Prevalence of Metabolic Dysfunction–Associated Steatotic Liver Disease and Hepatic Fibrosis in Patients with Rheumatoid Arthritis: A Cross-Sectional Case-Control Study

Abstract

Background:

Hepatic steatosis is commonly associated with rheumatoid arthritis (RA). Methotrexate is the first-line therapy for RA, and its long-term use is linked to hepatic steatosis and fibrosis. We wanted to study the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and hepatic fibrosis in patients with RA and healthy controls.

Materials and Methods:

 We conducted a prospective cross-sectional study on 200 individuals with RA who attended the Rheumatology Clinic at Sohag University and 100 matching healthy controls. History, clinical examination, laboratory investigations, and abdominal ultrasonography were performed. Hepatic steatosis was evaluated using abdominal ultrasonography and the Hepatic Steatosis Index (HSI). Liver fibrosis was assessed using the FIB-4, AST to Platelet Ratio Index (APRI), and BMI (Body Mass Index), AST/ALT ratio, and Diabetes (BARD) scores.

Results:

We found that the RA was statistically significant in MASLD patients compared with those without MASLD (P=0.04). The APRI score was significantly correlated with the methotrexate (MTX) cumulative dose (r=0.963, P=0.041) and age (r=0.963, P=0.004). FIB-4 score was significantly correlated with MTX dose (r=0.967, P=0.047) and disease duration (r=0.967, P=0.017). APRI score and FIB-4 score were highly significant in patients with a moderate degree of Disease Activity Score (DAS) than other degrees, with P=0.001, and P=0.005. BARD score correlated with MTX dose (r=0.887, P=0.01) and disease duration (r=0.887, P=0.001).

Conclusion:

There is an elevated risk of MASLD in patients with RA, particularly those on MTX therapy. APRI, FIB 4, and BARD scoring systems have significance in diagnosing hepatic fibrosis in patients with RA and RA activity (DAS score).