Liver Disease Risk in Patients With Psoriasis, Psoriatic Arthritis, or Rheumatoid Arthritis Receiving Methotrexate Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• In this Danish population-based cohort study, 5687 individuals with psoriasis, 6520 with psoriatic arthritis (PsA), and 28,030 with rheumatoid arthritis (RA) who received methotrexate therapy were identified. After controlling for comorbidities and dosage, the authors found that psoriasis patients on methotrexate had significantly elevated risk of mild liver disease (HR, 2.22), moderate to severe liver disease (HR, 1.56), cirrhosis (HR, 3.38), and hospitalization due to cirrhosis (HR, 2.25) compared with RA patients on methotrexate. Patients with PsA had significantly elevated risk of mild liver disease (HR, 1.27) and cirrhosis (HR, 1.63) compared with RA patients.

• Patients with psoriasis receiving methotrexate are more likely to develop liver disease — ranging from mild laboratory abnormalities to hospitalization — compared with RA patients receiving it. Conservative liver monitoring is warranted in these patients.

– Kelly B. Scarberry, MD

Abstract

BACKGROUND

Patients with psoriatic disease may be more susceptible to methotrexate hepatotoxicity than those with rheumatoid arthritis (RA) but direct evidence is lacking.

OBJECTIVE

To compare liver disease risk among patients with psoriasis (PsO), psoriatic arthritis (PsA), and RA receiving methotrexate METHODS: In a population-based cohort study, Danish individuals with PsO, PsA, or RA receiving methotrexate during 1997-2015 were compared with respect to four outcomes: mild liver disease, moderate-to-severe liver disease, cirrhosis, and cirrhosis-related hospitalization.

RESULTS

Among 5,687, 6,520, and 28,030 individuals with PsO, PsA, and RA, respectively, the incidence rate of any liver disease was greatest for PsO, followed by PsA, and lowest for RA. Compared to patients with RA, patients with PsO were 1.6-3.4 times more likely to develop one of the liver disease outcomes while those with PsA 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.

LIMITATIONS

Confounding by unmeasured variables, misclassification and surveillance bias CONCLUSION: PsO, PsA, and RA differentially influence liver disease risk in the setting of methotrexate use independent of other major risk factors. More conservative monitoring should be considered in patients receiving methotrexate for psoriatic disease, particularly PsO.

Journal of the American Academy of Dermatology

Risk of Liver Disease in Patients With Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis Receiving Methotrexate: A Population-Based Study

J Am Acad Dermatol 2021 Feb 16;[EPub Ahead of Print], JM Gelfand, J Wan, H Zhang, DB Shin, A Ogdie, MN Syed, A Egeberg 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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