OBJECTIVE: Psoriasis is associated with hepatic steatosis, fibrosis, and methotrexate-associated liver injury. There is a need for reliable methods to monitor liver disease in psoriasis. Transient elastography (TE) is a validated non-invasive method for assessing hepatic steatosis and fibrosis. Psoriasis-specific TE studies have been limited until recently. Here, we review the utility and limitations of TE to detect and monitor liver disease in the context of psoriasis.
METHODS: A comprehensive search using OVID, PubMed, and gray literature was conducted (2005-November 2019) to identify studies of TE use in psoriasis for assessment of hepatic steatosis and fibrosis.
RESULTS: Fifteen studies met inclusion criteria. A total of 1,536 patients with psoriasis or psoriatic arthritis were represented. TE-detected liver fibrosis is associated with age, diabetes, obesity, and severity of psoriasis. TE successfully evaluates hepatic steatosis and fibrosis. Elastography has a high negative predictive value and specificity in the context of methotrexate-associated liver fibrosis in psoriasis; however, reported associations between abnormal elastography results and cumulative methotrexate dose varied significantly despite methotrexate's association with hepatotoxicity and fibrosis. The presence of central adiposity is associated with increased TE failure rate.
LIMITATION: The TE studies included in this review date from 2007 to 2019, which could contribute to publication bias, as the technique of TE has improved over this time period.
CONCLUSION: TE is a useful and non-invasive modality to detect hepatic steatosis and fibrosis in psoriasis. Dermatologists might consider TE in psoriatic patients and concomitant risk factors for fibrosis with the understanding that failure rates may be higher in patients with central adiposity.
Las personas con psoriasis tomando metotrexato pueden estar en mayor riesgo de desarrollar fibrosis hepática en comparación con la población general. Los métodos no invasivos de fibrosis detección han sido ampliamente adoptados, pero su utilidad clínica es incierta. Para evaluar la precisión diagnóstica de métodos no invasivos para detectar fibrosis en comparación con la biopsia hepática (patrón de referencia) en las personas con psoriasis tomando metotrexato. Se realizó una búsqueda sistemática usando Ovidio / Medline, Embase, Cumulative Index de Enfermería y Salud Aliada Literatura, la Biblioteca Cochrane y registro de ensayos clínicos. Se consideraron las cohortes de diagnóstico o los estudios caso-control de los adultos que toman o se están considerando para la terapia con metotrexato. La calidad del estudio se evaluó utilizando la herramienta de Evaluación de la Calidad de Estudios precisión diagnóstica (QUADAS-2). Se realizó el análisis de datos agrupados mediante RevMan 5.1. Bayesiano meta-análisis se realizó utilizando la cadena de Markov Monte Carlo de simulación. Se incluyeron Diecisiete estudios. La sensibilidad y especificidad fueron del 38% y 83% para las pruebas estándar de la función hepática (PFH), 74% y 77% para procolágeno-3 péptido N-terminal (P3NP), 60% y 80% para Fibroscan (®) (Echosens, Francia, www.echosens.com), y el 55% y el 49% para la ecografía. La confianza en estos resultados es limitada debido a datos de baja calidad; viejos, pequeños estudios muestran un sesgo de selección importante y una variación significativa en la prevalencia de fibrosis. Ningún estudio se identificaron evaluando marcadores recientemente desarrollados. La utilidad clínica de pruebas de función hepática, P3NP y ecografía hepática es deficiente. Por lo tanto si se utilizan estas pruebas en el aislamiento, una proporción significativa de pacientes con fibrosis hepática puede permanecer no identificado. Se requieren estudios prospectivos más amplios en esta población para validar los métodos no invasivos más nuevos.
Psoriasis is associated with hepatic steatosis, fibrosis, and methotrexate-associated liver injury. There is a need for reliable methods to monitor liver disease in psoriasis. Transient elastography (TE) is a validated non-invasive method for assessing hepatic steatosis and fibrosis. Psoriasis-specific TE studies have been limited until recently. Here, we review the utility and limitations of TE to detect and monitor liver disease in the context of psoriasis.
METHODS:
A comprehensive search using OVID, PubMed, and gray literature was conducted (2005-November 2019) to identify studies of TE use in psoriasis for assessment of hepatic steatosis and fibrosis.
RESULTS:
Fifteen studies met inclusion criteria. A total of 1,536 patients with psoriasis or psoriatic arthritis were represented. TE-detected liver fibrosis is associated with age, diabetes, obesity, and severity of psoriasis. TE successfully evaluates hepatic steatosis and fibrosis. Elastography has a high negative predictive value and specificity in the context of methotrexate-associated liver fibrosis in psoriasis; however, reported associations between abnormal elastography results and cumulative methotrexate dose varied significantly despite methotrexate's association with hepatotoxicity and fibrosis. The presence of central adiposity is associated with increased TE failure rate.
LIMITATION:
The TE studies included in this review date from 2007 to 2019, which could contribute to publication bias, as the technique of TE has improved over this time period.
CONCLUSION:
TE is a useful and non-invasive modality to detect hepatic steatosis and fibrosis in psoriasis. Dermatologists might consider TE in psoriatic patients and concomitant risk factors for fibrosis with the understanding that failure rates may be higher in patients with central adiposity.
