Methotrexate-Related Liver Cirrhosis in Psoriatic Arthritis: A Case Report and Review of the Literature

MRI Findings in Axial Psoriatic Spondylarthritis

Psoriatic arthritis is a significant medical condition with a high prevalence, a wide variety of non-specific symptoms, and a high degree of overlap with other spondylarthritis disorders, particularly ankylosing spondylitis. Hence, knowledge of the magnetic resonance imaging (MRI) manifestations and a multidisciplinary strategy are required for the better management of these patients. We searched publications from the last 10 years and focused on the most relevant ones which discussed the classification criteria, the MRI characteristics of axial psoriatic arthritis, the importance of MRI for follow up, and the reliability of skin and synovial biopsy. Axial spondylarthritis can be diagnosed and followed up on using the well-established MRI technique and, additionally, a biopsy. The analysis and concordance between them can provide new directions for future studies.

Complete recovery of complicated methotrexate-induced liver cirrhosis in a patient with psoriasis: A case report

Cirrhosis is the most common indication for liver transplant. Literature addressing methotrexate (MTX)-induced liver cirrhosis in patients with psoriasis is sparse. We present a case of a nonalcoholic patient diagnosed with psoriasis that was treated with a weekly 5 mg dose of methotrexate, a chemotherapeutic and immunological modulator, for five years. The patient presented after five years with abdominal distension and lower limb edema along with ascites and esophageal varices and was diagnosed with liver cirrhosis. Upon the discontinuation of MTX, the patient showed clear regression of ascites and esophageal varices, and recovery of liver cirrhosis by de-escalating from Child-Pugh B to A. After five years of follow-up, Echography and Transient Elastography (Fibroscan) of the liver confirmed the full recovery of liver cirrhosis by the absence of steatosis and fibrosis. This study emphasizes the reversibility of MTX-induced liver cirrhosis: cirrhosis is not aggressive, can be reversible, and is dose- and duration-dependent.