Psoriasis, psoriatic arthritis predispose patients to liver disease
Patients with psoriasis (PsO) or psoriatic arthritis (PsA) appear to be at greater risk of developing serious liver disease compared with those who have rheumatoid arthritis (RA), as shown in a study.
The study followed for an average of 6 years patients with PsO (n=197,130), PsA (n=12,308) or RA (n=54,251) and matched unexposed controls (n=1,279,754) for the development of any liver disease (nonalcoholic fatty liver disease [NAFLD], cirrhosis and viral hepatitis, among others)—the primary outcome.
In the cohort, RA patients were more likely to be older, female and have more medical comorbidities. On the other hand, PsO and PsA patients receiving systemic therapy (ST) had higher body mass index (BMI). ST was prescribed in 6 percent in the PsO group, 53 percent in the PsA group and 61 percent in the RA group. Methotrexate was the most frequently used drug.
Multivariable Cox proportional hazard models showed that the risk of incident liver disease was elevated in all disease groups than in controls, with the exception of RA group prescribed an ST (adjusted hazard ratio [aHR], 0.96; 95 percent CI, 0.83 to 1.12).
The highest risk of incident liver disease was observed in the PsO group with ST (aHR, 1.97; 1.63 to 2.38), followed by the PsA group with ST (aHR, 1.67; 1.29 to 2.15), RA group without ST (aHR, 1.49; 1.26 to 1.76), PsA group without ST (aHR, 1.38; 1.02 to 1.86) and PsO group without ST (aHR, 1.37; 1.29 to 1.45).
Specifically, NAFLD (37.85 percent) was the most frequently diagnosed liver disease subtype, followed by alcoholic liver disease (18.53 percent), unknown causes (10.35 percent), viral aetiologies (7.76 percent), biliary disease (4.33 percent) and autoimmune liver disease (0.60 percent).
The present data lend empirical support to the long-held expert opinion that patients with PsO may be more predisposed to liver disease than patients with RA, researchers noted.
Physicians should inform patients regarding the increased risk of liver disease and recommend weight loss and moderation of alcohol use, and consider minimizing use of nonsteroidal anti-inflammatory drugs in combination with other hepatotoxic medications, they continued.
More studies are warranted to elucidate the role of inflammation in liver disease and, conversely, the role the liver plays in perpetuating inflammation in PsO, PsA and RA, researchers said.