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Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Liver Abnormalities in Patients with Psoriatic Arthritis
Rattapol Pakchotanon1,2, Justine Yang Ye1,2, Richard J Cook1,2
1From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo; University of Toronto, Department of Medicine, Division of Rheumatology, University of Toronto, Toronto; Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutlao Hospital and College of Medicine, Bangkok, Thailand.
Objective:
We aimed to determine the prevalence and incidence, and to identify the factors associated with liver abnormalities in patients with psoriatic arthritis (PsA).
Methods:
From a longitudinal cohort study, we identified PsA patients with either elevated serum transaminase or alkaline phosphatase levels or liver disease after the first visit to the PsA clinic (cases). Controls were subjects from the same cohort who never had such abnormalities or liver disease. Cases and controls were matched 1:1 by sex, age at the first clinic visit, and followup duration; variables at the onset of the first appearance of liver test abnormality associated with liver abnormalities were identified using univariate logistic and multivariate logistic regression analyses.
Results:
Among 1061 patients followed in the PsA clinic, 343 had liver abnormalities. Two hundred fifty-six patients who developed liver abnormalities after the first visit were identified as cases, and 718 patients were identified as controls. The prevalence of liver abnormalities was 32% and the incidence was 39/1000 patient-years where there were 256 cases over 6533 total person-years in the PsA cohort. Liver abnormalities were detected after a mean (SD) followup duration of 8.3 ± 7.8 years. The common causes of liver abnormalities were drug-induced hepatitis and fatty liver. Independent factors associated with liver abnormalities were higher body mass index (BMI), daily alcohol intake, higher damaged joint count, elevated C-reactive protein, and use of methotrexate, leflunomide, or tumor necrosis factor inhibitors.
Conclusion:
Liver abnormalities are common among patients with PsA and are associated with higher BMI, more severe disease, and certain therapies.
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