Psoriasis tied to highest liver disease risk relative to PsA, RA

In patients receiving methotrexate (MTX), psoriasis, psoriatic arthritis (PsA), and rheumatoid arthritis (RA) contribute to the risk of liver disease distinctively, independent of other major risk factors, reveals a recent study. Incidence of liver disease is highest among those with psoriasis.

“More conservative monitoring should be considered in patients receiving methotrexate for psoriatic disease, particularly in psoriasis patients,” the authors said.

In this population-based cohort study, the authors compared liver disease risk among Danish patients with psoriasis, PsA, or RA treated with MTX between 1997 and 2017. They compared participants according to four disease outcomes: mild liver disease, moderate-to-severe liver disease, cirrhosis, and cirrhosis-related hospitalization.

A total of 5,687 patients with psoriasis, 6,520 with PsA, and 28,030 with RA were included in the study. Among these patients, those with psoriasis had the highest incidence rate of any liver disease, followed by PsA, with the lowest for RA.

Patients with psoriasis were 1.6–3.4 times more likely to develop at least one of the liver disease outcomes, while those with PsA were 1.3–1.6 times more likely to develop mild liver disease and cirrhosis, relative to patients with RA, after adjustments for demographics, smoking, alcohol use, comorbidities, and MTX use.

“Psoriasis, PsA, and RA differentially influence liver disease risk in the setting of methotrexate use independent of other major risk factors,” the authors noted.

This study, however, was limited by confounding due to the following: unmeasured variables, misclassification, and surveillance bias.