Prospective Evaluation of Liver Function Abnormalities and Psychological Symptoms in Rheumatoid Arthritis Patients Receiving Conventional and Targeted Synthetic DMARD

Abstract

Background: Disease-modifying antirheumatic drugs (DMARDs) play a key role in the treatment of rheumatoid arthritis (RA), and abnormalities of liver-function parameters are an important safety concern. Depression and anxiety can also occur as part of RA and can increase the load of illness.

Objective: To determine the frequency of liver-function abnormalities among patients with RA receiving conventional synthetic DMARDs (csDMARDs) and targeted synthetic DMARDs (tsDMARDs) and to describe associated treatment patterns and psychological symptoms.

Methods: Prospective observational study carried out in an outpatient setting in a tertiary-care hospital in adult RA patients on therapy with csDMARDs or tsDMARDs. Demographic and lifestyle data, DMARD therapy and results of liver-function tests were recorded. Symptoms of depression and anxiety were measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) questionnaires, respectively. Descriptive statistics, Pearson's chi-square test and Mann-Whitney U test were used to analyse the data.

Results: They evaluated a total of 114 patients with a mean age of 48.46 ± 10.32 years, 76.3% of whom were female. Overall, 18 patients (15.8%) had abnormal liver-function test results. 18.2 % of persons taking methotrexate and leflunomide, 12.5 % of persons taking tofacitinib, 16.7 % of persons taking methotrexate alone and 14.3 % of persons taking leflunomide alone and other DMARD combinations had abnormal lab results. Overall class of the broad DMARD was not significantly associated with liver-function status. Significantly higher SGPT/ALT ratios were found in patients with abnormal liver-function findings. Moderate or greater depressive symptoms were detected by the PHQ-9 in 23 (20.2%) patients and moderate or greater anxiety symptoms by the GAD-7 in 20 (17.5%) patients.

Conclusion: Liver-function abnormalities were observed in approximately one in six patients with RA receiving DMARD therapy. While these differed in number across treatment regimens, broad DMARD class was not significantly related to liver-function status. A sufficient Number of patients were also identified who had moderate or greater depressive and anxiety symptoms, indicating that biochemical monitoring and psychological screening as a comprehensive follow-up for RA.