Hepatic toxicity of antirheumatic drugs.

Abstract

BACKGROUND: Many of the diverse group of pharmacologic agents available for the treatment of rheumatic diseases have the potential to cause serious hepatotoxicity. OBJECTIVE: To identify factors associated with drug-induced hepatotoxicity in rheumatic disease. SUMMARY: While mild elevations in plasma transaminase concentrations are associated with almost all nonsteroidal anti-inflammatory drugs (NSAIDs), clinically significant hepatic toxicity is very rare. NSAID-induced liver injury probably has an immunologic basis, but neither a detailed mechanism nor precise incidence rates are known. Methotrexate can cause hepatic fibrosis during chronic use, but the liver injury is poorly reflected by plasma transaminase concentrations; it is difficult to formulate monitoring recommendations when this agent is used in rheumatic disease. Gold and penicillamine have been associated with rare cases of hepatic toxicity as well. CONCLUSIONS: Drug treatment of rheumatic diseases is associated with a small but well-documented risk of hepatotoxicity. Recognizing the clinical syndromes associated with liver injury by these agents facilitates the minimization of morbidity from this complication.