Relatively little is known about the risk for incident liver disease in patients with psoriasis (PsO), psoriatic arthritis (PsA), or rheumatoid arthritis (RA). To help better treat this patient population, Joel M. Gelfand, MD, MSCE, and colleagues conducted a cohort study of patients with these conditions, and their results were published in the Journal of Investigative Dermatology.
“For decades, there has been the concept of ‘the psoriatic liver,’” says Dr. Gelfand. “Clinicians recognized that patients with psoriasis seemed to be more prone to liver problems. However, the hypothesis that psoriasis specifically predisposes patients to liver disease has not been rigorously tested. We tested the hypothesis that patients with psoriasis are more prone to liver disease while controlling for risk factors such as obesity and alcohol use. We evaluated these risks in patients with rheumatoid arthritis to determine if the risk appears specific to psoriasis or related in inflammation in general.” The study team evaluated data from The Health Improvement Network from 1994 to 2014. When compared with matched controls, the adjusted hazard ratios (aHR) for any liver disease were elevated among patients with PsO (without systemic therapy [ST], 1.37; with ST, 1.97), PsA (without ST, 1.38; with ST, 1.67), and RA without an ST (1.49) but not elevated in patients with RA prescribed ST (0.96). Incident nonalcoholic fatty liver disease was highest in patients with PsO prescribed ST (aHR, 2.23) and those with PsA on ST (aHR, 2.11). The risk of cirrhosis was highest among patients with PsO on ST (aHR, 2.62) and PsA not on ST (aHR, 3.15).
Dr. Gelfand says that hepatotoxic medications should be used cautiously in patients with psoriasis, especially when disease is more severe. The type of inflammation seen in psoriasis may also promote insulin resistance and hepatic inflammation.