Patients with psoriatic arthritis have a higher risk for NAFLD and related liver fibrosis than patients with psoriasis or other inflammatory arthritis.

There has been a need for further research on screening pathways for non-alcoholic fatty liver disease (NAFLD). Psychologist Anthony Harrison and his team conducted an audit to assess the prevalence of NAFLD in patients with psoriatic disease. In addition, the team evaluated the effectiveness of an NAFLD screening pathway, developed by the Leeds Teaching Hospitals NHS Trust (LTHT), in accurately identifying patients with psoriatic disease (PsD) at risk for acquiring fibrosis or cirrhosis. Their findings were presented at EULAR 2023, held May 31-June 2, in Italy.

The study investigated consecutive patients presented at the Leeds Specialist Spondyloarthritis and Dermatology departments, who underwent NAFLD screening using the LTHT pathway. The researchers categorized these patients into three groups: patients with psoriatic arthritis (PsA) (n=60), psoriasis (n=38), and other inflammatory arthritis (OIA) (n=18).

Most demographic and clinical variables were similar across all three groups. However, most patients with OIA (66.6%) were men, and half were receiving biologic disease-modifying antirheumatic disease (DMARD) monotherapy. In contrast, most patients with psoriasis (60.5%) were not taking any DMARDs, and only one was taking bDMARD therapy.

“We further screened these patients using Enhanced Liver Fibrosis (ELF) test scores combined with fibrosis-4 (FIB-4) index scores. We selected those with ELF score greater than 9.5 or FIB-4 score greater than 1.45 and sought fibroscan and hepatology opinion,” Dr. Harrison explained. A fibroscan reading above 10 was considered indicative of clinically expressive NAFLD.

The findings revealed that patients with psoriasis 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.

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

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