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Objective: To find out methotrexate induced hepatotoxicity in patients of rheumatoid arthritis treated for 6
months with methotrexate 15 mg once weekly.
Material and Methods: This non-interventional, descriptive study was carried out on 50 diagnosed
Rheumatoid Arthritis patients of more than 12 years of age, irrespective of sex, presented to medical outpatient
department of Post Graduate Medical Institute, Govt. Lady Reading Hospital, Peshawar, from
January to December 2004. These patients were treated with methotrexate 15 mg once weekly and followed
up for 06 months with monthly liver function tests (LFTs). Patients were selected by non-probability
convenient sampling method after obtaining an informed consent.
Results: Out of the 50 diagnosed cases of rheumatoid arthritis patients, females were 32(64%) and males
were 18 (36%), with age range from 20 to 80 years and mean age 46.4 years. Baseline mean alanine
aminotransferase (ALT) was 24.78 U/L (SD + 4.89) and baseline mean Alkaline Phosphatase (ALP) was
170.14 ( SD + 21.12). During he follow-up initially 10 cases ( 20%) had raised ALT and ALP levels while
bilirubin remained normal in all cases. Out of these 10 cases, 8 cases remained stable and only 2 cases
had persistently raised LFTs and had to discontinue methotrexate. At 6 months mean ALT and ALP were
26.74 U/L (+10.79) and 184.02 (+ 74.7) respectively.
Conclusion: Methotrexate (MXT) can be hepatotoxic and close monitoring is essential to reduce the risk
of unrecognized serious liver disease.
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