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Psoriasis patients at higher risk for liver disease

Study compares inflammatory illnesses

Jo Carlowe

Friday, 03 November 2017

Patients with psoriasis are at higher risk of serious liver disease than patients with rheumatoid arthritis.

These are the findings of a study* published this week in the Journal of Investigative Dermatology. The researchers from the Perelman School of Medicine at the University of Pennsylvania, note that the two autoimmune diseases are often treated with similar drugs that can cause liver damage. 

The study is the first population-based study to simultaneously address the risk for liver disease in patients with these inflammatory diseases and psoriatic arthritis (PsA), in a large population of more than 197,000 psoriasis (PsO) patients, 12,000 PsA patients, 54,000 rheumatoid arthritis (RA) patients, and 1.2 million matched controls.

Independent of risk factors commonly seen in liver disease, such as alcohol use and diabetes, the study found that patients with psoriatic skin or joint disease, particularly patients with more severe skin psoriasis, had an elevated risk for serious liver disease. 

Patients with psoriasis taking a systemic therapy drug like methotrexate (under brand names like Trexall, Rasuvo, and Otrexup PF), had the highest risk, particularly for non-alcoholic fatty liver disease and cirrhosis, while RA patients taking the similar drugs had the lowest liver disease risk.

The study suggests systemic inflammation - which is present in all three diseases - may play a significant role in development of liver disease, particularly in those with psoriasis. At the same time, certain medications use to treat these diseases also can cause liver toxicity. The authors note that future research should delve into whether adequate control of inflammation reduces liver disease risk.

"These findings offer evidence for the long-held view that psoriasis patients may be more predisposed to liver disease than patients with rheumatoid arthritis," said first author Alexis Ogdie, an assistant professor of Medicine and Epidemiology. 

"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.”

Previous studies have shown an increased prevalence of liver disease in psoriasis patients than in the general population, but this new research adjusts for risk factors for liver disease to determine if having PsO or PsA increases an individual's risk of developing new liver disease, and sheds light on how common liver disease is among patients with these 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, professor of dermatology and epidemiology.


* 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. Journal of Investigative Dermatology, November 2017. DOI: 10.1016/j.jid.2017.10.024

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