HP and rheumatoid arthritis: In rheumatoid arthritis patients treated with a high cumulative dose of methotrexate, significant liver fibrosis is rare and is not accurately detected in patients with abnormal liver enzymes. The kilopascal values and levels of biochemical markers are not related with the cumulative dose of methotrexate but are related with the AST to ALT ratio, AST to platelet ratio index, and haptoglobin level.