The prevalence of NAFLD and NASH among patients with psoriasis in a tertiary care dermatology and rheumatology clinic

Psoriasis, non-alcoholic fatty liver disease, and cardiovascular disease: Three different diseases on a unique background

Psoriasis is a chronic inflammatory immune-mediated skin disease, frequently associated with systemic comorbidities. According to recent data, patients with psoriasis show a greater prevalence of metabolic syndrome, which confers a higher cardiovascular risk. The link between these pathological conditions appears to be a chronic low-grade inflammatory status. The aim of this review is to focus on the multiple epidemiological and physio-pathogenetic aspects linking non-alcoholic fatty liver disease, psoriasis, and cardiovascular disease.

Relationship between Non-Alcoholic Fatty Liver Disease and Psoriasis: A Novel Hepato-Dermal Axis?

Over the past 10 years, it has become increasingly evident that nonalcoholic fatty liver disease (NAFLD) is a multisystem disease that affects multiple extra-hepatic organ systems and interacts with the regulation of several metabolic and immunological pathways. In this review we discuss the rapidly expanding body of clinical and epidemiological evidence supporting a strong association between NAFLD and chronic plaque psoriasis. We also briefly discuss the possible biological mechanisms underlying this association, and discuss treatment options for psoriasis that may influence NAFLD development and progression. Recent observational studies have shown that the prevalence of NAFLD (as diagnosed either by imaging or by histology) is remarkably higher in psoriatic patients (occurring in up to 50% of these patients) than in matched control subjects. Notably, psoriasis is associated with NAFLD even after adjusting for metabolic syndrome traits and other potential confounding factors. Some studies have also suggested that psoriatic patients are more likely to have the more advanced forms of NAFLD than non-psoriatic controls, and that psoriatic patients with NAFLD have more severe psoriasis than those without NAFLD. In conclusion, the published evidence argues for more careful evaluation and surveillance of NAFLD among patients with psoriasis.

Non-alcoholic fatty liver disease fibrosis score in patients with psoriasis

BACKGROUND

Patients with psoriasis are at risk of non-alcoholic fatty liver disease (NAFLD) and likely liver fibrosis.

OBJECTIVE

Investigate the prevalence of NAFLD in patients with psoriasis and measure their risk of liver fibrosis.

METHOD

One hundred and twenty-four patients with psoriasis and 79 healthy controls were included in this cross-sectional study. NAFLD was diagnosed in the presence of characteristic sonographic features of fatty liver after excluding other secondary causes of chronic liver disease. NAFLD fibrosis score (NAFLD-FS) was scored in those with NAFLD to measure the risk of advanced liver fibrosis.

RESULTS

Prevalence of NAFLD was greater in patients with psoriasis than in controls (44% vs. 26%, P < 0.001). NAFLD-FS was higher in patients with psoriasis than in controls, suggesting a higher risk of liver fibrosis in those with psoriasis (-1.57 ± 1.4 vs. -3.10 ± 1.5, mean ± SD, P < 0.0001). Psoriasis resulted in a significant predictor of advanced liver fibrosis independently of age, sex, BMI, hypertension and diabetes in the multivariate analysis.

CONCLUSIONS

Patients with psoriasis should be screened for common causes of liver disease, including NAFLD and liver fibrosis.