Liver fibrosis for the dermatologist: a review

The aim of this study was to assess whether correlation existed between procollagen III N-terminal peptide levels, used in the monitoring for hepatic fibrosis in psoriasis patients prescribed methotrexate, and other screening tools (Fibrosis-4 score) and then resultant FibroScan®, with the aim of potentially altering current clinical practice. The retrospective analysis highlighted how both screening tools, if used, can prompt onward referral for FibroScan®, however the small sample size limited statistical conclusions. Nevertheless, we feel this observational study can help guide future investigation into potential changes to hepatic fibrosis monitoring for this cohort.

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Screening for hepatic fibrosis in patients with psoriasis prescribed methotrexate: can we make a change?

Lyons

Callaghan

Murray

et al. 2023

Clinical and Experimental Dermatology

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Metabolic syndrome and psoriatic arthritis: the role of weight loss as a disease-modifying therapy

Williams,

Hum,

Rogers

et al. 2024

Therapeutic Advances in Musculoskeletal

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Psoriatic arthritis (PsA) is an inflammatory joint and entheseal disease associated with significant personal and public health burden. PsA has a prevalence of up to 1%, affecting ~20% of people suffering with psoriasis. PsA is frequently accompanied by metabolic syndrome (MetS), and both conditions are characterised by a chronic pro-inflammatory state, with several key cytokines in PsA (interleukin (IL)-17 and IL-23) also elevated in those with MetS. This narrative review aims to provide an update on MetS in PsA, focusing on its prevalence, pathogenesis, prognosis, treatment interactions and future therapeutic options. MetS is particularly prevalent in PsA compared to other inflammatory arthritides. Cohort studies indicate a higher risk of PsA in individuals with obesity, while Mendelian randomization studies link childhood obesity, insulin resistance, and dyslipidaemia to PsA. Weight loss interventions have been shown to reduce disease activity in PsA. Additionally, MetS negatively impacts the efficacy of tumour necrosis factor inhibitor (TNFi) drugs in treating PsA. Drugs given for PsA may also affect the conditions constituting MetS. Leflunomide has been shown to reduce body weight but also increase blood pressure. TNFi drugs lead to weight gain but reduce cardiovascular risk. Janus kinase inhibitors increase lipid levels and cardiovascular risk among high-risk groups. Anti-IL-17 and anti-IL-12/IL-23 drugs may cause a short-term increase in cardiovascular risk, although the long-term effects have yet to be established. Weight loss represents an unexplored avenue for disease modification in PsA, alongside a plethora of general health benefits. Dietary and exercise modifications are the cornerstone of weight management but vary substantially across individuals. Novel therapies to treat weight loss, such as glucagon-like peptide 1 agonists and sodium–glucose cotransporter 2 inhibitors, may prove useful alongside disease-modifying therapies for those with PsA and MetS and should be investigated as potential therapeutic adjuncts.

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Liver fibrosis for the dermatologist: a review

Cited by 2 publications

References 45 publications

Screening for hepatic fibrosis in patients with psoriasis prescribed methotrexate: can we make a change?

Screening for hepatic fibrosis in patients with psoriasis prescribed methotrexate: can we make a change?

Metabolic syndrome and psoriatic arthritis: the role of weight loss as a disease-modifying therapy

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