Methotrexate hepatotoxicity

Rheum Dis Clin North Am. 1997 Nov;23(4):883-915. doi: 10.1016/s0889-857x(05)70365-3.


Hepatoxicity is a major adverse reaction that can occur during methotrexate treatment of the rheumatic diseases. The pathologic lesions are nonspecific and the pathogenesis is poorly understood. Early studies in psoriasis clearly established a relationship between hepatic injury and several risk factors, particularly alcohol use. Methotrexate hepatoxicity occurs less frequently in rheumatoid arthritis than previously reported in psoriasis patients. Consequently, the American College of Rheumatology guidelines for methotrexate monitoring do not recommend baseline and surveillance liver biopsies in low-risk patients. These guidelines seem to be useful and cost-effective.

Publication types

  • Review

MeSH terms

  • Antirheumatic Agents / adverse effects*
  • Biopsy
  • Chemical and Drug Induced Liver Injury / etiology*
  • Chemical and Drug Induced Liver Injury / pathology
  • Chemical and Drug Induced Liver Injury / prevention & control
  • Drug Monitoring
  • Guidelines as Topic
  • Humans
  • Liver / drug effects*
  • Liver / pathology
  • Methotrexate / adverse effects*
  • Rheumatic Diseases / pathology


  • Antirheumatic Agents
  • Methotrexate