March 17, 2021
Patients with psoriasis, and to a lesser extent those with psoriatic arthritis, who use methotrexate have a higher risk of liver disease than patients with rheumatoid arthritis who use the immunosuppressant, according to a study published online ahead of print in the Journal of the American Academy of Dermatology.
“Psoriasis, psoriatic arthritis, and rheumatoid arthritis differentially influence liver disease risk in the setting of methotrexate use independent of other major risk factors,” advised researchers from the University of Pennsylvania Perelman School of Medicine and the University of Copenhagen. “More conservative monitoring should be considered in patients receiving methotrexate for psoriatic disease, particularly psoriasis.”
The population-based cohort study included more than 40,000 patients in Denmark who received methotrexate between 1997 and 2015. Among participants, 5687 had psoriasis, 6520 had psoriatic arthritis, and 28,030 had rheumatoid arthritis. Researchers compared instances of mild liver disease, moderate-to-severe liver disease, cirrhosis, and cirrhosis-related hospitalization among patients.
The study found incidence of liver disease was highest for patients with psoriasis and lowest for those with rheumatoid arthritis.
“Compared to patients with rheumatoid arthritis, patients with psoriasis were 1.6-3.4 times more likely to develop one of the liver disease outcomes,” researchers wrote, “while those with psoriatic arthritis were 1.3-1.6 times more likely to develop mild liver disease and cirrhosis after adjustment for demographics, smoking, alcohol use, comorbidities, and methotrexate dose.”
Gelfand JM, Wan J, Zhang H, et al. Risk of liver disease in patients with psoriasis, psoriatic arthritis, and rheumatoid arthritis receiving methotrexate: A population-based study [published online ahead of print, 2021 Feb 16]. J Am Acad Dermatol. 2021;S0190-9622(21)00343-1. doi:10.1016/j.jaad.2021.02.019