Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
J Am Acad Dermatol. 2021 Jun;84(6):1636-1643. doi: 10.1016/j.jaad.2021.02.019. Epub 2021 Feb 16.
Patients with psoriatic disease may be more susceptible to methotrexate hepatotoxicity than those with rheumatoid arthritis (RA); however, direct evidence supporting this notion is lacking.
To compare liver disease risk among patients with psoriasis (PsO), psoriatic arthritis (PsA), or RA receiving methotrexate.
In a population-based cohort study, Danish individuals with PsO, PsA, or RA receiving methotrexate between 1997 and 2015 were compared according to 4 disease outcomes: mild liver disease, moderate-to-severe liver disease, cirrhosis, and cirrhosis-related hospitalization.
Among 5687, 6520, and 28,030 patients with PsO, PsA, and RA, respectively, the incidence rate of any liver disease was greatest for PsO, followed by PsA, and lowest for RA. Compared with patients with RA, patients with PsO were 1.6-3.4 times more likely to develop at least one of the liver disease outcomes, whereas those with PsA were 1.3-1.6 times more likely to develop mild liver disease and cirrhosis after adjusting for demographics, smoking, alcohol use, comorbidities, and methotrexate dose.
Confounding due to unmeasured variables, misclassification, and surveillance bias.
PsO, PsA, and RA differentially influence liver disease risk in the setting of methotrexate use independent of other major risk factors. More conservative monitoring should be considered in patients receiving methotrexate for psoriatic disease, particularly in PsO patients.
与类风湿关节炎（RA）患者相比，患有银屑病（PsO）的患者可能更容易发生甲氨蝶呤肝毒性；然而，缺乏支持这一观点的直接证据。
比较接受甲氨蝶呤治疗的银屑病（PsO）、银屑病关节炎（PsA）或 RA 患者的肝病风险。
在一项基于人群的队列研究中，根据 4 种疾病结局（轻度肝病、中重度肝病、肝硬化和与肝硬化相关的住院治疗），比较了 1997 年至 2015 年间接受甲氨蝶呤治疗的患有 PsO、PsA 或 RA 的丹麦个体。
在分别患有 PsO、PsA 和 RA 的 5687、6520 和 28030 名患者中，任何肝病的发病率以 PsO 最高，其次是 PsA，最低的是 RA。与 RA 患者相比，患有 PsO 的患者发生至少一种肝病结局的可能性是 RA 患者的 1.6-3.4 倍，而调整了人口统计学因素、吸烟、饮酒、合并症和甲氨蝶呤剂量后，患有 PsA 的患者发生轻度肝病和肝硬化的可能性是 RA 患者的 1.3-1.6 倍。
由于未测量的变量、分类错误和监测偏倚导致的混杂。
在接受甲氨蝶呤治疗的情况下，无论其他主要危险因素如何，PsO、PsA 和 RA 对肝病风险的影响不同。对于接受甲氨蝶呤治疗的银屑病患者，特别是对于 PsO 患者，应考虑更保守的监测。
