Background Cross-sectional studies have suggested that psoriasis, psoriatic arthritis (PsA), and rheumatoid arthritis (RA) are associated with liver disease. Little is known about the risk for incident liver disease among patients with these diseases from a population-based perspective.
Objectives To examine the risk for incident liver disease among patients with psoriasis, PsA, and RA compared to the general population
Methods We conducted a population-based cohort study in the United Kingdom using The Health Improvement Network (THIN) data from 1994–2014. Patients age 18–89 with codes for PsA, RA, or psoriasis were matched to up to 5 controls from the general population on practice and start date in the practice. Patients with prior liver disease were excluded. Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). A priori we hypothesized an interaction with disease modifying antirheumatic drug (DMARD) use. Patients with psoriasis who received a DMARD or phototherapy were identified as having “severe” psoriasis.
Results Among patients with PsA (N=12,308) RA (N=54,251), psoriasis (N=197,130) and controls (N=1,279,754), 10,415 incident cases of liver disease were identified. After adjusting for age, sex, body mass index, drinking, smoking, NSAID use, systemic glucocorticoid use, and diabetes, the HR were significantly elevated for all groups except patients with RA who received a DMARD: PsA without a DMARD 1.37 (95%CI: 1.02–1.85), PsA with a DMARD 1.66 (95%CI: 1.29–2.14), RA without a DMARD 1.50 (1.27–1.77), RA with a DMARD 0.97 (0.83–1.13), psoriasis without a DMARD 1.37 (1.29–1.46), and severe psoriasis 1.94 (1.61–2.35). Among all patients, 38% of new liver disease was attributed to fatty liver disease, 19% was alcoholic liver disease, and 8% was viral mediated liver disease. Among patients with PsA prescribed a DMARD and patients with severe psoriasis, fatty liver disease accounted for more than half of new diagnoses of liver disease.
Conclusions Patients with PsA, RA, and psoriasis have a significantly increased risk for development of liver disease even after accounting for risk factors and among patients not prescribed a DMARD. These results suggest systemic inflammation may play a role in the development of liver disease beyond the relationship with treatment-related toxicity.
Acknowledgement This study was funded by an investigator initiated grant from Pfizer.
Disclosure of Interest A. Ogdie Grant/research support from: Pfizer, Consultant for: Novartis, S. Grewal: None declared, J. Takeshita Grant/research support from: Pfizer, D. Shin: None declared, R. Carr: None declared, J. Gelfand Grant/research support from: AbbVie, Janssen, Regeneron, Novartis Corp, and Pfizer Corp, Consultant for: AbbVie, Amgen Inc, Coherus, Celgene Corp, Eli Lilly, Merck, Janssen Biologics (formerly Centocor), Regeneron Novartis Corp, Leo Pharmaceuticals, Endo, and Pfizer Inc