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HU J, Shao Y, Gui C, Xiao Y, Li L, Li Z. Prevalence and risk of nonalcoholic fatty liver disease among adult psoriatic patients: A systematic review, meta-analysis, and trial sequential analysis. Medicine (Baltimore) 2024; 103:e38007. [PMID: 38701269 PMCID: PMC11062682 DOI: 10.1097/md.0000000000038007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to report the evaluation of the prevalence and risk of nonalcoholic fatty liver disease (NAFLD) among adult psoriatic patients in a systematic review and meta-analysis. METHODS A comprehensive search was conducted across 4 databases of PubMed, Scopus, Cochrane Library, and Web of Science to collect relevant studies until November 30, 2023, without any restrictions for finding observational studies. The comprehensive meta-analysis version 3.0 software was used to calculate effect sizes, showing the event rate (ER), odds ratio (OR), and a 95% confidence interval (CI) to evaluate NAFLD risk or prevalence in psoriatic patients and controls or psoriatic patients alone. The quality scoring was performed by 1 author based on the Newcastle-Ottawa Scale tool. Publication bias, meta-regression analysis, and sensitivity analyses were performed. Additionally, Trial Sequential Analysis (TSA) was performed using TSA software. RESULTS A total of 581 records were identified among the databases and electronic sources. At last, 41 studies involving 607,781 individuals were included in the meta-analysis. The pooled ER of NAFLD among psoriatic patients was 29.5% (95%CI: 19.6%-41.7%) and I2 = 99.79%. The pooled OR of NAFLD in psoriatic patients compared to controls was 1.685 (95%CI: 1.382-2.055; P < .001) and I2 = 87.96%. CONCLUSIONS The study found a significant link between psoriasis and NAFLD, with psoriatic patients having a higher chance of developing NAFLD compared to the controls. The study calls for regular NAFLD screening in psoriatic patients to prevent liver complications.
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Affiliation(s)
- Jie HU
- Thoracic Oncology, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - YaQiong Shao
- Department of Integrated Traditional Chinese and Western Medicine, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Cheng Gui
- Department of Integrated Traditional Chinese and Western Medicine, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Yihui Xiao
- Department of Integrated Traditional Chinese and Western Medicine, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Lixia Li
- Department of Integrated Traditional Chinese and Western Medicine, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Zheng Li
- Department of Integrated Traditional Chinese and Western Medicine, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
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Costache DO, Blejan H, Cojocaru DL, Ioniță GA, Poenaru M, Constantin MM, Costache AC, Căruntu C, Balaban DV, Costache RS. Intersecting Pathways: Nonalcoholic Fatty Liver Disease and Psoriasis Duet-A Comprehensive Review. Int J Mol Sci 2024; 25:2660. [PMID: 38473907 DOI: 10.3390/ijms25052660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Psoriasis is a chronic, immune-mediated, inflammatory disease that has a major impact on patients' quality of life. Common psoriasis-associated comorbidities include cardiovascular diseases, psoriatic arthritis, inflammatory bowel syndromes, type-2 diabetes, and metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD) is affecting a substantial portion of the population and is closely linked with psoriasis. The interplay involves low-grade chronic inflammation, insulin resistance, and genetic factors. The review presents the pathophysiological connections between psoriasis and nonalcoholic fatty liver disease, emphasizing the role of cytokines, adipokines, and inflammatory cascades. The "hepato-dermal axis" is introduced, highlighting how psoriatic inflammation potentiates hepatic inflammation and vice versa. According to the new guidelines, the preliminary examination for individuals with psoriasis should encompass evaluations of transaminase levels and ultrasound scans as part of the initial assessment for this cohort. Considering the interplay, recent guidelines recommend screening for NAFLD in moderate-to-severe psoriasis cases. Treatment implications arise, particularly with medications impacting liver function. Understanding the intricate relationship between psoriasis and NAFLD provides valuable insights into shared pathogenetic mechanisms. This knowledge has significant clinical implications, guiding screening practices, treatment decisions, and the development of future therapeutic approaches for these chronic conditions.
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Affiliation(s)
- Daniel Octavian Costache
- Discipline of Dermatology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Dermatology Department, Carol Davila Central Emergency Military University Hospital, 010825 Bucharest, Romania
| | - Horia Blejan
- Dermatology Department, Carol Davila Central Emergency Military University Hospital, 010825 Bucharest, Romania
| | - Damian Lucian Cojocaru
- Gastroenterology Department, Carol Davila Central Emergency Military University Hospital, 010825 Bucharest, Romania
| | - Georgiana Alexandra Ioniță
- Gastroenterology Department, Carol Davila Central Emergency Military University Hospital, 010825 Bucharest, Romania
| | - Marcela Poenaru
- Dermatology Department, Carol Davila Central Emergency Military University Hospital, 010825 Bucharest, Romania
| | - Maria Magdalena Constantin
- Discipline of Dermatology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- 2nd Dermatology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Andrei Cătălin Costache
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Constantin Căruntu
- Discipline of Internal Medicine and Gastroenterology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniel Vasile Balaban
- Gastroenterology Department, Carol Davila Central Emergency Military University Hospital, 010825 Bucharest, Romania
- Discipline of Physiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Raluca Simona Costache
- Gastroenterology Department, Carol Davila Central Emergency Military University Hospital, 010825 Bucharest, Romania
- Discipline of Physiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Academy of Romanian Scientists, 050091 Bucharest, Romania
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Jiang Y, Huang D, Chen Q, Yu Y, Hu Y, Wang Y, Chen R, Yao L, Zhong X, Kong L, Yu Q, Lu J, Li Y, Shi Y. A novel online calculator based on clinical features and hematological parameters to predict total skin clearance in patients with moderate to severe psoriasis. J Transl Med 2024; 22:121. [PMID: 38297242 PMCID: PMC10829231 DOI: 10.1186/s12967-023-04847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Treatment responses to biologic agents vary between patients with moderate to severe psoriasis; while some patients achieve total skin clearance (TSC), a proportion of patients may only experience partial improvement. OBJECTIVE This study was designed to identify potential predictors for achieving TSC in psoriasis patients treated with IL-17 inhibitors. It also aimed to develop an easy-to-use calculator incorporating these factors by the nomogram to predict TSC response. METHODS A total of 381 patients with psoriasis receiving ixekizumab were included in the development cohort and 229 psoriasis patients who initiated secukinumab treatment were included in the validation cohort. The study endpoint was achieving TSC after 12 weeks of IL-17 inhibitors treatment, defined as the 100% improvement in Psoriasis Area and Severity Index (PASI 100). Multivariate Cox regression analyses and LASSO analysis were performed to identify clinical predictors and blood predictors respectively. RESULTS The following parameters were identified as predictive factors associated with TSC: previous biologic treatment, joint involvement, genital area affected, early response (PASI 60 at week 4), neutrophil counts and uric acid levels. The nomogram model incorporating these factors achieved good discrimination in the development cohort (AUC, 0.721; 95% CI 0.670-0.773) and validation cohort (AUC, 0.715; 95% CI 0.665-0.760). The calibration curves exhibited a satisfactory fit, indicating the accuracy of the model. Furthermore, the decision curve analysis confirmed the clinical utility of the nomogram, highlighting its favorable value for practical application. Web-based online calculator has been developed to enhance the efficiency of clinical applications. CONCLUSIONS This study developed a practical and clinically applicable nomogram model for the prediction of TSC in patients with moderate to severe psoriasis. The nomogram model demonstrated robust predictive performance and exhibited significant clinical utility. Trial registration A multi-center clinical study of systemic treatment strategies for psoriasis in Chinese population;ChiCTR2000036186; Registered 31 August 2020; https://www.chictr.org.cn/showproj.html?proj=58256 .
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Affiliation(s)
- Yuxiong Jiang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Dawei Huang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Qianyu Chen
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yingyuan Yu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yifan Hu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yu Wang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Rongfen Chen
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Lingling Yao
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyuan Zhong
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Luyang Kong
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Qian Yu
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiajing Lu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China.
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China.
| | - Ying Li
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China.
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China.
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China.
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China.
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Barbarroja N, Ruiz-Ponce M, Cuesta-López L, Pérez-Sánchez C, López-Pedrera C, Arias-de la Rosa I, Collantes-Estévez E. Nonalcoholic fatty liver disease in inflammatory arthritis: Relationship with cardiovascular risk. Front Immunol 2022; 13:997270. [PMID: 36211332 PMCID: PMC9539434 DOI: 10.3389/fimmu.2022.997270] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Liver disease is one of the most important causes of morbidity and mortality worldwide whose prevalence is dramatically increasing. The first sign of hepatic damage is inflammation which could be accompanied by the accumulation of fat called non-alcoholic fatty liver disease (NAFLD), causing damage in the hepatocytes. This stage can progress to fibrosis where the accumulation of fibrotic tissue replaces healthy tissue reducing liver function. The next stage is cirrhosis, a late phase of fibrosis where a high percentage of liver tissue has been replaced by fibrotic tissue and liver functionality is substantially impaired. There is a close interplay of cardiovascular disease (CVD) and hepatic alterations, where different mechanisms mediating this relation between the liver and systemic vasculature have been described. In chronic inflammatory diseases such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), in which the CVD risk is high, hepatic alterations seem to be more prevalent compared to the general population and other rheumatic disorders. The pathogenic mechanisms involved in the development of this comorbidity are still unraveled, although chronic inflammation, autoimmunity, treatments, and metabolic deregulation seem to have an important role. In this review, we will discuss the involvement of liver disease in the cardiovascular risk associated with inflammatory arthritis, the pathogenic mechanisms, and the recognized factors involved. Likewise, monitoring of the liver disease risk in routine clinical practice through both, classical and novel techniques and indexes will be exposed. Finally, we will examine the latest controversies that have been raised about the effects of the current therapies used to control the inflammation in RA and PsA, in the liver damage of those patients, such as methotrexate, leflunomide or biologics.
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