The Prevalence of Nonalcoholic Fatty Liver Disease and Related Metabolic Comorbidities Was Associated with Age at Onset of Moderate to Severe Plaque Psoriasis: A Cross-Sectional Study

Abstract

Nonalcoholic fatty liver disease (NAFLD) has been found to be highly prevalent in psoriatic patients. Adult onset psoriasis could be divided into either early or late onset psoriasis. The associations between NAFLD and related metabolic comorbidities and age at onset of psoriasis have not yet been investigated. Our study was to evaluate the associations between prevalence of NAFLD and related metabolic conditions and early, late, and childhood onset psoriasis. A cross-sectional observational study was conducted on patients with moderate to severe plaque psoriasis. Data on clinical characteristics of NAFLD and related metabolic diseases (diabetes, hypertriglyceridemia, hyperuricemia, and metabolic syndrome) were collected. The prevalence of NAFLD in 439 patients (mean: 51±14 years, range: 18–85 years) was 55.8%. NAFLD was frequently identified in early onset patients (74.2%), and this diagnosis was particularly common in patients currently younger than 40 (85.3%). Diabetes was the least prevalent component of metabolic syndrome in early onset patients with metabolic syndrome but the most often found component in late onset ones. Patients with childhood onset psoriasis had the lowest frequencies of all metabolic comorbidities except hyperuricemia among the three groups. In the multivariate analyses, early onset was independently and positively associated with NAFLD, hypertriglyceridemia and hyperuricemia and independently and negatively associated with diabetes among early and late onset patients. The results suggested prevalence of NAFLD and related metabolic comorbidities was associated with age at onset of moderate to severe plaque psoriasis. Early onset of psoriasis was independently associated with greater odds of NAFLD, hypertriglyceridemia, hyperuricemia and smaller odds of diabetes compared to late onset. Early onset patients have metabolic syndrome mainly related to lipid disorders and abnormal glucose metabolism was not often involved.

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

“…This suggests a neutral, or in patients with pre‐existing diabetes, a neutral to minimally lowering effect on FPG levels. Furthermore, the trend towards a decrease in the diabetic population observed for both active compounds, but not for placebo, might be a sign of reduced systemic inflammation, which is known to contribute to insulin resistance …”

“…Furthermore, the trend towards a decrease in the diabetic population observed for both active compounds, but not for placebo, might be a sign of reduced systemic inflammation, which is known to contribute to insulin resistance. 9,14 Uric acid levels decreased over 52 weeks of treatment with secukinumab, both in the overall population and in patients with elevated baseline levels of uric acid. In recent years, it was shown that hyperuricemia is associated with a risk for cardiovascular and metabolic diseases, with inflammatory response regarded as a potential pathogenic mechanism of the vascular effects of uric acid.…”

“…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 …”

“…10 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. 6,[11][12][13][14] This is also reflected by the growing number of compounds and clinical trials targeting inflammation in diabetes or coronary artery disease, 15 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. 16 In this context, it is of high interest to examine the metabolic and liver effects of systemic psoriasis treatments.…”

Rheumatic Manifestations in Autoimmune Liver Disease

“…Nearly 70% of PSC cases also demonstrate findings of IBD 104 , frequently in mild asymptomatic forms, while 7% of IBD patients have PSC 105 . Liver abnormalities are more frequently found in psoriatic patients, and this is typically attributed to non-alcoholic or alcoholic fatty liver 106 . However, in generalized pustular psoriasis, a less common form of psoriasis associated with extra-cutaneous manifestations, evidence for biliary involvement has been suggested, and neutrophilic cholangitis has been observed on liver biopsy, while magnetic resonance cholangiopancreatography showed features similar to those observed in PSC 107 .…”