Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Center for Arthritis and Rheumatologic Excellence, Chula Vista, California.
Clin Gastroenterol Hepatol. 2023 Oct;21(11):2789-2796. doi: 10.1016/j.cgh.2023.02.021. Epub 2023 Mar 5.
BACKGROUND & AIMS: Previous studies have shown a potential association between nonalcoholic fatty liver disease (NAFLD) and some immune-mediated inflammatory diseases, such as rheumatoid arthritis (RA), but this association has not been analyzed systematically. Therefore, we aimed to perform a systematic review and meta-analysis to ascertain a pooled prevalence estimate of NAFLD among patients with RA to fill this gap in knowledge.
We conducted a literature search in PubMed, Embase, Web of Science, Scopus, and ProQuest, for observational studies published from inception to August 31, 2022, which reported prevalence of NAFLD in 100 or more adult (age, ≥18 y) patients with RA. To be included, NAFLD diagnosis was based on either imaging or histologic assessment. The results were presented as pooled prevalence, odds ratio, and 95% CI. The I statistic was used to measure the heterogeneity between studies.
This systematic review included 9 eligible studies derived from 4 continents comprising 2178 patients (78.8% women) with RA. The pooled prevalence of NAFLD was 35.3% (95% CI, 19.9-50.6; I = 98.6%; P < .001) in patients with RA. All studies used ultrasound for the diagnosis of NAFLD, except for 1 study that used transient elastography. The pooled prevalence of NAFLD in men with RA was significantly higher than in women with RA (35.2%; 95% CI, 24.0-46.5 compared with 22.2%; 95% CI, 17.9-26.58; P for interaction = .048). Each 1-unit increase in body mass index was associated directly with a 24% increased risk of NAFLD in RA patients (adjusted odds ratio, 1.24; 95% CI, 1.17-1.31; I = 0.0%; P = .518).
Based on this meta-analysis, 1 in 3 patients with RA had NAFLD, which appears comparable with its overall prevalence among the general population. Clinicians should actively screen for NAFLD in patients with RA.
先前的研究表明，非酒精性脂肪性肝病（NAFLD）与一些免疫介导的炎症性疾病之间存在潜在关联，例如类风湿关节炎（RA），但这种关联尚未进行系统分析。因此，我们旨在进行系统回顾和荟萃分析，以确定 RA 患者中 NAFLD 的总体患病率估计值，以填补这一知识空白。
我们在 PubMed、Embase、Web of Science、Scopus 和 ProQuest 中进行了文献检索，检索了从成立到 2022 年 8 月 31 日发表的观察性研究，这些研究报告了 100 例或更多成年（年龄≥18 岁）RA 患者中 NAFLD 的患病率。纳入标准为：NAFLD 的诊断基于影像学或组织学评估。结果以总体患病率、比值比和 95%置信区间表示。I ² 用于衡量研究之间的异质性。
本系统评价纳入了来自四大洲的 9 项符合条件的研究，共纳入 2178 例（78.8%为女性）RA 患者。RA 患者中 NAFLD 的总体患病率为 35.3%（95%CI，19.9-50.6；I²=98.6%；P<0.001）。所有研究均使用超声诊断 NAFLD，除 1 项研究使用瞬时弹性成像外。RA 男性患者中 NAFLD 的总体患病率明显高于女性患者（35.2%；95%CI，24.0-46.5 与 22.2%；95%CI，17.9-26.58；P 交互=0.048）。RA 患者的 BMI 每增加 1 个单位，NAFLD 的风险就会直接增加 24%（调整后的比值比，1.24；95%CI，1.17-1.31；I²=0.0%；P=0.518）。
基于这项荟萃分析，RA 患者中有 1/3 患有 NAFLD，这与一般人群中 NAFLD 的总体患病率相当。临床医生应积极筛查 RA 患者的 NAFLD。
