Objective: Methotrexate (MTX) is used for the treatment 
of inflammatory disorders but can cause liver enzyme 
abnormalities. Liver enzyme elevations are neither specific 
nor sensitive for detecting liver fibrosis. Liver biopsy is an 
imperfect gold standard with its own limitations. Fibroscan 
is a non-invasive technique used to evaluate liver fibrosis. 
The objective of this study was to review the literature to 
characterize the utility of Fibroscan for detection of liver 
fibrosis compared to biopsy in patients with inflammatory 
conditions treated with MTX. 
Methods: A systematic literature search was carried out of 
all English publications. The search was limited to studies 
involving subjects greater than 18 years of age, meeting 
criteria for the diagnosis of Crohn's Disease (CD), 
Rheumatoid Arthritis (RA), psoriasis (Ps) or psoriatic 
arthritis (PsA).Studies where liver biopsy was not 
performed were excluded. 

Results:

Among 18 references identified, three 
publications met the criteria. The selected studies were 
prospective, cross-sectional studies (n=21-518).The 
cutoffs for significant or severe fibrosis based on 
Fibroscan score (FSS) differed amongst the studies 
(7kPA-8.7kPa).FSS did not reflect biopsy findings in a 
large portion of patients (40%-69%).The accuracy of 
Fibroscan for the detection of no or mild fibrosis (F<2) 
ranged from 0%-88%.The accuracy of Fibroscan for the 
detection of significant fibrosis or cirrhosis (F2-4) 
ranged from 0%-30%.  

Conclusions: There is insufficient evidence to support 
the use of Fibroscan for detecting liver fibrosis in a 
MTX-taking population with inflammatory disorders. 
Keywords: Fibroscan; Liver fibrosis; Crohn's Disease; 
Psoriatic Arthritis; Rheumatoid Arthritis; MTZ