Histologic liver abnormalities in an autopsy series of patients with rheumatoid arthritis

UMMS Affiliation

Department of Medicine, Division of Rheumatology

Publication Date


Document Type



Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Female; Humans; Liver; Liver Cirrhosis; Male; Middle Aged; Retrospective Studies; Single-Blind Method


Hepatology | Musculoskeletal Diseases | Pathology | Rheumatology | Skin and Connective Tissue Diseases


A retrospective review was performed on 188 autopsied cases of rheumatoid arthritis at our institutions during 1958-1985, prior to the widespread use of methotrexate. Hepatic histology was reported in 182 cases. All available microscopic liver slides from cases in which the autopsy report described portal tract inflammation, fibrosis, cirrhosis, tumour, amyloid, vasculitis, or infections involving the liver were examined and graded by a hepatic pathologist blinded to the original diagnosis, along with a representative sample of cases with reports describing fatty change or no hepatic pathologic abnormalities. Ninety normal and abnormal cases were reviewed from the 182 for which hepatic histology was available. Fifteen cases of diffuse fibrosis were identified upon blinded review. Two cases were graded as severe fibrosis (grades 3 or 4 on a scale of 0-4) without an identifiable pathologic cause, in both of which the liver disease was suspected premortem (alcohol abuse and viral hepatitis). Although the incidence of fibrosis in this series is slightly higher than that previously described, serious fibrotic liver disease was rare. These results support the current practice of limiting pre-treatment liver biopsies prior to methotrexate therapy to patients with suspected liver disease.

DOI of Published Version



Br J Rheumatol. 1997 Feb;36(2):210-3. doi: 10.1093/rheumatology/36.2.210

Journal/Book/Conference Title

British journal of rheumatology


At the time of publication, Ellen Gravallese was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID