Liver fibrosis and steatosis in psoriatic arthritis: A real-world elastography-based study

To estimate the prevalence of clinically significant liver fibrosis in a real-world cohort of patients with psoriatic arthritis (PsA) using a guideline-based sequential screening strategy including vibration-controlled transient elastography (VCTE).

We conducted a cross-sectional study including patients with PsA under active follow-up at a tertiary hospital receiving biologic or targeted synthetic disease-modifying antirheumatic drugs. Non-invasive liver indices were calculated, and a guideline-based sequential screening algorithm was applied to identify patients requiring VCTE. Clinically significant fibrosis was defined using BMI-adjusted liver stiffness thresholds.

Among 198 patients (mean age 55 years; 53% female), 120 (60.6%) were classified as intermediate or high risk and underwent VCTE. Hepatic steatosis (CAP≥248dB/m) was present in 63.3% of patients. Clinically significant fibrosis was identified in 4 patients (2.0%) using BMI-adjusted thresholds and in 6 (3.0%) using a≥7.0kPa cut-off. Median liver stiffness was 4.1kPa (IQR 3.5-5.2). In multivariable analyses, inflammatory disease activity was not associated with liver stiffness or steatosis, whereas age showed a modest association with liver stiffness. BMI was strongly associated with steatosis but not with fibrosis. Methotrexate exposure was not associated with liver fibrosis or steatosis. These findings indicate a dissociation between hepatic steatosis and fibrosis in treated PsA and support the predominant role of metabolic factors in shaping hepatic involvement. The treated status of the cohort may have contributed to attenuated progression from steatosis to fibro-inflammatory liver disease, with implications for fibrosis-oriented screening strategies.