Liver Abnormalities in Patients with Psoriatic Arthritis

Abstract

Objective.We aimed to determine the prevalence and incidence, and to identify the factors associated with liver abnormalities in patients with psoriatic arthritis (PsA).Methods.From a longitudinal cohort study, we identified PsA patients with either elevated serum transaminase or alkaline phosphatase levels or liver disease after the first visit to the PsA clinic (cases). Controls were subjects from the same cohort who never had such abnormalities or liver disease. Cases and controls were matched 1:1 by sex, age at the first clinic visit, and followup duration; variables at the onset of the first appearance of liver test abnormality associated with liver abnormalities were identified using univariate logistic and multivariate logistic regression analyses.Results.Among 1061 patients followed in the PsA clinic, 343 had liver abnormalities. Two hundred fifty-six patients who developed liver abnormalities after the first visit were identified as cases, and 718 patients were identified as controls. The prevalence of liver abnormalities was 32% and the incidence was 39/1000 patient-years where there were 256 cases over 6533 total person-years in the PsA cohort. Liver abnormalities were detected after a mean (SD) followup duration of 8.3 ± 7.8 years. The common causes of liver abnormalities were drug-induced hepatitis and fatty liver. Independent factors associated with liver abnormalities were higher body mass index (BMI), daily alcohol intake, higher damaged joint count, elevated C-reactive protein, and use of methotrexate, leflunomide, or tumor necrosis factor inhibitors.Conclusion.Liver abnormalities are common among patients with PsA and are associated with higher BMI, more severe disease, and certain therapies.

Efficacy of secukinumab and adalimumab in patients with psoriatic arthritis and concomitant moderate‐to‐severe plaque psoriasis: results from EXCEED, a randomized, double‐blind head‐to‐head monotherapy study

“…Combination therapy with MTX and biologics has not been shown to be superior to biological treatment alone 22,23 and many patients discontinue MTX as primary or combination therapy because of poor tolerability and/or toxicity, or cannot receive MTX owing to liver abnormalities. 6,15 EXCEED is the first double-blind, randomized controlled head-to-head monotherapy study to compare secukinumab with adalimumab in patients with active PsA. 17 This study was primarily designed for rheumatologists to address a key question of whether secukinumab was superior to adalimumab for the treatment of patients with PsA as first-line bDMARD treatment after csDMARD failure, intolerance or contraindication.…”

“…The study evaluated an important current gap in our understanding by examining the initiation of biological monotherapy in patients with active PsA. Combination therapy with MTX and biologics has not been shown to be superior to biological treatment alone 22,23 and many patients discontinue MTX as primary or combination therapy because of poor tolerability and/or toxicity, or cannot receive MTX owing to liver abnormalities 6,15 …”

“…8,10,14 However, approximately 40% of patients treated with MTX stop treatment owing to poor tolerability and/or toxicity problems, or cannot be treated with MTX, because of hepatic abnormalities related to PsA or concomitant alcohol abuse. 6,15,16 EXCEED is the first double-blind head-to-head study to evaluate the efficacy and safety of secukinumab vs. adalimumab as a first-line biological monotherapy in patients with active PsA who were na€ ıve to bDMARDs for PsA and psoriasis, and who were intolerant or had an inadequate response to csDMARDs. The results of the study showed that secukinumab narrowly missed statistical significance for superiority vs. adalimumab in the primary endpoint of American College of Rheumatology (ACR) 20 response at week 52; ACR 20 responses at week 52 were 67Á4% with secukinumab vs. 61Á5% with adalimumab (P = 0Á071).…”

“…Both adalimumab and secukinumab have been proven to be effective options for the treatment of patients with active PsA with or without the use of concomitant MTX 8,10,14 . However, approximately 40% of patients treated with MTX stop treatment owing to poor tolerability and/or toxicity problems, or cannot be treated with MTX, because of hepatic abnormalities related to PsA or concomitant alcohol abuse 6,15,16 …”

Psoriatic Arthritis: The Influence of Co-morbidities on Drug Choice

“…Patients with PsA and treated PsO are at an increased risk of liver disease with a 32% prevalence of liver abnormalities and are twice as likely to develop liver injury, respectively [56,57]. PsA and treated PsO are also risk factors for kidney disease with a hazard ratio of 7.60 and 1.19, respectively, of developing end-stage renal disease [58].…”