Increased Methotrexate Liver Disease in Psoriasis Save

A Danish cohort study examined the risk of methotrexate related liver disease risk in patients with psoriasis (PsO)and psoriatic arthritis (PsA), and found that compared to rheumatoid arthritis (RA), psoriatic patients had up to a 3 fold higher risk of liver disease. 

In a population-based cohort study, patients PsO, PsA, or RA receiving methotrexate between 1997 and 2015 were compared for 4 liver disease outcomes: mild liver disease, moderate-to-severe liver disease, cirrhosis, and cirrhosis-related hospitalization.

The cohorts included 5687 PsO, 6520 PsA, and 28,030 RA patients.  Overall liver disease was more frequently found in PsO, followed by PsA, and the lowest for RA patients.

After adjusting for demographics, smoking, alcohol use, comorbidities, and methotrexate dose, PsO patients were 1.6-3.4 times more likely to develop at least one of the liver disease outcomes. PsA patients were 1.3-1.6 times more likely to develop mild liver disease and cirrhosis

Psoriatic disease significantly increases the risk of liver disease in patients receiving methotrexate.  Vigilant monitoring of MTX hepatotoxicity should be a standard in those with PsO and PsA.