Is there a role for the use of transient elastography (FibroScan) to monitor liver fibrosis in patients on long term methotrexate?

Liver elastography is a useful tool to use when assessing the potential hepatotoxicity of various drug therapies. Traditionally, methotrexate accounted for nearly all the hepatotoxicity issues that we faced; however, we can add many other drugs to that list. Virtually, every immune suppressive drug we prescribe carries a potential hepatotoxic risk.

A hypothetical scenario for using liver elastography would be the obese patient with risks for metabolic syndrome who is responding to an immune supp...

No

Factors that tend to increase the potential hepatotoxicity of MTX include obesity, as mentioned, diabetes, hyperlipidemia, alcohol, underlying liver disease such as latent hep C infection for example (I hep C screen everybody with RA and autoimmune disorders), fatty liver, and the concomitant use of other hepatotoxic drugs such as INH, rifampin, statins, lack of folate use, etc. If I determine the patient needs further investigations for persistent LFT elevation, I refer these patients to our li...