Abstract:
Methotrexate (MTX) is an effective and affordable systemic therapy for psoriasis
but requires continued biochemical and sonographic monitoring to detect
liver damage early. This study evaluates liver functions and ultrasonographic
findings among MTX-treated psoriasis patients, with emphasis on hepatic steatosis
and associated factors. This cross-sectional study of 80 adults with chronic
plaque psoriasis assessed demographic characteristics, disease severity using body
surface area (BSA) and Psoriasis Area Severity Index (PASI), cumulative MTX
dose, and liver biochemistry. Ultrasonography was performed by a radiologist
blinded to clinical data. Comparisons between groups were assessed using the
Mann-Whitney U test. Of the 80 patients assessed, 34 were males (42.5%), and
the majority (45%) belonged to social class 3. The median (IQR) disease duration
was 12 (5–19) years, with a median (IQR) cumulative MTX dose of 885 (90–2272)
mg. Ultrasound assessment showed a normal liver in 45% of participants, grade
I steatosis in 50%, and grade II in 5%. Mean values of total protein (7.05 ± 0.45
g/dL), albumin (4.54 ± 0.24 g/dL), total bilirubin (0.70 ± 0.33 mg/dL), ALP (60.9
± 26.3 U/L), ALT (36.0 ± 28.7 U/L), AST (29.4 ± 13.2 U/L), and GGT (25.7
± 16.5 U/L) were within normal limits. Patients with steatosis had higher BMI,
waist circumference, diastolic blood pressure, fasting blood sugar, TG/HDL ratio,
hs-CRP, and GGT, and lower HDL levels (all p < 0.05). No significant differences
were found for age, gender, cumulative MTX dose, disease severity indices, other
lipid parameters, or liver function markers. Overall, most methotrexate-treated
patients demonstrated normal liver biochemistry. Metabolic risk factors, rather
than exposure to higher cumulative doses of MTX, were more prevalent among
patients with hepatic steatosis. Therefore, metabolic screening combined with
ultrasound may aid in detecting liver abnormalities in MTX-treated psoriasis patients.
