MASLD Linked to Worsened Psoriasis Conditions, Inflammatory Markers

Findings from a recent study are calling attention to a high prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and lean MASLD among patients with plaque psoriasis, additionally highlighting increased psoriasis scores and inflammatory markers compared to those without metabolic disorders.¹

Results suggest MASLD may worsen psoriasis conditions, pointing to the necessity of targeted health education to reduce the risk of MASLD in this patient population. Further, serological analysis revealed increased levels of cytokeratin 19 fragment (CYFRA21-1) in both MASLD and lean MASLD groups, implying a potential synergistic role between psoriasis and MASLD.¹

The most common kind of psoriasis, plaque psoriasis affects about 6.7 million adults, with about 80% - 90% of people with psoriasis having plaque psoriasis. Patients with psoriasis are at a greater risk of developing certain other conditions, including hepatic disease, diabetes, hypertension, obesity, metabolic syndrome, and cardiovascular disease.² Although the association between psoriasis and nonalcoholic fatty liver disease (NAFLD) has previously been described, the change in nomenclature in 2023 and the subsequent introduction of MASLD merits updated research.³

“Previous research indicates a relationship between the onset and severity of psoriasis with metabolic syndrome and NAFLD,” Yi Cao, professor at the First Affiliated Hospital of Zhejiang Chinese Medical University, and colleagues wrote.¹ “This study revisits these associations using the MASLD diagnostic criteria, marking it as the first to explore the connection with psoriasis under these new guidelines.”

To examine this association and further identify potential serum-specific markers in patients with plaque psoriasis affected by MASLD or lean MASLD, investigators conducted a retrospective, observational study of patients seen at The First Affiliated Hospital of Zhejiang Chinese Medical University from January 2021 to January 2023. Patients ≥ 18 years of age with a clinical diagnosis of plaque psoriasis formed the observation group, while patients undergoing routine physical examinations matched with the observation group on age, gender, and BMI formed the control group.¹

SLD was diagnosed through ultrasound examination, and investigators compared the incidence of MASLD and lean MASLD between the groups based on results from the latest Delphi procedure. However, investigators noted that for classifying overweight, they used the obesity standard released by the Chinese Nutrition Society in June 2022 due to its more accurate reflection of the anthropometric characteristics of Chinese individuals.¹

In total, the study enrolled 158 patients with plaque psoriasis and 158 gender-, age-, and BMI-matched healthy controls. Investigators pointed out age, height, weight, gender, and BMI were not statistically significantly different between the groups (P >.05), indicating that the baseline characteristics were comparable and well-matched.¹

The incidence of MASLD was 43.67% in patients with plaque psoriasis and 22.15% among the healthy controls (P <.01). Additionally, investigators pointed out the occurrence of lean MASLD was significantly greater in the observation group (10.76%) compared to the control group (4.43%; P <.05).¹

Although diabetes and metabolic syndrome were both more common among patients with plaque psoriasis (P <.05), no significant differences were found between the groups concerning overweight, obesity, hypertension, low high-density lipoprotein cholesterol levels, or hypertriglyceridemia incidences (P >.05). Further analysis controlling for potential confounding variables revealed plaque psoriasis was an independent risk factor for MASLD (Odds ratio [OR], 1.88; 95% CI, 1.10-3.21).¹

Investigators conducted serological comparisons among 3 subgroups: patients with plaque psoriasis without metabolic disease (n = 37), patients with plaque psoriasis accompanied by MASLD (n = 67), and patients with plaque psoriasis accompanied by lean MASLD (n = 16). Compared to the simple psoriasis group without metabolic disease, investigators observed a significant elevation in the tumor marker CYFRA21-1 levels in both the MASLD and lean MASLD groups (P <.01). Additionally, they noted the MASLD group, but not the lean MASLD group, exhibited elevated levels of inflammatory markers and psoriasis score.¹

Investigators pointed out the study was conducted at a tertiary care center where the majority of admitted patients presented with moderate to severe psoriasis; the inability to establish causality due to the case-control study design; use of liver ultrasonography to diagnose SLD; and the small sample size of the lean MASLD group could serve as potential limitations to these findings.¹

“Our findings highlight the high prevalence of MASLD and lean MASLD among patients with plaque psoriasis. Consequently, this study advocates that treatment for patients with plaque psoriasis should extend beyond merely addressing skin lesions,” investigators concluded.¹

References:

1. ^{Lin Z, Shi YY, Yu LY, et al. Metabolic dysfunction associated steatotic liver disease in patients with plaque psoriasis: a case-control study and serological comparison. Front Med (Lausanne). 2024;11:1400741. Published 2024 May 15. doi:10.3389/fmed.2024.1400741}
2. ^{National Psoriasis Foundation. Related Conditions of Psoriasis. December 22, 2023. Accessed May 30, 2024. https://www.psoriasis.org/related-conditions/}
3. ^{Brooks, A. From NAFLD to MASLD: 2023 Brings New Liver Disease Nomenclature. HCPLive. December 13, 2023. Accessed May 30, 2024. https://www.hcplive.com/view/from-nafld-to-masld-2023-new-liver-disease-nomenclature}