Nonalcoholic fatty liver disease in patients with psoriasis: a consequence of systemic inflammatory burden?

Abstract

Summary Patients with psoriasis are at an increased risk for nonalcoholic fatty liver disease (NAFLD) compared with the general population. However, the pathophysiology underlying this comorbidity and elucidation of effective treatment strategies are unclear. This review provides insights into the possible role of chronic, low‐grade inflammation in the pathogenesis of NAFLD in patients with psoriasis. Both conditions are associated with increased levels of proinflammatory adipokines (such as tumour necrosis factor‐α and interleukin‐6) and hepatokines, and decreased levels of adiponectin, an anti‐inflammatory adipokine. This imbalance in inflammatory mediators could result in insulin resistance and, thereby, facilitate the occurrence and progression of NAFLD in a multistep manner. All patients with psoriasis should, therefore, be considered candidates for NAFLD screening and managed accordingly. Given the common aetiology of inflammation between these conditions, it is hypothesized that biological therapies for psoriasis may attenuate the systemic inflammatory process and progression of NAFLD in patients with psoriasis.

Effects of secukinumab on metabolic and liver parameters in plaque psoriasis patients

“…Psoriasis is associated with cardiovascular and metabolic comorbidities including atherosclerosis, obesity, diabetes, hyperuricemia, NAFLD and MetS . Genetic studies suggest only a modest association between psoriasis and cardiovascular or metabolic diseases .…”

“…Psoriasis is associated with a range of inflammatory and metabolic comorbidities, including obesity, diabetes, dyslipidemia, hyperuricemia and psychiatric conditions, and is associated with increased cardiovascular risk . The exact aetiology of comorbidity in psoriasis remains a topic of current research, but a state of systemic low‐grade inflammation induced by dysregulated Th1 and Th17 activation may contribute to the development of (pre)diabetes, obesity, non‐alcoholic fatty liver disease (NAFLD) and atherosclerosis …”

“…Psoriasis patients are also at increased risk of metabolic syndrome (MetS), which may be related to an increase in circulating adipocytokines, mediating systemic pro‐inflammatory effects . The metabolic and cardiovascular comorbidity of psoriasis is characterized by inflammatory processes as key parts of their pathophysiology, such as adipose tissue inflammation in obesity, insulin resistance and diabetes; liver tissue inflammation in NAFLD; or vascular inflammation in coronary artery disease . This is also reflected by the growing number of compounds and clinical trials targeting inflammation in diabetes or coronary artery disease, such as the successful proof of concept for anti‐inflammatory treatment of coronary artery disease with canakinumab, anti‐interleukin (IL)‐1‐beta‐directed monoclonal antibody …”

Liver-skin axis: a new view or viewed already?

“…In this issue of the BJD , Prussick and Miele have explored the link between psoriasis and nonalcoholic fatty liver disease (NAFLD). Briefly, for both NAFLD and psoriasis, the pathogenesis is not completely clear; however, genetic, immunological and environmental factors are thought to be involved.…”

“…When reading the review by Prussick and Miele, we can imagine the liver–skin axis as a bidirectional pathway. In fact, as reported by Mantovani et al ., it is easy to speculate that several pro‐inflammatory cytokines [e.g.…”