Objective: To explore the significance of the association between treatment with methotrexate (MTX) and liver stiffness in rheumatoid arthritis (RA) patients by transient elastography (TM). Methodology: In this cross-sectional study, a total of 100 adult patients of RA were selected randomly as the study population, and 50 were the control population. Out of the total study population, half of them were taking MTX for >2 years to 5 years, and the rest for >5 years. Hepatic fibrosis was determined by measuring the hepatic stiffness by TE method (by FibroScan) in kilopascal unit (kPa), where >9 kPa value was considered to be significant for developing hepatic fibrosis. The hepatic stiffness of the patient group was compared with that of healthy controls. Result: The mean BMI value between the two groups taking methotrexate therapy for < 5 years and >5 years was 22.37 ± 2.67 kg/m² and 25.13 ± 3.09 kg/m², and the control population was 20.71 ± 2.06 kg/m². P-value came to be < 0.0001, which was statistically significant, and the effect of mean BMI on liver stiffness was also found significant (p = 0.04). The mean (mean ± SD) kPa value among the study population and control group is 6.04 ± 0.95, 6.67 ± 1.68, and 3.83 ± 0.52. Having compared among three groups, p-value was < 0.0001. A significant association was also found regarding the duration of MTX therapy with increased liver stiffness (p = 0.018). SDAI has been found to be positively correlated with increased hepatic stiffness (r = 0.077). Conclusion: The long-term use of methotrexate therapy in RA patients has been found to be significantly associated with progressive liver fibrosis and increased hepatic stiffness.