FIB-4 as an effective screening tool in psoriatic arthritis patients at high-risk for liver disease: a...

To evaluate the performance of non-invasive screening tools in identifying metabolic dysfunction-associated steatotic liver disease (MASLD) causing clinically significant liver disease (CSLD) in PsA patients at high risk for liver disease, and to identify factors associated with CSLD.

A single-centre, cross-sectional study of PsA patients referred for liver assessment due to suspected CSLD secondary to MASLD was conducted. Fibrosis-4 (FIB-4), Enhanced Liver Fibrosis (ELF) and BARD (BMI, aspartate aminotransferase/alanine transaminase ratio and Diabetes) scores were calculated using routine laboratory and clinical data. Liver imaging was performed as clinically indicated, including FibroScan in most patients. CSLD was defined as liver stiffness measurement (LSM) >10 kPa on FibroScan and/or US and/or biopsy showing steatosis/fibrosis/cirrhosis secondary to MASLD. Univariable and multivariable analyses identified variables independently associated with CSLD.

Eighty-nine PsA patients were included (median age 51.0 years; 57.3% male). Cardiometabolic comorbidities were common: 96.6% had one or more metabolic risk factor and 69.7% were obese. CSLD was identified in 55/89 patients (61.8%). In univariable analyses, hypertriglyceridaemia, hypertension, statin use, BMI >30 kg/m2, higher ELF and FIB-4 scores, and elevated LSM were significantly associated with CSLD. In multivariable regression, hypertension, BMI >30 kg/m2 and FIB-4 ≥1.3 remained independently associated. FIB-4 ≥1.3 demonstrated sensitivity of 47.8%, specificity of 77.2%, positive predictive value of 6.1% and negative predictive value of 98.0%. MTX exposure was not associated with CSLD.

CSLD is common in high-risk PsA patients and strongly associated with metabolic risk factors. FIB-4 ≥1.3 had high negative predictive value, supporting its use as a first-line screening tool. Routine MASLD screening using a pathway incorporating FIB-4 followed by FibroScan may inform safer prescribing and improve outcomes.