas, Murat Aladag

Yahya Atayan, Yasir Furkan Cagın, Mehmet Ali Erdogan, Yılmaz Bilgic, Remzi 1, Yasir Furkan Cagın1, Mehmet Ali Erdogan1, Yılmaz Bilgic1, Remzi

Anahtar Kelimeler:

-

Prolonged Cholestatic Liver Disease Secondary to Methotrexate

AbstractMethotrexate (MTX) is a folate antagonist which damages the DNA and classified as an antimetabolite antineoplastic agent. It is the most commonly used drug in the treatment of rheumatoid arthritis (RA) and its efficiency and reliability were well established. Drug-induced hepatotoxicity varies from non-specific liver changes to acute fulminant failure, cirrhosis and liver cancer. The mechanism in which methotrexate causes liver damage is not known. It may cause acute increase in transaminase enzymes, and on the long-term it may lead to liver fibrosis and cirrhosis. Whether it is used in high doses (eg, cyclic use of 1 gram or more) or on low doses (eg, weekly doses of 7.5 to 25 mg), MTX may lead to life threatening conditions like hepatotoxicity. Presented in this case report, a 52 year old male patient was diagnosed with rheumatoid arthritis. in which hepatic fibrosis and prolonged cholestatic liver disease occurred secondary to prolonged usage of MTX Keywords: Methotrexate, liver disease, cholestasis

Keywords:

Methotrexate, liver disease cholestasis,

PDF

___

Jakson CG, Williams HJ. Disease-modifying antirheumatic drugs. Drugs. 1998;56(3):337-44.
Abu-Shakra M, Nicol P, Urovvitz MB. Accelerated nodulosis, pleural, and pericardial tamponade during methotrexate theraphy. J Rheumatol. 1994;21(5):934-7.
Rodenhuis S, Kremer JM, Bertino JR. Increase of dihydrofolate reductase in peripheral blood lymphocytes of rheumatoid arthritis patients treated with low-dose oral methotrexate. Arthritis Rheum. 1987;30(4):369-74.
Prey S, Paul C. Effect of folic or folinic acid supplementation on methotrexate-associated safety and efficacy in inflammatory disease: a systematic review. Br J Dermatol. 2009;160(3):622-8.
Van ede AE, Laan RF, Rood MJ, Huizinga TW, van de Laar MA, van Denderen CJ, Westgeest TA, Romme TC, de Rooij DJ, Jacobs MJ, de Boo TM, van der Wilt GJ, Severens JL, Hartman M, Krabbe PF, Dijkmans BA, Breedveld FC, van de Putte LB. Effect of folic or folinic acid supplementation on the toxicity and efficacy of methotrexate in rheumatoid arthritis: a forty-eight week, multicenter, randomized, double-blind, placebo-controlled study. Arthritis Rheum. 2001;44(7):1515-24.
Roenigk HH, Auerbach R, Maibach HI, et al. Methotrexate in psoriasis: revised guidelines. J Am Acad Dermatol. 1988;19(1 Pt 1):145-56.
Top C,Terekeci H. Romatoid artrit tedavisinde hastalığı modifiye eden anti romatizmal ilaçlar. Türkiye Klinikleri J Med Sci. 2008;28:387-98.
Aithal GP, Haugk B, Das S, Card T, Burt AD, Record CO. Monitoring methotrexate-induced hepatic fibrosis in patients with psoriasis: are serial liver biopsies justified? Aliment Pharmacol Ther. 2004;19(4):391-9.
Turkiewicz AM, Moreland LW. Romatoid artrit. In: Barlett SJ, ed, (Çeviri ed, Dinç A.) Romatizmal Hastalıklarda Klinik Tedavi. 2007;157-66.
Kırnap M, Demir H, Kalkan A. Comparison of the efficacy and side effectes of cyclosporine-A and methotrexate in the treatment of the patients with rheumatoid arthritis. Erciyes Tıp Dergisi [Erciyes Medical Journal]. 2000;22(4):178-84.
Salliot C, van der Heijde D. Long term safety of Methotrexate monotherapy in rheumatoid arthritis patients: A systematic literature research. Ann Rheum Dis. 2009;68(7):1100-4.
Zvaifler NJ, Corr M. Evaluation and Treatment of Rheumatoid Arthritis. In: Koopman WJ, Moreland LW, eds, Arthritis and Allied Conditions, 15th edition. Philadelphia: Lippincott Williams & Wilkins, 2005;1249-62.