Pos0022 nafld in Psoriatic Disease: Identifying Patients at High Risk of Serious Liver Disease

Abstract

BackgroundPatients with psoriatic disease(PsD) [psoriasis(PsO) and psoriatic arthritis(PsA)] are at greater risk of non-alcoholic fatty liver disease(NAFLD) and NAFLD-associated fibrosis/cirrhosis compared with the general population and other inflammatory arthritis(1) independent of disease-modifying medications [biological(b)DMARDs or methotrexate(MTX)][2]. Conversely, using these medications in patients with significant NAFLD might accelerate progression to fibrosis/cirrhosis[1]. The Leeds Teaching Hospitals NHS Trust(LTHT) NAFLD screening pathway is not validated in PsD and may underestimate prevalence of NAFLD in PsD[3].Objectives:1.To assess the prevalence of NAFLD in our PsD population2.To determine the effectiveness of the LTHT NAFLD pathway for identifying PsD patients at risk of fibrosis/cirrhosisMethodsThis audit included consecutive patients from the Leeds Specialist Spondyloarthritis and Dermatology departments who underwent screening for NAFLD fibrosis/cirrhosis using the LTHT pathway. Briefly, patients are first screened using ELF and FIB4 scores. ELF>9.5 and FIB4 >1.45 triggers referral for fibroscan and hepatology opinion. A fibroscan >10 was considered indicative of clinically significant NAFLD. We compared baseline demographics (age, sex, BMI, diabetic status), biochemistry (ALT, AST, platelet count, albumin, hepatitis B and C), and NAFLD screening tests (ELF, FIB4 and fibroscan +/- liver ultrasound and biopsy) with the final hepatology diagnosis (NAFLD/ fibrosis/ cirrhosis/ other). We compared results from our PsD patients and patients with other inflammatory arthritis (Other IA).ResultsOverall 110 patients were included; 86.4% (95/110) PsD, and 14.6% (15/110) Other IA. Regarding demographic and clinical variables, age, sex, BMI, AST, ALT, platelets and albumin were similar between all groups. Other IA patients were more likely to be male and taking bDMARD monotherapy. No PsO patients were taking bDMARDs and over half were on no DMARD(Table 1). ELF scores were higher in the PsO group, possibly because the P3NP peptide (part of the ELF score) may be elevated in active skin PsO. Contrastingly, FIB-4 scores were higher in PsA compared with all other groups. Higher FIB4 scores, but not ELF scores, were associated with a fibroscan score >10 and a diagnosis of NAFLD fibrosis/cirrhosis in PsA (p=0.05 and p=0.09 respectively).ConclusionPsA patients had higher rates of significant fibrosis/cirrhosis compared with patients with Other IA. FIB-4 was better than ELF at identifying PsA patients requiring a fibroscan to exclude significant fibrosis/ cirrhosis. Findings will now be validated in a larger prospective cohort study.References[1]Prussick RB, et al.J Clin Aesthet Dermatol.2015;8:43-45.[2]Prussick RB, et al.Br J Dermatol.2017;179:16-29.[3]LTHT Pathways – Suspected NAFLD/ ALD.http://lhp.leedsth.nhs.uk/leedspathways/DEtail.aspx?id=25.Table 1.Summary of demographic and clinical data for the cohortPsA(n=59)PsO(n=36)Other IA(n=15)Age(years)52(±15)48(±13)49(±15)Sex(% male)58(34/59)47(17/36)80(12/15)BMI(kg/m²)33(±5)31(±7)33(±7)Diabetes(%) Yes21(12/58)11(4/36)20(3/15) No67(39/58)81(29/36)73(11/15) Impaired Glucose Tolerance13(7/58)9(3/36)7(1/15)DMARDs MTX32(19/59)39(14/36)20(3/15) bDMARD9(5/59)067(10/15) MTX + bDMARD36(21/59)07(1/15) Other2(1/59)3(1/36)0 None22(13/59)58(21/36)7(1/15)ALT57(±32)37(±26)89(±45)AST42(±22)31(±16)63(±41)Hepatitis B or C1(1/59)00ELF >9.5(%)46(22/48)70(23/33)36(4/11)FIB-4 >1.3(%)38(19/50)20(7/35)27(3/11)Fibroscan median liver stiffness >10(%)31(15/48)83(5/6)25(3/12)Liver US Cirrhosis/fibrosis10(4/41)15(2/13)8(1/13) NAFLD73(30/41)77(10/13)77(10/13) Other17(7/41)00 Normal liver08(1/13)15(2/13)Biopsy Cirrhosis/fibrosis46(5/11)00 NAFLD46(5/11)00 Other000 Normal9(1/11)00Diagnosis (%) Cirrhosis/fibrosis12(7/59)6(2/36)7(1/15) NAFLD66(39/59)19(7/36)80(11/15) Other5(3/59)75(27/36)0 Normal15(9/59)013(2/15) Awaiting diagnosis1(1/59)00Acknowledgements:NIL.Disclosure of InterestsNone Declared.