Liver Disease and Psoriasis: Understanding the Critical Link

April 20, 2024

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Psoriasis is a common skin disease characterized by red, itchy, scaly patches on the skin. An estimated 7.5 million Americans have psoriasis. On the other hand, liver disease encompasses a variety of disorders that damage the liver, affecting close to 30 million adults in the US. At first glance, these two conditions may seem unrelated. However, research shows that psoriasis, especially severe cases, can significantly increase the risk of liver disease.

Psoriasis as a Systemic Inflammatory Disease

For a long time, psoriasis was viewed primarily as a skin condition. However, it is now established that psoriasis issystemic inflammatory disease. The inflammation is not limited to the skin lesions but affects the whole body at a cellular level. This inflammation underlies many of the comorbidities seen in psoriasis patients, including the risk of liver disease.

Inflammation plays a key role in both psoriasis and many common liver diseases like non-alcoholic fatty liver disease (NAFLD). Chronic inflammation can activate fibroblasts in the skin and hepatic stellate cells in the liver, leading to uncontrolled tissue remodeling and fibrosis. This explains the link between psoriasis and increased liver fibrosis.

Furthermore, proteins released due to inflammation can directly damage liver tissue and worsen hepatic inflammation. Over time, this sustained cycle of inflammation can scar the liver resulting in irreversible damage.

Key Takeaways:

  • Psoriasis is now established as a systemic inflammatory disease rather than just a skin condition
  • Inflammation in psoriasis can damage the liver and drive liver disease
  • Cellular inflammation underlies comorbidities like NAFLD seen in psoriasis patients

Role of Metabolic Syndrome in Psoriasis and Liver Disease

Metabolic syndrome refers to a cluster of conditions that occur together – obesity, high blood pressure, high blood sugar, and abnormal cholesterol levels. It is closely linked to insulin resistance as well.

Studies show that metabolic syndrome is significantly more prevalent in psoriasis patients compared to the general population. Up to 40% of psoriasis patients have metabolic syndrome.

On the other hand, NAFLD, which is the hepatic manifestation of metabolic syndrome, affects up to 30% of psoriasis patients. Severe psoriasis is associated with close to a 3-fold higher risk of NAFLD.

Furthermore, the risk of cirrhosis and liver failure is 2-3 times higher in patients with both psoriasis and metabolic syndrome compared to the general population. The exact mechanism behind this correlation is unclear but likely multifactorial.

Metabolic syndrome creates a proinflammatory state characterized by cytokine dysregulation. This results in systemic inflammation that can impact both the skin and liver. The associated insulin resistance also drives NAFLD. Together, these factors create an inflammatory milieu that accelerates liver disease in psoriasis.

Key Takeaways

  • Up to 40% of psoriasis patients have metabolic syndrome
  • Metabolic syndrome significantly increases the risk of NAFLD and advanced liver disease in psoriasis
  • Insulin resistance and inflammation underlying metabolic syndrome likely drive liver disease

Genetic Factors Influencing Liver Disease Risk in Psoriasis

Twin studies show that genetics accounts for up to 70% of psoriasis risk. Certain genetic loci have been strongly implicated in psoriasis. Variants in HLA genesIL23ATNFAIP3, and TNIP1 among others underlie disease pathogenesis.

Interestingly, HLA genes and TNFAIP3 polymorphisms that predispose individuals to psoriasis also increase susceptibility to autoimmune hepatitis and primary biliary cirrhosis. This might explain the higher prevalence of autoimmune hepatitis in psoriasis patients.

Furthermore, variants in PSORS2 locus along with CARD14 mutations are associated with early onset and severe psoriasis. These genetic factors also predispose patients to developing metabolic syndrome and NAFLD.

Overall, the genetic architecture of psoriasis involves key inflammatory pathways and predisposes patients to comorbidities like NAFLD, metabolic syndrome, and autoimmune hepatitis. Identifying high-risk patients early and screening for liver disease may improve outcomes.

Key Takeaways

  • Genetic factors like HLA genes increase liver disease risk in psoriasis patients
  • Early onset and severe psoriasis has strong genetic underpinnings that also drive liver disease
  • Screening high-risk patients could help improve management of liver comorbidities

Impact of Psoriasis Treatment on Liver Health

Over the past two decades, there has been a paradigm shift in psoriasis treatment with the advent of biologics and small molecules. However, some medications can have hepatotoxic effects and worsen underlying liver disease.

Methotrexate, which is the most commonly prescribed systemic therapy for psoriasis, has known hepatotoxic potential. Nearly 25% of patients on long-term, low-dose methotrexate develop some degree of fibrosis. Other oral treatments like acitretin can also cause transient liver enzyme elevations.

Among the biologics, infliximab has been associated with drug-induced liver injury and reactivation of hepatitis B. Adalimumab can potentially cause new onset autoimmune hepatitis. Cases of liver injury have been reported less frequently with etanercept and ustekinumab as well.

Therefore, it is vital to regularly monitor liver health in psoriasis patients, especially those on potentially hepatotoxic medications. Identifying and managing liver comorbidities early is critical to prevent progression to cirrhosis and liver failure.

Key Takeaways

  • Methotrexate, oral retinoids, and some biologics have hepatotoxic potential
  • Medication can worsen underlying NAFLD and increase liver fibrosis
  • Regular screening and monitoring of liver health is crucial during psoriasis treatment

Frequently Asked Questions (FAQ)

Psoriasis significantly increases the risk of liver disease like NAFLD and autoimmune hepatitis. Up to 30% of psoriasis patients develop NAFLD compared to only 20% in the general population. Inflammation and metabolic syndrome underlie this connection between psoriasis and liver disease.

How does psoriasis increase the risk of liver problems?

The chronic inflammation in psoriasis can directly damage liver tissue and activate hepatic stellate cells. This results in liver fibrosis. Additionally, the high prevalence of metabolic syndrome and associated insulin resistance further drive NAFLD development in psoriasis patients.

Is liver disease common in people with psoriasis?

Yes, liver disease is very common in psoriasis patients. About 30% of people with psoriasis develop NAFLD. The risk of advanced liver disease like cirrhosis also goes up by 2 to 3 folds compared to healthy individuals. Severe psoriasis further escalates the likelihood of serious liver problems.

What tests are done to check liver in psoriasis?

People with psoriasis should undergo regular blood tests to check liver health including ALT, AST, and ALP levels which indicate liver inflammation and injuryFibroScan is also increasingly used to quantitatively evaluate liver fibrosis in psoriasis patients receiving systemic treatment or phototherapy.

How to prevent liver problems if you have psoriasis?

Controlling psoriasis severity with medications to lower systemic inflammation helps prevent liver disease. It’s also vital to maintain a healthy body weight, follow a Mediterranean diet, exercise regularly, and avoid alcohol intake to minimize the risk of developing NAFLD. Checking for signs of metabolic syndrome can identify patients for early liver disease intervention as well.

In summary, key points to note about the connection between psoriasis and liver disease:

  • Psoriasis significantly increases the risks of NAFLD, advanced fibrosis, cirrhosis, and liver failure
  • Underlying systemic inflammation in psoriasis likely drives liver damage
  • Metabolic syndrome and insulin resistance further worsen NAFLD risk
  • Certain medications used in psoriasis have hepatotoxic potential
  • Regular screening and monitoring of liver health is crucial, especially in patients with severe psoriasis
  • Controlling psoriasis, maintaining healthy lifestyles, and avoiding hepatotoxic drugs helps mitigate liver disease risk

The article establishes that psoriasis is closely associated with liver comorbidities, especially NAFLD. A mix of inflammation, metabolic factors, and medication effects drive liver problems in psoriasis patients. Understanding these mechanisms and identifying high-risk groups for screening and monitoring can help optimize management of both skin and liver disease in people with psoriasis.

References

  1. Takeshita, J., Grewal, S., Langan, S.M., Mehta, N.N., Ogdie, A., Van Voorhees, A.S. and Gelfand, J.M., 2017. Psoriasis and comorbid diseases: epidemiology. Journal of the American Academy of Dermatology, 76(3), pp.377-390.
  2. Papandreou, D., Roussos, A., Fotou, F. and Zouboulis, C.C., 2019. Is there any association between nonalcoholic fatty liver disease and psoriasis? An evidence-based evaluation. Archives of dermatological research, 311(1), pp.11-20.
  3. Wan, J., Wang, S., Haynes, K., Denburg, M.R., Shin, D.B., Gelfand, J.M. and Ogdie, A., 2020. Risk of moderate to advanced liver fibrosis with psoriasis and the impact of non-alcoholic fatty liver disease. Journal of hepatology, 72(4), pp.673-679.
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