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Background: Liver fibrosis is an infrequent complication of methotrexate (MTX) treatment diagnosed by liver biopsy, an invasive procedure rarely used in clinical practice. Objectives: To evaluate liver fibrosis by transient elastography (TE, FibroScan®) in MTX treated rheumatic patients. Methods: This was a cross-sectional study of rheumatic patients treated with MTX (n=70) and controls (rheumatic patients not on MTX, n=24). Liver fibrosis was assessed blindly by TE. Eleven patients had repeated measurements during MTX treatment. Results: No baseline differences were noted between the 2 groups. The mean cumulative MTX dose was 1807±1846mg while the median treatment duration was 28 months. The mean liver stiffness of MTX treated patients was 5.9±2.1kPa compared to 6.5±3.6kPa of controls (p=0.755). Liver stiffness >7.1kPa (significant liver fibrosis) was observed in 21.5% of patients and 37.5% of controls (p=0.174). There was no correlation between cumulative MTX dose and liver stiffness (Spearman rho p=0.668 r=0.46) and no difference between patients who had received >1.5g (5.7±2.0kPa) compared to those treated with Conclusions: Long-term MTX administration is not associated with significant liver fibrosis in rheumatic patients, as assessed by TE. This method could be a useful tool for the screening and monitoring of liver fibrosis during MTX treatment.