iarjcmbIARJCMBIARJCMB2789-600510.47310/iarjcmb.2025.v05i01.001Impact of Disease Severity (DAS-28) on Hepatic and Renal Functions in Rheumatoid Arthritis PatientsBackground: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that primarily affects the joints and can lead to systemic complications, including hepatic and renal dysfunction. Methotrexate (MTX) is a cornerstone in RA treatment, but its prolonged use has been associated with hepatotoxicity and nephrotoxicity. Aim: This study investigates the impact of disease severity, assessed by the Disease Activity Score-28 (DAS-28), on liver and kidney function, considering the potential role of MTX in exacerbating these effects. Methods: The study included 120 RA patients receiving MTX and 100 healthy controls. Biochemical parameters, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), De-Ritis ratio, urea, creatinine, urea/creatinine ratio and C-reactive protein (CRP), were measured. Patients were stratified into mild, moderate and severe disease activity groups based on DAS-28 scores. Correlation and ROC curve analyses were performed to evaluate the predictive value of these biochemical markers. Results: RA patients showed a significant increase in AST (52.8 ± 24.1 U/L vs. 34.9 ± 19.4 U/L in mild cases, P ≤ 0.0001), ALT (34.7 ± 7.0 U/L) and De-Ritis ratio (1.6 ± 0.8 vs. 0.53 ± 0.08 in controls, P ≤ 0.0001). Urea (33.1 ± 15.6 mg/dL), creatinine (1.5 ± 0.4 mg/dL) and the urea/creatinine ratio (26.7 ± 10.7) were significantly elevated in RA patients. These alterations were more pronounced in severe cases (p ≤ 0.0001). CRP levels correlated strongly with disease severity (r = 0.61, P = 0.01). ROC analysis demonstrated that the De-Ritis ratio and CRP were strong discriminators for RA disease activity (AUC = 0.906 and 0.903, respectively). Conclusion: RA patients exhibit significant liver and kidney dysfunction, which worsens with increasing disease severity. The observed biochemical alterations may be attributed to both the inflammatory burden of RA and the hepatotoxic and nephrotoxic effects of long-term MTX use. Regular liver and kidney function monitoring in RA patients on MTX is recommended to prevent potential complications.