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Hepatoprotective effect of tumour necrosis factor α blockade in psoriatic arthritis: a cross-sectional study
  1. Michael Seitz1,
  2. Stephan Reichenbach1,2,3,
  3. Burkhard Möller1,
  4. Marcel Zwahlen3,
  5. Peter M Villiger1,
  6. Jean-Francois Dufour4
  1. 1Department of Rheumatology, Clinical Immunology and Allergology, Bern University Hospital, Bern, Switzerland
  2. 2Clinical Trials Unit Bern, Bern University Hospital, Bern, Switzerland
  3. 3Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
  4. 4Institute of Clinical Pharmacology and Visceral Research, Bern University Hospital, Bern, Switzerland
  1. Correspondence to Professor Michael Seitz, Department of Rheumatology and Clinical Immunology or Allergology, Bern University Hospital, Bern 3010, Switzerland; michael.seitz{at}


Objective To evaluate the impact of tumour necrosis factor α (TNFα) blockers on the presence of liver fibrosis in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) treated with methotrexate (MTX).

Methods Participants were consecutive patients with RA and PsA who had undergone MTX treatment for at least 1 year ± TNF blockade for over 6 months. Liver fibrosis was assessed using non-invasive transient elastography (FibroScan). Regression models were used to compare FibroScan values of patients with RA and patients with PsA receiving TNFα blockers with those who were not.

Results FibroScan assessments were performed on 51 patients with RA and 43 patients with PsA. Compared to patients with RA, those with PsA were predominantly young men, received lower cumulative dosages of MTX and exhibited a higher incidence of liver steatosis and hyperlipidaemia. An abnormal result was observed in 7.1% of the anti-TNFα-naïve and in 13% of the anti-TNFα-treated patients in the RA group and in 30% of the anti-TNFα-naïve and 4.3% of the anti-TNFα-treated patients in the PsA group (OR=0.11, 95% CI 0.02 to 0.98). Results of the PsA group were robust when adjusted for baseline characteristics.

Conclusion The results suggest a protective effect of TNFα inhibitors against the development of liver fibrosis in patients with PsA.

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  • Competing interests None.

  • Ethics approval The local research committee deemed the study as a quality improvement activity and waived the requirement for institutional review board approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.