New Insights on Psoriasis and Liver Disease

Alexis Ogdie Beatty

Patients with psoriasis and with rheumatoid arthritis (RA) are often treated with similar drugs, but those with psoriatic skin or joint disease—particularly patients with more severe skin psoriasis—are at higher risk for serious liver disease, reports a team led by Alexis Ogdie-Beatty, MD, MSCE. “These findings offer evidence for the long-held view that psoriasis patients may be more predisposed to liver disease than patients with rheumatoid arthritis,” said Dr.Ogdie-Beatty. “Understanding the role of inflammation in liver disease and how the liver can perpetuate inflammation in these conditions can help us advise patients, and their clinicians, on how to more effectively manage their health.”

In this first-of-its kind population-based study, subjects included more than 197,000 psoriasis patients, 12,000 psoriatic arthritis patients, 54,000 rheumatoid arthritis (RA) patients, and 1.2 million matched controls. Independent of common liver-disease risk factors such as alcohol use and diabetes, the study found that patients with psoriasis who take a systemic therapy drug like methotrexate (under brand names like Trexall, Rasuvo and Otrexup PF) had the highest risk, particularly for non-alcoholic fatty liver disease and cirrhosis, while rheumatoid arthritis patients taking similar drugs had the lowest liver-disease risk.

The study suggests that systemic inflammation – which is present in all three diseases — may play a significant role in development of liver disease, particularly in patients with psoriasis. At the same time, certain medications used to treat these diseases also can cause liver toxicity. The authors note that future research should delve into whether adequate control of inflammation reduces liver disease risk.

The findings could help provide relief for the many Americans—approximately 7.5 million, according to the American Academy of Dermatology—who suffer each year from psoriasis, a chronic inflammatory disease most commonly marked by patches of raised, reddish skin covered with silvery-white scale.

The study also offers insights on how the liver responds to specific types and severity of chronic inflammation and about how skin disease severity, obesity, diabetes, and medication use play a role in development of liver disease in patients with these conditions.

“Based on these data, physicians should educate psoriasis  patients on the increased risk for liver disease and be cautious about the use of hepatoxic medications in these patients, especially when additional risk factors such as diabetes, obesity, or heavy alcohol use are present,” said senior author Joel M. Gelfand, MD, MSCE.


Alexis Ogdie-Beatty,  Sungat K. Grewal, Megan H. Noe, Daniel B. Shin, Junko Takeshita, Zelma C. Chiesa Fuxench,  Rotonya M. Carr, Joel M. Gelfand