FibroScan Pre-MTX — SCE Dermatology MCQ

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ModerateDermatopharmacologyFibroScan Pre-MTXSCE Dermatology

A 40-year-old woman with psoriasis has elevated liver stiffness on FibroScan before starting Methotrexate. The reading is 8.5 kPa. What does this suggest?

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Correct answer: E — Possible significant fibrosis (F2-F3) — values >7.0-7.5 kPa suggest significant fibrosis warranting hepatology referral and potentially contraindicating Methotrexate

FibroScan (transient elastography) measures liver stiffness as a non-invasive surrogate for hepatic fibrosis. In the context of psoriasis/Methotrexate: <6 kPa = likely normal (F0-F1); 6-7.5 kPa = indeterminate; >7.5-8 kPa = suggests significant fibrosis (≥F2); >12-14 kPa = suggests cirrhosis (F4). A reading of 8.5 kPa suggests significant fibrosis — hepatology referral is recommended before starting Methotrexate (which is hepatotoxic). BAD guidelines increasingly recommend baseline FibroScan/liver stiffness measurement before starting Methotrexate, particularly in patients with risk factors for NAFLD (obesity, diabetes, metabolic syndrome, alcohol use). FibroScan has largely replaced liver biopsy for baseline assessment in many centres.

Reference: BAD 2016 MTX; NICE NAFLD