Dafna Gladman, MD, on Liver Abnormalities in Psoriatic Arthritis

Psoriasis and psoriatic arthritis (PsA) have been associated with a number of metabolic comorbidities. Research regarding liver disease and liver abnormalities in PsA is limited.

Findings of a new study by Dafna D. Gladman, MD, from the University of Toronto, and colleagues suggest that liver abnormalities in patients with PsA are common and are associated with higher body mass index, more severe disease, and certain therapies.

Consultant360 caught up with Dr Gladman about the research.

Consultant360: What prompted you to conduct your study?

Dafna Gladman: Many patients with PsA have comorbidities, including obesity, diabetes, and the metabolic syndrome which may be accompanied by liver abnormalities. Patients with PsA are also known to consume alcohol more commonly than the general population. Moreover, some of the medications we use for the treatment of patients with PsA have liver toxicity; the most commonly used medication in PsA is methotrexate, which is known for this toxicity. We decided to determine how common liver abnormalities are among patients with PsA and identify the factors associated with these abnormalities.

C360: What was the most important finding from the study?

DG: We found that liver abnormalities are common among patients with PsA. We also found that higher body mass index, daily alcohol intake, and more severe disease, as well as the use of disease-modifying antirheumatic drugs, including methotrexate and leflunomide, or tumor necrosis factor inhibitors, are associated with the development of liver abnormalities in patients with PsA. It is important for physicians looking after these patients to monitor liver function on a regular basis.

C360: Liver abnormalities were associated with higher body mass index. Do you think rheumatologists should recommend a specific diet or lifestyle change to patients with PsA?

DG: There is no specific diet that we can recommend to our patients. However, weight reduction for patients with PsA is not only important to prevent the development of liver disease, but also is important because it may be therapeutic in and of itself. There are several studies that demonstrate the beneficial effect of weight reduction on both the skin and joint manifestations of PsA.

C360: What are the next steps of your research?

DG: We will continue to look at a variety of clinical, laboratory, and imaging features associated with PsA. Our research is currently focused on identifying biomarkers for the development of PsA and for specific aspects of the disease once it develops. 

Dafna D. Gladman, MD, is professor of medicine at the University of Toronto and senior scientist at the Krembil Research Institute in Toronto, Canada.

Reference:

Pakchotanon R, Ye Y, Cook RJ, Chandran V, Gladman DD. Liver abnormalities in patients with psoriatic arthritis [published online October 15, 2019]. J Rheumatol. doi:10.3899/jrheum.181312.