Diagnostic performance of FIB-4 in detecting advanced liver fibrosis in patients with rheumatoid arthritis, psoriatic arthritis and psoriasis using methotrexate.
9 affiliations
- 1Department of Internal Medicine, Universidade Federal do Paraná, Curitiba, Brazil.
- 2Department of Gastroenterology, Hepatology and Liver Transplantation, Hospital Nossa Senhora das Graças, Curitiba, Brazil.
- 3School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. [email protected].
- 4Faculdade Evangélica Mackenzie de Medicina do Paraná, Curitiba, Brazil. [email protected].
- 5Department of Internal Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.
- 6School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.
- 7Department of Dermatology, Hospital Santa Casa de Misericórdia, Curitiba, Brazil.
- 8Faculdade Evangélica Mackenzie de Medicina do Paraná, Curitiba, Brazil.
- 9Department of Internal Medicine, Hospital Municipal de São José dos Pinhais, Curitiba, Brazil.
Abstract
Background
Methotrexate is a first-line therapy for rheumatoid arthritis, psoriatic arthritis, and psoriasis, but its long-term use has been associated with hepatic fibrosis, highlighting the need for effective screening strategies. In this context, and considering the limitations of liver biopsy as well as the high cost and limited availability of elastography, the FIB-4 score has emerged as the most widely used noninvasive screening tool. This multicenter cross-sectional study evaluated patients followed at specialized Rheumatology and Dermatology centers to assess the accuracy of FIB-4 in predicting advanced hepatic fibrosis in patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis undergoing chronic methotrexate therapy. The specific objectives were to identify optimal cutoff values for FIB-4 in this population and factors associated with advanced fibrosis.Methods
Medical records, interviews, and physical examinations were used to collect demographic, clinical, laboratory, lifestyle, and treatment data, calculate age-adjusted FIB-4 scores, and assess disease activity using validated indices. Liver fibrosis and steatosis were evaluated by vibration-controlled transient elastography, and FIB-4 performance for detecting advanced fibrosis was analysed using age-stratified Receiver Operating Characteristic curves and multivariable logistic regression.Results
A total of 172 patients were included, predominantly women, with a mean age of 58 years; rheumatoid arthritis was the most common underlying disease. Advanced fibrosis was identified by elastography in 11%. FIB-4 values increased progressively with fibrosis stage, and Receiver Operating Characteristic curve analysis identified a cutoff of 1.62 - a threshold not previously reported for methotrexate-treated patients. This cutoff demonstrated better performance in individuals younger than 65 years (Area Under the Curve = 0.68 versus 0.64 in those aged 65 years or older) and showed particular utility for ruling out advanced fibrosis. In multivariable analysis, a high-risk FIB-4 category, obesity, diabetes mellitus, and advanced hepatic steatosis were independently associated with advanced fibrosis, whereas inflammatory disease activity and cumulative methotrexate dose were not.Conclusions
FIB-4 is an accessible and potentially useful tool for ruling out advanced hepatic fibrosis in methotrexate-treated patients younger than 65 years, demonstrating reasonable performance in this population. Advanced fibrosis is primarily driven by metabolic factors rather than methotrexate exposure or inflammatory disease activity.
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BibTeX
@article{furlan2026diagnostic,
title = {{Diagnostic performance of FIB-4 in detecting advanced liver fibrosis in patients with rheumatoid arthritis, psoriatic arthritis and psoriasis using methotrexate.}},
author = {Fernanda Luiza Schumacher Furlan and Patricia Martin and Alcindo Pissaia Junior and Claudia Alexandra Pontes Ivantes and Marcia Olandoski and Adriane Reichert Faria and Adriano Reinaldo Timm and Jhony Maciel de Oliveira and Giuliano Camati Dourado and Lana Bassi Ferdinando and Rebeca Rebouças Pereira and Beatriz Gallo Teixeira and Raphaela Suzin Marini Munaretto and Odery Ramos Junior},
journal = {Advances in rheumatology (London, England)},
year = {2026},
month = jul,
doi = {10.1186/s42358-026-00567-7},
url = {https://europepmc.org/article/MED/42897703},
note = {CC BY},
}
RIS
TY - JOUR
TI - Diagnostic performance of FIB-4 in detecting advanced liver fibrosis in patients with rheumatoid arthritis, psoriatic arthritis and psoriasis using methotrexate.
AU - Fernanda Luiza Schumacher Furlan
AU - Patricia Martin
AU - Alcindo Pissaia Junior
AU - Claudia Alexandra Pontes Ivantes
AU - Marcia Olandoski
AU - Adriane Reichert Faria
AU - Adriano Reinaldo Timm
AU - Jhony Maciel de Oliveira
AU - Giuliano Camati Dourado
AU - Lana Bassi Ferdinando
AU - Rebeca Rebouças Pereira
AU - Beatriz Gallo Teixeira
AU - Raphaela Suzin Marini Munaretto
AU - Odery Ramos Junior
PY - 2026
DA - 2026/07/01
JO - Advances in rheumatology (London, England)
DO - 10.1186/s42358-026-00567-7
UR - https://europepmc.org/article/MED/42897703
AB - Background Methotrexate is a first-line therapy for rheumatoid arthritis, psoriatic arthritis, and psoriasis, but its long-term use has been associated with hepatic fibrosis, highlighting the need for effective screening strategies. In this context, and considering the limitations of liver biopsy as well as the high cost and limited availability of elastography, the FIB-4 score has emerged as the most widely used noninvasive screening tool. This multicenter cross-sectional study evaluated patients followed at specialized Rheumatology and Dermatology centers to assess the accuracy of FIB-4 in predicting advanced hepatic fibrosis in patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis undergoing chronic methotrexate therapy. The specific objectives were to identify optimal cutoff values for FIB-4 in this population and factors associated with advanced fibrosis.Methods Medical records, interviews, and physical examinations were used to collect demographic, clinical, laboratory, lifestyle, and treatment data, calculate age-adjusted FIB-4 scores, and assess disease activity using validated indices. Liver fibrosis and steatosis were evaluated by vibration-controlled transient elastography, and FIB-4 performance for detecting advanced fibrosis was analysed using age-stratified Receiver Operating Characteristic curves and multivariable logistic regression.Results A total of 172 patients were included, predominantly women, with a mean age of 58 years; rheumatoid arthritis was the most common underlying disease. Advanced fibrosis was identified by elastography in 11%. FIB-4 values increased progressively with fibrosis stage, and Receiver Operating Characteristic curve analysis identified a cutoff of 1.62 - a threshold not previously reported for methotrexate-treated patients. This cutoff demonstrated better performance in individuals younger than 65 years (Area Under the Curve = 0.68 versus 0.64 in those aged 65 years or older) and showed particular utility for ruling out advanced fibrosis. In multivariable analysis, a high-risk FIB-4 category, obesity, diabetes mellitus, and advanced hepatic steatosis were independently associated with advanced fibrosis, whereas inflammatory disease activity and cumulative methotrexate dose were not.Conclusions FIB-4 is an accessible and potentially useful tool for ruling out advanced hepatic fibrosis in methotrexate-treated patients younger than 65 years, demonstrating reasonable performance in this population. Advanced fibrosis is primarily driven by metabolic factors rather than methotrexate exposure or inflammatory disease activity.
SN - 2523-3106
ER -