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Fatty Liver Disease and Psoriatic Arthritis: Understanding Your Risk

Posted on February 04, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Kelly Crumrin
Article written by
Nyaka Mwanza

  • People living with psoriatic arthritis (PsA) have a higher risk of developing nonalcoholic fatty liver disease (NAFLD).
  • Keeping your PsA managed with medication and maintaining a healthy weight can help prevent the development of NAFLD.
  • Talk to your doctor about regular monitoring for liver health and ask whether any medications you take might negatively affect the liver.

Systemic, chronic inflammation caused by PsA can result in symptoms and conditions beyond the joints. For instance, people with psoriasis and PsA experience higher rates of NAFLD than the general population.

Read on to learn how these conditions are related, as well as what you can do to manage the risk of NAFLD if you have psoriasis or PsA (collectively known as psoriatic disease).

PsA is an autoimmune condition that causes inflammatory arthritis. The condition is commonly diagnosed in people with psoriasis, and both conditions are associated with several comorbidities (health conditions related to or caused by a health condition that a person already has). A few of these include:

  • Metabolic disease
  • Obesity
  • Cardiovascular (heart) disease
  • Diabetes
  • NAFLD

Nonalcoholic Fatty Liver Disease

NAFLD is characterized by an excess of fat in your liver cells that is not caused by alcohol consumption. NAFLD can lead to inflammation and liver scarring including fibrosis and, more severely, cirrhosis. In some cases, NAFLD can progress to liver failure or liver cancer. NAFLD affects approximately 30 percent of people in developed countries, making it the most frequently occurring liver disease in the world.

Nonalcoholic steatohepatitis (NASH) is the progressive form of NAFLD. Progression of NAFLD to NASH is believed to be caused by an imbalance of inflammatory inhibitors and inflammatory markers, such as tumor necrosis factor, in the liver.

The Relationship Between NAFLD and Psoriatic Arthritis

People with PsA have a higher prevalence of liver damage and liver disease, including NAFLD and NASH, than the general population. NAFLD may also occur more frequently in people with PsA than it does in those with plaque psoriasis alone.

Research suggests that systemic inflammation is a major contributing factor in the development of liver disease in people with psoriatic disease. Comorbidities of psoriatic disease — metabolic syndrome, diabetes, obesity, and heart disease, in particular — may compound the risk of liver complications and the likelihood of the liver complications being more severe.

The relationship between psoriatic disease and NAFLD is complex and not fully understood. It is thought that NAFLD may also worsen psoriatic disease by resulting in greater levels of certain inflammatory mediators released by the liver, including C-reactive protein. Some research suggests that people with psoriatic disease and NAFLD have more severe psoriasis and PsA than those without NAFLD.

Shared Risk Factors and Comorbidities

NAFLD risk factors include obesity, diabetes, insulin resistance, and metabolic syndrome. Many people with psoriasis or PsA also have obesity or diabetes, and they are twice as likely to develop metabolic syndrome. The prevalence of NAFLD in people who also have psoriasis is nearly double that of the general population, with estimates as high as 60 percent. Among people who have psoriasis or PsA with comorbid diabetes and obesity, the estimated rates of NAFLD may be as high as 90 percent.

If a person has PsA or psoriasis, NAFLD, diabetes, and obesity, they’re at significantly higher risk of more severe disease and symptoms, mortality, and other complications. Additionally, these co-occurring conditions can create treatment challenges.

Some medications commonly used to treat and manage PsA, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can harm the liver. Methotrexate is another commonly used psoriasis treatment that can contribute to liver problems in a similar way. In some research, people with psoriasis who took methotrexate were shown to experience liver damage at higher rates, especially in those with obesity or diabetes. It’s best to reduce or eliminate your alcohol intake while on methotrexate due to the risk of liver damage.

Reducing Risk of NAFLD When You Have Psoriatic Arthritis

NAFLD is preventable and treatable, and it’s possible to reverse NAFLD with treatment and lifestyle changes.

Managing Psoriatic Disease

If you have PsA, it is critical to get your systemic inflammation under control to avoid further health problems. Treating psoriatic disease effectively may lower the risk of comorbidities that compound the risk of liver issues.

That said, there is cause for liver concerns when people with psoriasis are taking a systemic therapy drug. In one study, those with PsA who were prescribed systemic treatment had the highest risk of developing liver disease. Talk to your doctor about the potential risks and benefits of systemic treatment for PsA.

Regular Screening and Follow-Up

NAFLD doesn’t often have noticeable symptoms, so many people are unaware they have the condition. Your doctor can recognize if you’re at risk and suggest you undergo regular screening for liver disease through liver function tests, liver biopsy, or metabolic panels. Checking for markers of liver inflammation and promptly addressing any signs of liver problems can help you avoid or manage liver issues.

Weight Management

To promote healthy weight loss and maintain a healthy body mass index (BMI) and weight, combine healthy nutrition with regular exercise. Healthful nutrition and regular physical activity are important parts of any chronic disease treatment and management plan. In particular, exercising, eating a healthful diet, maintaining a healthy weight, and monitoring blood sugar levels can help decrease the risk of NAFLD.

How Fatty Liver Disease Affects MyPsoriasisTeam Members

MyPsoriasisTeam members often discuss how their liver health affects their lives. Some report that their doctors recommended treatment decisions based on high levels of liver enzymes shown in blood test results. “I was taken off methotrexate because they suspected liver damage,” wrote one member. Another shared, “When I went for a blood test, my liver function was three to four times the normal level. Had to stop my medication.”

Members of MyPsoriasisTeam who have had liver problems are quick to advise caution and remind others to go for monitoring. “I’m sure you are having your liver functions tested at least yearly … Right?” asked one member of another. “I didn’t and had my liver shut down. I almost died,” they warned.

In another conversation about treatment options for PsA, one member advised, “If you take either medication you’re considering, make sure you’re as aware of your liver test results as your doctor.” They went on to warn: “Be careful with booze on methotrexate. Make sure your liver is checked every three months.”

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis. More than 102,000 members come together to ask questions, give advice, and share their experiences with others who understand life with psoriatic disease.

Do you have psoriatic arthritis and fatty liver disease? If not, have you talked to your doctor about monitoring your liver health? Share your experience in the comments below or by starting a discussion on MyPsoriasisTeam.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.
Nyaka Mwanza has worked with large global health nonprofits focused on improving health outcomes for women and children. Learn more about her here.

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