This study was aimed at the evaluation of patient preferences concerning long-term methotrexate (MTX) therapy and whether or not to perform unselective liver biopsy to detect serious liver disease due to MTX therapy in rheumatoid arthritis (RA).
Seventeen literate patients with RA consecutively selected from a rheumatic disease unit and 17 rheumatologists (asked to consider themselves as RA patients) were assessed by a trained interviewer. The Bedside Decision Board instrument was used to assess the patient preference. Scenarios described the options in terms of follow-up for RA patients treated with MTX. The benefits and risks of liver biopsy, defined according to the published literature, were presented to RA patients and rheumatologists in an unbiased fashion.
Twelve patients (71%) preferred not to be subjected to the liver biopsy within 1 month, even though they had already taken MTX for 3 years, and consequently ran the risk of development of cirrhosis in the long term. Conversely, 12 rheumatologists (71%) preferred to undergo an unselective liver biopsy.
Given patients' preferences, liver biopsy following long term MTX treatment should not be performed unselectively. It can be postulated that rheumatologists did not perceive liver biopsy as an intimidating procedure or were influenced by the until recently recommended guidelines for following up patients treated with MTX.