Hepatic Steatosis and Disease Activity in Subjects with Psoriatic Arthritis Receiving Tumor Necrosis Factor-α Blockers

Objective. Little is known about tumor necrosis factor-a (TNF-alpha) blockers, disease activity, and liver steatosis (hepatic steatosis; HS) in subjects with psoriatic arthritis (PsA). We prospectively evaluated changes in HS during treatment with TNF-alpha blockers. Methods. In 48 patients with PsA who had evidence of HS before the beginning of TNF-alpha blocker treatment, an ultrasound followup examination was performed after a 12-month treatment period with TNF-alpha blockers. All subjects were stratified according to minimal disease activity (MDA) or not (n-MDA), during treatment with TNF-alpha blockers. Changes in grade of HS were evaluated in parallel in 42 controls with HS and without PsA. Results. At baseline, no significant difference in HS score was found between PsA subjects and controls (HS scores 1.46 +/- 0.65 vs 1.62 +/- 0.66, respectively; p = 0.249). At 12-month followup, a worsening HS score was found in 20 (41.7%) patients with PsA and in 6 (14.3%) controls (p = 0.005). Overall, the grade of HS worsening was higher in patients with PsA (0.37 +/- 0.70) than in controls (0.09 +/- 0.43; p = 0.028). A significantly lower prevalence of worsening HS was found among patients with PsA with MDA, compared with n-MDA subjects (16.7% vs 66.7%, respectively; p = 0.001). Laboratory measures of liver function behaved similarly. The risk of worsening HS in patients with PsA who had MDA was similar to that in controls (HR 1.20, 95% CI 0.34-4.33, p = 0.77), and higher in patients who did not have MDA (HR 4.46,95% CI 1.73-11.47, p = 0.001, regression analysis). Conclusion. Compared with patients with MDA, those with active disease after 12-month treatment with TNF-alpha blockers exhibited significantly higher incidence of worsening liver steatosis. (First Release March 15 2012; J Rheumatol 2012;39:1042-6; doi:10.3899/jrheum.111391)