PsA patients: highest risk of developing NAFLD

Compared with patients with psoriasis (PsO) and other inflammatory arthritis (OIA), patients with psoriatic arthritis (PsA) have the highest risk of developing non-alcoholic fatty liver disease (NAFLD) and related liver fibrosis. Moreover, in PsA patients, fibrosis-4 (FIB-4) index scores showed a significant association with fibrosis, whereas ELF scores were not indicative of fibrosis.

Psoriatic disease (PsD), encompassing PsO and PsA, increases the susceptibility to developing NAFLD compared with other forms of inflammatory arthritis [1]. This risk persists despite disease-modifying antirheumatic drug (DMARDs) use and may rapidly progress to severe fibrosis [2].

Until present, a NAFLD screening pathway previously developed by the Leeds Teaching Hospitals NHS Trust (LTHT) is not validated in patients with PsD, highlighting the need for further research. Therefore, psychologist Anthony Harrison (Leeds Teaching Hospitals NHS Trust, UK) and his team conducted an audit to assess the prevalence of NAFLD in the PsD population [3]. Additionally, the team evaluated the effectiveness of the LTHT NAFLD pathway in accurately identifying PsD patients at risk of acquiring fibrosis or cirrhosis.

The study investigated consecutive patients presented at the Leeds Specialist Spondyloarthritis and Dermatology departments who underwent NAFLD screening using the LTHT pathway. The researchers categorised these patients into 3 groups according to the disease: PsA (n=60), PsO (n=38), and OIA (n=18).

Most demographic and clinical variables were similar across all 3 groups. However, the majority of the patients with OIA (66.6%) were males, and half were receiving biological DMARD monotherapy. In contrast, a large proportion of patients with PsO (60.5%) were not taking any DMARDs, and only 1 was under biological DMARD.

“We further screened these patients using ELF test scores combined with FIB-4 index scores. We selected those with ELF >9.5 or FIB-4 >1.45 and sought fibroscan and hepatology opinion,” Mr Harrison explained. A fibroscan reading above 10 was considered indicative of clinically expressive NAFLD.

The findings revealed that patients with PsO had higher ELF scores, while patients with PsA displayed higher FIB-4 scores than all other groups. In the PsA group, higher FIB-4 scores showed a significant association with fibroscan scores above 10 (P=0.05) but not the ELF scores. An association between higher FIB-4 scores and diagnosis of liver fibrosis (P=0.09) was suggested.

Mr Harrison concluded that patients with PsA have higher rates of NAFLD fibrosis/cirrhosis than patients with PsO or OIA. Moreover, FIB-4 showed higher potential than ELF in identifying PsA patients at high risk of NAFLD fibrosis. A comprehensive prospective cohort study in the future is needed to validate these findings.

1. Prussick RB, et J Clin Aesthet Dermatol. 2015;8:43-45.
2. Prussick RB, et Br J Dermatol. 2017;179:16-29.
3. Harrison S, et Non-alcoholic fatty liver disease (NAFLD) in psoriatic disease (PsD): identifying patients at high risk of serious liver disease. POS0022, EULAR 2023, 31 May–3 June, Milan, Italy.

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Posted on 31 July, 20231 February, 2024