Comparative Evaluation of Fibrosis-4 Index and FibroScan for Liver Fibrosis Estimation among Psoriatic Arthritis Patients on Methotrexate

Abstract

Background:

Psoriatic arthritis (PsA) often requires long-term methotrexate (MTX) therapy, which is associated with the risk of liver fibrosis. Non-invasive tests like elastography and the Fibrosis-4 (FIB-4) index have been studied to assess liver stiffness. This study aimed to compare the FIB-4 index with liver fibrosis severity measured by FibroScan in PsA patients on MTX.

Materials and Methods:

A cross-sectional study included patients with PsA on MTX at the Rheumatology Clinic of Hazrat Rasoul Akram Hospital. Data were collected on demographics, clinical characteristics, FIB-4 index, and liver stiffness measured by FibroScan. Statistical analyses evaluated correlations between FIB-4 and FibroScan results.

Results:

Among 70 participants, 21 (30%) were men. The mean (+ standard deviation [SD]) age of all study subjects was 55.11 (±15.15) years. The average (+SD) disease duration was 7.34 (±5.18) years. The mean (+SD) FIB-4 index was 1.19 (±0.64). A total of 53 (75.71%), 15 (21.43%), and 2 (2.86%) study subjects according to FIB-4 index, and 56 (80%), 8 (11.43%), and 6 (8.57%) according to Fibroscan grades were categorized as having ‘normal to mild’, ‘mild to moderate’, and ‘moderate to severe’ liver fibrosis, respectively. There was a weak positive but non-significant correlation between FIB-4 and FibroScan scores (r=0.01; P=0.936). A normal to mild FIB-4 index correctly excluded moderate to severe fibrosis in 51% of cases, which was not statistically significant (P=0.504).

Conclusion:

 The FIB-4 index showed a limited correlation with liver fibrosis severity measured by FibroScan in patients with PsA on MTX therapy. While FIB-4 may be a potential screening tool, it is not sufficiently accurate to replace elastography. Further studies with larger samples are required.