Introduction: Liver fibrosis is a side effect of methotrexate (MTX) that develops with prolonged use in psoriasis patients. Currently, patients are followed up for MTX-induced hepatic fibrosis either through liver biopsy, which carries danger and burden for the patient, or with the non-conclusive measurement of plasma procollagen type III amino peptide (PIIINP). Transient elastography (TE) has recently been utilized to identify liver fibrosis. Aim of the study is to determine the effectiveness of transient elastography for monitoring psoriasis patients for MTXinduced hepatic fibrosis and to identify Serum Wingless Integration 5a Protein (Wnt5a) as a novel predictive and preferably non-invasive biomarker. Subjects and methods: The study comprised 59 individuals with methotrexate-treated persistent psoriasis who were divided into two groups (I, II): Psoriasis patients who take MTX at a low dose (0.2mg/kg/week) and a high dose (0.4mg/kg/week) for longer than three months. Both a clinical examination and biochemical workup were done. Results: There are 19 women and 40 men among the patients. Wnt5a, which is linked to hepatic fibrosis and considerably more prevalent in group II, was found in the sera of psoriasis patients receiving high MTX doses. Group II showed TE values >7 kPa while group I showed values <7 kPa. High TE value and Wnt5a level were both substantially correlated with high methotrexate dose. Conclusion: In psoriasis patients receiving high doses of MTX, Wnt5a Protein was found as a potentially predictive biomarker for MTX-induced hepatic fibrosis. A non-invasive method for detecting liver fibrosis is TE. In most chronic liver diseases, a value of >7 kPa is associated with liver fibrosis.