Both psoriasis and psoriatic arthritis may have a greater association with liver disease than rheumatoid arthritis (RA), with a particularly high association with nonalcoholic fatty liver disease (NAFLD) and cirrhosis, even in patients who were not exposed to systemic therapy (ST), according to study results in press in the Journal of Investigative Dermatology.
“These findings offer evidence for the long held view that psoriasis patients may be more predisposed to liver disease than patients with RA,” said first author Alexis Ogdie, MD, MSCE, assistant professor, Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. “Understanding the role of inflammation in liver disease and how the liver can perpetuate inflammation in these conditions can help us advise patients, and their clinicians, on how to more effectively manage their health.”
Because few clinical trials have been undertaken to assess the risk for incident liver disease in patients with psoriasis, psoriatic arthritis, and RA, Dr. Ogdie and colleagues undertook this cohort study, enrolling patients with these three conditions and comparing them to matched controls identified through The Health Improvement Network from 1994-2014.
Dr. Ogdie and fellow researchers included 197,130 patients with psoriasis, 12,308 with psoriatic arthritis, 54,251 with RA, and compared them with 1,279,754 matched controls. They found elevated adjusted hazard ratios (HRs) for any liver disease in patients with psoriasis (HR: 1.37 without ST; HR: 1.97 with ST), psoriatic arthritis (HR: 1.38 without ST; 1.67 with ST), and RA (HR: 1.49 without ST). The adjusted HRs were not elevated, however, in RA patients being treated with ST (HR: 0.96).
Further, they found that incidence NAFLD was highest in patients with psoriasis (HR: 2.23) or psoriatic arthritis (HR: 2.11) who were prescribed an ST. The risk of cirrhosis was highest in patients with psoriasis prescribed an ST (HR: 2.62) and patients with psoriatic arthritis not prescribed ST (HR: 3.15).
Finally, the prevalence of liver disease and cirrhosis were increased in a stepwise fashion as the body surface area affected by psoriasis increased (P for trend < 0.001).
While previous studies have demonstrated the increased incidence of liver disease in patients with psoriasis compared with the general population, this is the first study in which researchers adjusted for risk factors for liver disease to assess whether psoriasis or psoriatic arthritis act to increase the risk of developing new liver disease. This is also the first population-based study to address the risk for liver disease in patients with these inflammatory diseases.
“Based on these data, physicians should educate psoriasis patients on the increased risk for liver disease and be cautious about the use of hepatoxic medications in these patients, especially when additional risk factors such as diabetes, obesity, or heavy alcohol use are present,” said senior author Joel M. Gelfand, MD, MSCE, professor, Dermatology and Epidemiology.
This study was supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24-AR064310, K23-AR063764, K23-AR068433), a Medical Dermatology Fellowship from The National Psoriasis Foundation, NIH Pharmacoepidemiology Training Grant T32-GM075766, NIH Training Grant T32-AR007465-32, Dermatology Foundation Career Development Award, an unrestricted grant from Pfizer Inc. to the trustees of the University of Pennsylvania, an NIH grant (K08-AA021424, R01 AA026302-01), Robert Wood Johnson Foundation, Harold Amos Medical Faculty Development Award (7158), IDOM DRC Pilot Award (P30 DK019525) and NIH (P30-DK050306) and its pilot program, Health Resources and Services Administration (D34HP24459), Center of Excellence for Diversity in Health Education and Research, and Perelman School of Medicine.
Dr. Ogdie has served as a consultant for Pfizer and Takeda and is a co-investigator on a research grant from Pfizer. Dr. Gelfand has served as a consultant for Pfizer Inc., receiving honoraria; and receives research grants from Pfizer Inc. Pfizer had no role in the design, analysis, or reporting of the data.