Table III.

Hepatotoxicity of drugs used in rheumatology

Drugs	Hepatotoxic effect	Outcome
NSAIDs	Hepatocellular or cholestatic pattern	Liver damage, reversible after discontinuation of the suspected NSAIDs
Methotrexate	NAFLD	Liver fibrosis and cirrhosis (BMI, alcohol consumption and lack of folic acid supplementation may play a role)
Leflunomide	Elevated liver enzymes	Liver tests normalize during ongoing treatment
Tumor necrosis factor inhibitors	AIH, cholestasis, jaundice, acute liver failure (very rare) hepatitis B reactivation	Some patients require treatment of AIH (glucocorticoids) and discontinuation of anti-TNF-treatment
Tocilizumab	Elevated liver enzymes (transient)	Liver tests normalize during ongoing treatment or after dose reduction
JAK inhibitors	Elevated ALT (transient)	Liver tests normalize during ongoing treatment

NSAIDs – nonsteroidal anti-inflammatory drugs, NAFLD – nonalcoholic fatty liver disease, AIH – autoimmune hepatitis, ALT – alanine aminotransferase, BMI – body mass index