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Liver Abnormalities in Psoriatic Arthritis

Jul 01, 2020 3:17 pm

A new report in the Journal of Rheumatology shows that liver abnormalities are common in psoriatic arthritis (PsA) and may be associated with obesity, more severe disease and select therapies.

An analysis of a prospective PsA cohort study included 1061 patients. Of these, over one-third (n 343) had liver abnormalities.

A comparison of 256 PsA patients with liver abnormalities and 718 PsA patients controls (normal LFTs) showed the incidence rate to be 39/1000 patient-years (256 cases over 6533 total person-years). 

These lab abnormalities occured after a mean 8.3 ± 7.8 years with drug-induced hepatitis and fatty liver being the most common causes.

Risk factors for liver abnormalities included higher body mass index (BMI), daily alcohol intake, higher damaged joint count, elevated C-reactive protein, and use of methotrexate (MTX), leflunomide (LEF), and tumor necrosis factor inhibitors (TNFi).

While the hepatotoxic effects of MTX and LEF are well known, liver abnormalities are very uncommon with most TNFi use. It is likely that many of those using TNFi, had already been exposed to either MTX or LEF and it is also possible that TNFi were preferably used in those whom the hepatotoxic risks of MTX or LEF were to be avoided.

Nonetheless, hepatic enzyme monitoring is recommended in these high-risk patients 


The author has no conflicts of interest to disclose related to this subject

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