Rheumatoid Arthritis, Psoriasis Patients Have Varied Risk of Liver Disease

Both psoriasis (PsO) and rheumatoid arthritis (RA) are autoimmune conditions that are treated with similar drugs that carry the risk of liver disease. Despite similar treatments, patients with psoriasis may have a higher risk of developing liver disease compared with RA patients, according to a study published by the Journal of Investigative Dermatology.
These findings may better educate patients with the inflammatory conditions about the risks of liver disease and how they may be able to lower the risk. The results may also help guide prescribing, according to the authors.
This new study is the first to address the risk for liver disease in these inflammatory conditions, according to the authors. Included in the study were 197,000 patients with PsO, 12,000 patients with psoriatic arthritis (PsA), 54,000 patients with RA, and 1.2 million controls.
After adjusting for common risk factors, the authors discovered with patients with PsO or PsA—especially those with more severe disease—had a significantly higher risk of serious liver disease, according to the study.
Notably, patients with PsO taking systemic drugs, such as methotrexate, had the highest risk of non-alcoholic fatty liver disease and cirrhosis; however, RA patients taking the same drugs did not have such a high risk.
The authors said that these findings suggest that inflammation may play a role in liver disease, while certain medications further increase the risk due to liver toxicity, according to the study.
Further studies should investigate whether reducing inflammation among these patients can also reduce the risk of liver disease, according to the study.
“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, MD, MSCE. “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.” 
The results offer insights on how the liver responds to different types and severities of chronic inflammation. The authors also said their findings provide information on how skin severity, obesity, diabetes, and medication use can increase the risk of liver disease among patients with PsO, PsA, and RA, according to the study.
“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. 

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