Severe Psoriasis Associated with Increased Risk of Advanced Liver Fibrosis

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Patients with severe psoriasis are also at a significant increase for developing advanced liver fibrosis, new research shows.

In a study published in a JAMA Dermatology , investigators determined individuals with a severe form of the condition had a seven-fold increased in having advanced liver fibrosis than the general population. Obesity and insulin resistance were also identified as significant contributing factors.

“Our data suggest that people with central obesity, insulin resistance, and active psoriasis are the most at risk for liver fibrosis,” says Jonathan N. Barker, M.D., professor of clinical dermatology at King’s College London.

Out of 400 patients included in the prospective observational cohort study, 47 (14.1 percent) had advanced liver fibrosis diagnosed by transient elastography. This group also had a higher prevalence of being overweight (2 percent) or obese (9 percent). Together, investigators said, individuals with active psoriasis, central obesity, and insulin resistance are most at risk for liver fibrosis.

Based on findings, investigators identified a significant association between advanced fibrosis and many factors, including age, psoriasis severity, psoriatic arthritis, body mass index, waist circumference, metabolic syndrome, physical activity score, non-alcoholic fatty liver disease, fasting glucose levels, insulin resistance, triglycerides, high-density lipoprotein, cholesterol, and aspartate aminotransferase.

Researchers also acknowledged methotrexate exposure, which is associated with liver inflammation, could play a role in the developed of advanced liver fibrosis. Of the study population, the majority of patients, 340 (85 percent, had been exposed to methotrexate with 85 patients (21 percent) currently taking it. Still, they determined, methotrexate use is unlikely to be the most significant risk factor.

Ultimately, researchers said, individuals with sever psoriasis should be screened for advanced liver fibrosis regardless of what systemic medications they take, and clinicians should work with patients to proactively manage obesity and insulin resistance to prevent any poor prognoses.

REFERENCE:

Maybury C, Porter H, Kloczko E, et al. "Prevelance of Advanced Liver Fibrosis in Patients with Severe Psoriasis."JAMA Dermatology (2019), DOI:10.1001/jamadermatol.2019.0721