Hepatoprotective effect of tumour necrosis factor alpha blockade in psoriatic arthritis: a cross-sectional study.
OBJECTIVE
To evaluate the impact of tumour necrosis factor alpha (TNFalpha) blockers on the presence of liver fibrosis in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) treated with methotrexate (MTX).


METHODS
Participants were consecutive patients with RA and PsA who had undergone MTX treatment for at least 1 year + or - TNF blockade for over 6 months. Liver fibrosis was assessed using non-invasive transient elastography (FibroScan). Regression models were used to compare FibroScan values of patients with RA and patients with PsA receiving TNFalpha blockers with those who were not.


RESULTS
FibroScan assessments were performed on 51 patients with RA and 43 patients with PsA. Compared to patients with RA, those with PsA were predominantly young men, received lower cumulative dosages of MTX and exhibited a higher incidence of liver steatosis and hyperlipidaemia. An abnormal result was observed in 7.1% of the anti-TNFalpha-naïve and in 13% of the anti-TNFalpha-treated patients in the RA group and in 30% of the anti-TNFalpha-naïve and 4.3% of the anti-TNFalpha-treated patients in the PsA group (OR=0.11, 95% CI 0.02 to 0.98). Results of the PsA group were robust when adjusted for baseline characteristics.


CONCLUSIONS
The results suggest a protective effect of TNFalpha inhibitors against the development of liver fibrosis in patients with PsA.
Seitz
Michael
M
Department of Rheumatology and Clinical Immunology or Allergology, Bern University Hospital, Bern 3010, Switzerland. michael.seitz@insel.ch
Reichenbach
Stephan
S
Möller
Burkhard
B
Zwahlen
Marcel
M
Villiger
Peter M
PM
Dufour
Jean-Francois
JF
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D056486:Chemical and Drug Induced Liver Injury / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004341:Drug Evaluation; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate