Background The association between rheumatic diseases, liver cirrhosis and liver cancer has rarely been explored in Asian populations, an endemic area of viral hepatitis.
Objectives The aim of this study was to investigate the relative risk of liver cirrhosis and liver cancer in Taiwanese patients with diverse rheumatic diseases and to identify groups of patients with a high risk.
Methods We conducted a nationwide cohort study of the risk of liver cirrhosis and liver cancer in different rheumatic diseases among 29856 patients who had no history of malignancies, using the National Health Insurance database of Taiwan from 2005 to 2009. Hazzard ratios (HRs) of liver cirrhosis and liver cancer for various rheumatic diseases were analyzed.
Results Among the patients with rheumatic diseases, 1987 liver cirrhosis and 1225 liver cancers were observed. Patients with psoriasis had a significantly increased risk of liver cirrhosis (HR 1.87, 95% CI 1.25-2.81). Patients with Sjogren’ s syndrome (HR 1.04, 95% CI 0.62-1.75) and systemic sclerosis (HR 1.33, 95% CI 0.33-5.35) also had relative higher risk of liver cirrhosis. The risk of liver cirrhosis was significantly lower in patients with rheumatoid arthritis (HR 0.29, 95% CI 0.19-0.44). Among rheumatic diseases patients, the patients with systemic sclerosis (HR 6.01, 95% CI 1.5-24.07), psoriasis (HR 1.74, 95% CI 1.06-2.85) and Sjogren’s syndrome (HR 1.76, 95% CI 1.01-3.06) had significantly increased risk of liver cancer and the patients with Rheumatoid arthritis (HR 0.24, 95% CI 0.14-0.39) and systemic lupus erythematosus (HR 0.14, 95% CI 0.12-0.99) had decreased risk.
Conclusions Patients with psoriasis, systemic sclerosis and Sjogren’s syndrome have an increased risk of liver cirrhosis and liver cancer. Traditional DMARDs administration should be careful to avoid adverse effect of chronic liver fibrosis. Healthy lifestyle, avoidance of smoking and alcohol consumption, anti-viral treatment for co-existing viral hepatitis and regular monitoring of liver condition should be recommended in any rheumatic patients with high risks.
Disclosure of Interest None Declared
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