Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis☆
Introduction
Psoriasis is a chronic inflammatory skin disease that affects 1–3% of the general population. It is characterized by epidermal hyperproliferation, abnormal keratinocyte differentiation, angiogenesis with vasodilatation, and activated CD4+ and CD8+ T-cell infiltrates in the dermis and epidermis, respectively [1]. The clinical presentation is highly variable in terms of lesion localization and severity, and in nearly one-third of all cases the skin lesions are associated with an inflammatory joint disease known as psoriatic arthritis (PsA).
Recent studies have linked psoriasis to obesity and the metabolic syndrome [2], [3], [4], [5] which are known risk factors for non-alcoholic fatty liver disease (NAFLD). The latter term refers to a broad spectrum of conditions ranging from simple fatty liver, which is relatively benign, to non-alcoholic steatohepatitis (NASH), which can give rise to fibrosis, cirrhosis, and end-stage liver disease. Anecdotal data suggest that NAFLD itself might also be associated with psoriasis [6], and an increased prevalence of this chronic liver disease might partly explain the increased risk of liver cirrhosis observed in this population [7].
Thus far, this link between NAFLD and psoriasis has never been explored in epidemiological studies. To eliminate this gap, we recently completed a two-phase study. Phase 1 consisted in a cross-sectional cohort analysis aimed at defining the prevalence and clinical features of NAFLD in psoriatic outpatients seen in a tertiary health-care center in Italy. This was followed by a non-interventional case-control study (Phase 2) conducted to compare the features of NAFLD in patients with and without psoriasis.
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Study design
This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines [8] and the protocol was pre-approved by the institutional review board of the Catholic University of the Sacred Heart Medical Center in Rome, Italy. Informed consent was obtained from all study participants.
Study population
To determine the prevalence and characteristics of NAFLD associated with psoriasis (Ps-NAFLD), we recruited a cohort of patients from the Dermatology Outpatient
Characteristics of the psoriasis cohort
During the 2-year enrollment period, 231 adults with psoriasis were seen in the Dermatology Outpatient Clinic, and 142 (61.3%) agreed to participate in our study. Their characteristics are summarized in Table 1. All participants had psoriasis vulgaris, and almost one-third had PsA. Two-thirds had PASIs >10, which are correlated with common indicators of severe disease (e.g., need for hospitalization, use of systemic therapy). Fewer than 10% had received methotrexate, and all denied previous
Discussion
To our knowledge, this is the first independent, prospective, observational study on the potential association between NAFLD and psoriasis. The prevalence of clinically diagnosed NAFLD in our Italian psoriasis patients (59.2%) was markedly increased over rates observed in the general Italian population (20%) [18]. Indeed, NAFLD emerged as the number 1 liver disease in this cohort, with a frequency far higher than that of alcohol-related, viral, and autoimmune forms. Strong association between
Acknowledgement
This study was conducted with general research funds from Università Cattolica del Sacro Cuore, Rome, Italy.
References (34)
- et al.
Pathogenesis and clinical features of psoriasis
Lancet
(2007) - et al.
Disease concomitance in psoriasis
J Am Acad Dermatol
(1995) - et al.
Prevalence of cardiovascular risk factors in patients with psoriasis
J Am Acad Dermatol
(2006) - et al.
Concurrent non-alcoholic steatohepatitis and psoriasis. Report of three cases from the POLI.ST.E.N.A. study
Dig Liver Dis
(2001) - et al.
STROBE initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
Lancet
(2007) - et al.
Psoriatic arthritis
Semin Arthritis Rheum
(1973) AGA technical review on nonalcoholic fatty liver disease
Gastroenterology
(2002)- et al.
Familial aggregation of insulin resistance in first-degree relatives of patients with nonalcoholic fatty liver disease
Clin Gastroenterol Hepatol
(2006) - et al.
Gene expression of tumor necrosis factor alpha and TNF-receptors, p55 and p75, in nonalcoholic steatohepatitis patients
Hepatology
(2001) - et al.
Methotrexate and histologic hepatic abnormalities: a meta-analysis
Am J Med
(1991)
Methotrexate in psoriasis: consensus conference
J Am Acad Dermatol
Psoriasis patients with diabetes type 2 are at high risk of developing liver fibrosis during methotrexate treatment
J Hepatol
Risk of myocardial infarction in patients with psoriasis
JAMA
Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study
Br J Dermatol
Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes
Dermatologica
Severe psoriasis – oral therapy with a new retinoid
Dermatologica
Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man
Diabetologia
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The authors who have taken part in this study declared that they do not have anything to disclose regarding funding from industry or conflict of interest with respect to this manuscript.
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These authors contributed equally to this work.
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These authors shared senior authorship.