LIVER BIOPSIES FROM PSORIATICS RELATED TO METHOTREXATE THERAPY.

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Abstract
An increasing number of cases of liver disease, particularly cirrhosis have been reported in psoriatics during methotrexate (MTX) therapy. A prospective study was started in 1969 to describe morphological features of liver biopsies from patients with severe psoriasis. Among 123 patients evaluated for possible MTX therapy, liver biopsies disclosed pathological history (mainly fatty change and/or non-specific reactive hepatitis) in 51%. The incidence of pathological liver histology did not statistically correlate with psoriasis parameters such as duration and extent. Statistically significant correlations (P < 0.0001) were found between the frequency of pathological liver histology and other factors such as age, obesity and daily alcoholic intake. Comparison of liver histology with SGOT [serum glutamic oxalacetic transaminase] value at the time of liver biopsy showed that while the diagnostic specificity of this test was high (1.00), the diagnostic sensitivity was low (0.17). Normal values of SGOT should not be relied upon to indicate all types of liver pathology. A risk index indicating the probability of pathological liver histology was developed. It is calculated as follows: 2 times the height (cm) minus weight (kg) minus age (yr) minus 50 (in case of daily alcoholic intake) minus 50 (in case of elevated SGOT). To elucidate liver histology and particularly to rule out fibrosis and cirrhosis, a liver biopsy should be performed in every psoriatic patient with a low score in the risk index prior to beginning MTX therapy.

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