0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary | Practice Gaps

Methotrexate-Induced Liver Toxicity Replacing the Liver Biopsy

Bruce E. Strober, MD, PhD1,2
[+] Author Affiliations
1Department of Dermatology, University of Connecticut Health Center, Farmington
2Probity Medical Research, Waterloo, Ontario, Canada
JAMA Dermatol. 2014;150(8):862-863. doi:10.1001/jamadermatol.2014.681.
Text Size: A A A
Published online

Extract

Methotrexate-induced hepatotoxicity in patients with psoriasis occurs rarely and unpredictably. Although liver monitoring must occur, dermatologists currently lack a reliable test. Unfortunately, many of the current recommendations for the monitoring of patients with psoriasis are poorly substantiated by rigorous data. For example, cumulative methotrexate dosage appears to be irrelevant. In addition, the liver biopsy, considered the criterion standard, suffers from sampling error, intraobserver and interobserver variability, and procedural pain and morbidity, making it a poor test. Most relevant, approximately 50% of patients with moderate to severe psoriasis have nonalcoholic fatty liver disease,1 a condition that displays histopathologic features indistinguishable from those associated with methotrexate-induced toxicity. Therefore, the liver biopsy cannot distinguish between drug-induced and disease-associated liver disease. Furthermore, with increasing age, patients with psoriasis are at increased risk for nonalcoholic fatty liver disease; thus, long-term therapy with methotrexate with signs demonstrating steatosis or fibrosis might represent the natural aging of the psoriatic liver. Summarily, the additive toxicity of methotrexate on the inherently unhealthy psoriatic liver remains uncertain, and our understanding of liver risk is based on studies that are poorly controlled—devoid of large comparator groups of patients with psoriasis who are not receiving methotrexate.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,453 Views
2 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Are the Results Valid?

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Are There Important Aspects of Health-Related Quality of Life That Have Been Omitted?

brightcove.createExperiences();