5th International Conference of Orthopedic Surgeons and Rheumatology

Biography

Biography: Bita Anvari

Abstract

Background: Rheumatoid Arthritis is a common chronic disease and concern about the adverse eff ect of methotrexate especially hepatotoxicity could be a reason for discontinuation or reducing dose but the result of multiple policy in this situation is unclear and the physicians need to know what would be happened aft er each decision. Aim of the work: To demonstrate the result of multiple approaches to transaminitis in patients with Rheumatoid Arthritis who received methotrexate. Patients & Methods: Th e data has been collected from the previous work (since 2006) on 295 patients with Rheumatoid Arthritis who received at least 7.5 mg methotrexate for one month in a referral rheumatology clinic. Th e patients who developed transaminitis at least one time were selected for this study (N=102). At this point, physicians’ decision on discontinuing, decreasing, increasing or fi xed dose of methotrexate in approach to patients was collected and the result of the next liver enzyme was evaluated. Results: Decreased dose or discontinuation was happened among 32 patients (31.4%) and fi xed dose or rising dose in 53.9% and 8.8% respectively. Th e result of next enzyme in each group was normal in 93%, 65% and 67% respectively. Among 30 patients who had two consecutive elevated liver enzymes, 30% discontinued or decreased MTX dose. Th e next enzyme became normal in all of them however it was seen in 67% of the others with fi xed or rising dose. Conclusion: Obvious improvement in liver enzymes aft er decreased dose or discontinuation of methotrexate could be seen that makes this policy the best of action in approach to transaminitis of methotrexate, however trend to improvement despite of physicians’ decision were observed. If this natural course may be due to adjustment of hepatocyte activity or renal clearance, it needs to be further investigated.