Treatment of methotrexate in rheumatoid arthritis: In-depth understanding of hepatotoxicity and its molecular mechanisms

Rheumatoid Arthritis is a systemic autoimmune disease characterized by persistent synovitis and chronic, invasive arthritis. At lower doses, Methotrexate plays an anti-inflammatory role in RA mainly by regulating adenosine signaling pathways and is a cornerstone drug in RA treatment. However, the potential hepatotoxicity of MTX poses a challenge to clinical treatment , especially in the elderly RA patient population, where long-term treatment and multiple medications aggravate the risk of hepatotoxicity. In vivo studies show that: Pathological processes such as inflammation, oxidative stress and lipid peroxidation may be involved in MTX-induced liver injury. However, the exact molecular mechanism of MTX-induced liver injury remains unclear. Therefore, this paper will review the research progress of MTX-induced liver injury in RA treatment, including clinical features, risk factors and possible molecular mechanisms. The aim is to provide ideas for finding new drug targets or therapeutic strategies to treat or prevent MTX-associated liver injury in RA treatment.