Aminotransferases activity on additional therapy in rheumatoid arthritis patients with liver disease.

Iryna Klymas 1 * , Liudmyla Khimion 1
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1 Shupyk National Healthcare University of Ukraine
* Corresponding Author
J CLIN MED KAZ, Volume 21, Issue 2, pp. 89-94. https://doi.org/10.23950/jcmk/14398
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ABSTRACT

Aim. Investigate the effect of additional therapy of atorvastatin, essential phospholipids and their combination on activity of aminotransferases in RA patients with NAFLD.
Materials and Methods. We investigated 126 RA patients and 30 in control. 77 RA patients with NAFLD were divided into three groups. I: 25 RA patients received 10 mg of atorvastatin per day. II: 26 RA patients received essential phospholipids 1800 mg per day. III: 26 RA patients received essential phospholipids 1800 mg per day and atorvastatin 10 mg per day for 6 months.
The results. In the I group, a transient increase in ALT and AST activity was observed to 35.11±3.501 U/l and 30.51±2.19 U/l, respectively, and a spontaneous decrease in elevated transaminases was recorded after 6 months of atorvastatin use. In the II group, a decrease in ALT by 25.6% was observed compared to the indicators before treatment, and they remained unchanged even after 6 months. After 3 months of complex use of atorvastatin and essential phospholipids, ALT activity decreased by 33.8% and AST decreased by 8.2%, which was not observed in RA patients with NAFLD of groups I and II.
Conclusions. Use essential phospholipids 600 mg three times a day and atorvastatin 10 mg per day for 6 months in addition to antirheumatic therapy in RA patients with NAFLD allows to avoid a transient increase in aminotransferases, reduce the severity of hepatotoxic reactions, and avoid stopping or canceling antirheumatic therapy.
Keywords: rheumatoid arthritis, nonalcoholic fatty liver disease, aminotransferases, atorvastatin, essential phospholipids.

CITATION

Klymas I, Khimion L. Aminotransferases activity on additional therapy in rheumatoid arthritis patients with liver disease.. J CLIN MED KAZ. 2024;21(2):89-94. https://doi.org/10.23950/jcmk/14398

REFERENCES

  • Lee YH, Bae SC, Song GG. Meta-analysis of associations between the peroxisome proliferator-activated receptor-γ Pro12Ala polymorphism and susceptibility to nonalcoholic fatty liver disease, rheumatoid arthritis, and psoriatic arthritis. Genet Test Mol Biomarkers. 2014;18(5):341-348. doi:10.1089/gtmb.2013.0503
  • Radovanović-Dinić B, Tešić-Rajković S, Zivkovic V, Grgov S. Clinical connection between rheumatoid arthritis and liver damage. Rheumatol Int. 2018;38(5):715-724. doi:10.1007/s00296-018-4021-5
  • Wendt MMN, de Oliveira MC, Franco-Salla GB, et al. Fatty acids uptake and oxidation are increased in the liver of rats with adjuvant-induced arthritis. Biochim Biophys Acta Mol Basis Dis. 2019;1865(3):696-707. doi:10.1016/j.bbadis.2018.12.019
  • Vassiliadis E, Oliveira CP, Alvares-da-Silva MR, et al. Circulating levels of citrullinated and MMP-degraded vimentin (VICM) in liver fibrosis related pathology. Am J Transl Res. 2012;4(4):403-414.
  • Radovanović-Dinić B, Tešić-Rajković S, Zivkovic V, Grgov S. Clinical connection between rheumatoid arthritis and liver damage. Rheumatol Int. 2018;38(5):715-724. doi:10.1007/s00296-018-4021-5
  • Zamani M, Alizadeh-Tabari S, Chitkara P, Singh S, Loomba R. Prevalence of Nonalcoholic Fatty Liver Disease in Patients With Rheumatoid Arthritis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2023 Oct;21(11):2789-2796. doi: 10.1016/j.cgh.2023.02.021. Epub 2023 Mar 5. PMID: 36871771.
  • Lucas CJ, Dimmitt SB, Martin JH. Optimising low-dose methotrexate for rheumatoid arthritis-A review. Br J Clin Pharmacol. 2019;85(10):2228-2234. doi:10.1111/bcp.14057
  • Conway R, Carey JJ. Risk of liver disease in methotrexate treated patients. World J Hepatol. 2017;9(26):1092-1100. doi:10.4254/wjh.v9.i26.1092
  • Shetty A, Cho W, Alazawi W, Syn WK. Methotrexate Hepatotoxicity and the Impact of Nonalcoholic Fatty Liver Disease. Am J Med Sci. 2017;354(2):172-181. doi:10.1016/j.amjms.2017.03.014
  • Sumida Y, Nakajima A, Itoh Y. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol. 2014;20(2):475-485. doi:10.3748/wjg.v20.i2.475
  • Lewis JR, Mohanty SR. Nonalcoholic fatty liver disease: a review and update. Dig Dis Sci. 2010;55(3):560-578. doi:10.1007/s10620-009-1081-0
  • Hashimoto E, Tokushige K, Ludwig J. Diagnosis and classification of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: Current concepts and remaining challenges. Hepatol Res. 2015;45(1):20-28. doi:10.1111/hepr.12333
  • Machado MV, Cortez-Pinto H. Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal. J Hepatol. 2013;58(5):1007-1019. doi:10.1016/j.jhep.2012.11.021
  • Karlsson Sundbaum J, Eriksson N, Hallberg P, Lehto N, Wadelius M, Baecklund E. Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long-term follow-up of predictors, surveillance, and outcome in clinical practice. Int J Rheum Dis. 2019;22(7):1226-1232. doi:10.1111/1756-185X.13576
  • Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34(3):274-285. doi:10.1111/j.1365-2036.2011.04724.x
  • Zhao S, Mysler E, Moots RJ. Etanercept for the treatment of rheumatoid arthritis. Immunotherapy. 2018;10(6):433-445. doi:10.2217/imt-2017-0155
  • Li Y, Zhang W. Sheng Wu Gong Cheng Xue Bao. 2017;33(1):36-43. doi:10.13345/j.cjb.160241
  • Eslami L, Merat S, Malekzadeh R, Nasseri-Moghaddam S, Aramin H. Statins for non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Cochrane Database Syst Rev. 2013;(12):CD008623. Published 2013 Dec 27. doi:10.1002/14651858.CD008623.pub2
  • Chatrath H, Vuppalanchi R, Chalasani N. Dyslipidemia in patients with nonalcoholic fatty liver disease. Semin Liver Dis. 2012;32(1):22-29. doi:10.1055/s-0032-1306423
  • Lewis JH. Clinical perspective: statins and the liver--harmful or helpful?. Dig Dis Sci. 2012;57(7):1754-1763. doi:10.1007/s10620-012-2207-3
  • Dajani AI, Abu Hammour AM, Zakaria MA, Al Jaberi MR, Nounou MA, Semrin AI. Essential phospholipids as a supportive adjunct in the management of patients with NAFLD. Arab J Gastroenterol. 2015;16(3-4):99-104. doi:10.1016/j.ajg.2015.09.001
  • Gundermann KJ, Gundermann S, Drozdzik M, Mohan Prasad VG. Essential phospholipids in fatty liver: a scientific update. Clin Exp Gastroenterol. 2016;9:105-117. Published 2016 May 5. doi:10.2147/CEG.S96362
  • Dajani AI, Popovic B. Essential phospholipids for nonalcoholic fatty liver disease associated with metabolic syndrome: A systematic review and network meta-analysis. World J Clin Cases. 2020;8(21):5235-5249. doi:10.12998/wjcc.v8.i21.5235
  • Lüchtenborg C, Niederhaus B, Brügger B, Popovic B, Fricker G. Lipid Profiles of Five Essential Phospholipid Preparations for the Treatment of Nonalcoholic Fatty Liver Disease: A Comparative Study. Lipids. 2020;55(3):271-278. doi:10.1002/lipd.12236
  • Jamwal R, Barlock BJ. Nonalcoholic Fatty Liver Disease (NAFLD) and Hepatic Cytochrome P450 (CYP) Enzymes. Pharmaceuticals (Basel). 2020;13(9):222. Published 2020 Aug 29. doi:10.3390/ph13090222
  • Udut VV, Vengerovsky AI, Dygai AM. Effects of phospholipid hepatoprotectors on apoptosis during experimental liver pathology induced by isoniazid and paracetamol. Bull Exp Biol Med. 2013;154(5):614-617. doi:10.1007/s10517-013-2012-9
  • Vasilevskaia AS, Butov MA, Uzbekova DG, Mnikhovich MV, Nikiforov AA. Eksp Klin Gastroenterol. 2013;(12):79-82.