STRUCTURAL AND FUNCTIONAL ABNORMALITIES OF THE LIVER IN PSORIASIS BEFORE AND DURING METHOTREXATE THERAPY

Abstract

Summary.— The treatment of psoriasis with methotrexate carries a low but definite risk of producing histological abnormalities in the liver. Forty-two patients treated for 3 to 80 months were found to have more histological abnormalities than 25 untreated patients with equally severe psoriasis. Of the treated patients, 3 had cirrhosis, all of whom were heavy drinkers, and 12 had fibrosis. None of the untreated patients had cirrhosis, but 4 had fibrosis. Only the cirrhotic patients showed clinical evidence of hepatic inpairment. The incidence of histological abnormality increased with increasing cumulative dosage of methotrexate, but patients on weekly therapy had less abnormality than those on daily oral therapy. Fourteen of the 25 untreated patients were given the drug subsequently, once weekly for a mean period of 23 months. Very few additional histological abnormalities have developed. In patients with socially and physically crippling psoriasis where methotrexate would be used, the risk of significant hepatic damage is low enough to be acceptable, providing supervision is thorough.