Patients with inflammatory disorders, including psoriasis, psoriatic arthritis (PsA), and rheumatoid arthritis (RA), have an increased risk for the development of liver disease, according to the results of a recent longitudinal, population-based cohort study published in the Journal of Investigative Dermatology.
The investigators sought to better understand the epidemiology of liver disease in individuals with psoriasis, PsA, and RA. They used The Health Improvement Network (THIN), a population-based electronic medical records database, and the Incident Health Outcomes and Psoriasis Events cohort, a nested study of patients with psoriasis from the THIN database, which included data on affected body surface area, to compare patients with inflammatory disorders with those in the general UK population.
Study outcomes included any liver disease, nonalcoholic fatty liver disease (NAFLD), and cirrhosis.
Among patients with psoriasis (n=197,130), PsA (n=12,308), and RA (n=54,251) and matched control patients (n=1,279,754), the greatest adjusted hazard ratio (aHR) for development of any liver disease was seen in the psoriasis group (with systemic therapy [ST]: aHR 1.97 [95% CI, 1.63-2.38]; without ST: aHR 1.37 [95% CI, 1.29-1.45]). Hazard ratios for the other groups were, for PsA, with ST, aHR, 1.67 (95% CI, 1.29-2.15), and without ST, aHR, 1.38 (95% CI, 1.02-1.86); for RA, with ST, aHR, 0.96 (95% CI, 0.83-1.12), and without ST, aHR, 1.49 (95% CI, 1.26-1.76).
Regarding types of liver disease, NAFLD was the most common (37.85%), followed by alcoholic liver disease (18.53%), unknown causes (10.35%), viral etiologies (7.76%), biliary disease (4.33%), and autoimmune liver disease (0.60%). During the observational period, 10% of patients with liver disease were diagnosed with cirrhosis. Moreover, the prevalence of liver disease and cirrhosis was correlated with increasing body surface area affected by psoriasis (P for trend <.001).
The investigators concluded that among patients with inflammatory disorders, those with psoriasis and PsA have an elevated risk for liver disease, particularly NAFLD and cirrhosis, which is true even among those without exposure to ST. Risk factors for severe liver disease, including obesity, alcohol intake, and use of hepatotoxic medications, should all be carefully considered in patients with psoriatic disease, especially when systemic treatments are indicated for more extensive skin or joint disease.
Ogdie A, Grewal SK, Noe MH, et al. Risk of incident liver disease in patients with psoriasis, psoriatic arthritis, and rheumatoid arthritis: a population-based study [published online October 27, 2017]. J Invest Dermatol. doi:10.1016/j.jid.2017.10.024