Miele L, Vallone S, Cefalo C et al. J Hepatol 2009;51:778–86.
In this investigation conducted at a single center, clinical evidence of non-alcoholic fatty disease was very common in a cohort of psoriasis patients, particularly in those with psoriatic arthritis.
The American Academy of Dermatology recommendations for monitoring for methotrexate hepatic toxicity in psoriasis patients, which still include liver biopsy at defined intervals, differ substantially from the recommendations of the American College of Rheumatology for monitoring in methotrexate-treated patients with rheumatoid arthritis (RA). Some have argued that this difference is appropriate and relates to the differential risk of liver disease in the two patient populations. One area that has been poorly defined is the underlying incidence of non-alcoholic fatty liver disease (NAFLD), and the potential impact that this might have on hepatotoxic therapy. Psoriasis patients have higher body-mass indexes and a higher incidence of metabolic syndrome than the general population, both of which might increase the likelihood of NAFLD.