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    Ideal monitoring guidelines cannot be fully evidence-based until a large prospective study is done in which patients are stratified according to the indication for MTX therapy (e.g., psoriasis, psoriatic arthritis, rheumatoid arthritis, etc.), and clinical variables such as obesity, diabetes, alcohol intake, and age and laboratory variables such as liver enzymes, albumin, serological tests for fibrogenesis, fibrogenic and inflammatory cytokine levels in the serum, viagra generico walmart and modern liver imaging are correlated with liver histology (169). But it is not known whether PIIIP rises again in this setting when hepatic fibrosis starts, pIIIP is elevated in untreated rheumatoid arthritis and normalizes with MTX therapy. In a study (198) whose objectives were to determine quantitative liver function prospectively and to assess the relationship between such testing and liver histology, neither galactose elimination, aminopyrine breath tests, liver enzymes, γ-glutamyl transpeptidase (transferase), serum bile acids, bilirubin, nor albumin was of any practical use. In particular, no relationship was found between changes in results of galactose elimination, aminopyrine breath tests, and MTX dose, age, enzyme elevation, alcohol intake, or liver histology. Studies on fibrogenesis markers in MTX-treated rheumatoid arthritis patients are limited.