People suffering from chronic inflammatory diseases such as psoriasis and rheumatoid arthritis (RA) are associated with an increased risk of developing serious liver damage. Methotrexate is a medication often used to treat inflammatory diseases, which has been associated with an increased risk of serious liver damage.
In this study, researchers followed more than 1 million people for an average of 6 years to assess the patient's risk of developing the serious liver disease, and whether this was associated with chronic inflammatory disorders and methotrexate. People with psoriasis were 37% more likely to develop liver diseases when compared to people without chronic inflammatory diseases. The patients with psoriasis treated with methotrexate treatment had roughly twice the risk of liver damage.
Patients without any drug therapy for psoriatic arthritis had a 38% risk of developing liver disease and for those on methotrexate therapy, the risk increased to 67%. There was no increased risk of liver disease in rheumatoid arthritis patients who were medicated with methotrexate.
Dr. Joel Gelfand, the senior study author, said, "Medications which are toxic to the liver, such as methotrexate, should be used cautiously in patients with a psoriatic disease, especially those with additional risk factors such as obesity or regular alcohol use."
For the study, researchers examined data on almost 1.3 million people without chronic inflammatory disorders as well as roughly 198,000, 12,000, and 54,000 people with psoriasis, psoriatic arthritis, and rheumatoid arthritis, respectively. The systemic inflammation plays a vital role in the development of liver disease, particularly in those with psoriasis. The systemic inflammation was commonly present in all 3 diseases assessed.
Systemic therapy was prescribed to 6% of psoriasis patients, 53% psoriatic arthritis and 61% of rheumatoid arthritis patients. Methotrexate was the most commonly prescribed drug.
A limitation of this study was that deaths arising from liver diseases were not considered. Another drawback was the lack of data on whether people at risk of liver disease risk may have been prescribed other treatment options instead of methotrexate. Dr. Lawrence Eichenfield said that despite these limitations, patients need to consider the liver risks associated with these disorders, and the findings add evidence.
Psoriasis patients should be aware that the management of the disorder has impacts beyond the skin. The results of liver function tests in patients should influence the choice of therapy. Physicians should carefully evaluate the benefits of non-steroidal anti-inflammatory drugs (NSAID) and methotrexate before prescribing them to patients with the chronic inflammatory disease.